HLM: What percentage of the burden of the failure to expand in these states will be borne by the safety net hospitals you represent?
Siegel: The lion's share, especially in Florida, Texas, and Louisiana. If you go to Parkland in Dallas or Jackson Memorial in Miami, the care of the uninsured is very concentrated in those hospitals. In the big cities of America, the majority of charity care is born by our members.
HLM: What do you mean "lion's share"?
Siegel: The majority, more than half of the burden.
HLM: What options do you have before you, at this point, to fight back?
Siegel: The question for us is, how can (the federal government) make the Medicaid expansion optional but leave these enormous disproportionate share fund (DSH) cuts that are in the Affordable Care Act. The ACA cuts the DSH funds by about half, and though it's phased in, you're looking at cuts of over $5 billion a year when the cuts are maxed...$5.6 billion by 2019 per year. Safety net hospitals depend on that money to care for uninsured patients and were banking on the coverage expansion to make up for that loss of money.
So what we're seeing now, and if you cut the DSH, it will be a disaster, a disaster for the safety net and a disaster for patients. You can have a safety net for public hospitals or you can have Medicaid coverage. One or the other. But what's happening is that we are walking away from both.