In the first of an expected avalanche of post-election regulations, the Bush administration has narrowed the scope of services that can be provided to poor people under Medicaid's outpatient hospital benefit. The new rule conflicts with efforts by Congressional leaders and governors to increase federal aid to the states for Medicaid as part of a new economic action plan. Public hospitals and state officials immediately protested the action, saying it would reduce Medicaid payments to many hospitals at a time of growing need.
One day after internal medicine specialists at Health Center Associates notified West Penn Allegheny they were leaving the hospital system to join the University of Pittsburgh Medical Center on Dec. 1, two West Penn administrators walked into the group's Bloomfield offices and ordered the doctors to leave the premises that day. The incident this week underscores the ongoing intense competition between the two health systems. Earlier this year, a group of six obstetrics/gynecology physicians at UPMC Mercy were locked out of their offices one month after giving notice that they were moving to West Penn Hospital.
President-elect Barack Obama can't ignore healthcare reform in his first months in office, but changes may be less ambitious than he promised during the campaign, health experts say. With the meltdown of the economy, Americans should expect changes in healthcare that are phased in or incremental—reform described as a "down payment" on greater strides in the future once the economy has stabilized.
For three-quarters of a century, Los Angeles County's flagship public hospital called a cavernous Depression-era building home. The hospital was drab, with few windows. Most wards housed six patients to a room, few were air-conditioned. But at the end of a two-day move, the county's neediest patients instead will be cared for in a $1.02-billion state-of-the-art facility.
As chief executive of Vanderbilt University Medical Center, Harry Jacobson, MD, likes President-elect Obama's pledge to expand health insurance coverage. For hospitals and doctors, coverage for the more than 46 million Americans who now lack insurance could mean more people can pay their bills. At Vanderbilt, that could help lessen the financial wallop of providing $245 million worth of care to people unable or unwilling to pay last fiscal year. In Nashville's signature healthcare industry, Democratic control of the White House and both houses of Congress has raised hopes among some medical providers. But other sectors might not fare so well under Obama's administration, experts say.
The American healthcare system often haphazardly handles cases involving uninsured immigrants who are gravely injured or seriously ill. Whether these patients receive sustained care in this country or are privately deported by a hospital depends on what emergency room they initially visit. There is only limited federal financing for these patients, and no governmental oversight of what happens to them. Instead, it is left to individual hospitals, many of whom see themselves as stranded at the crossroads of a failed immigration policy and a failed healthcare system as they try to cut through a thicket of financial, legal, and ethical concerns.