Cook County Health's Dr. John Jay Shannon: Impending Medicaid DSH cuts are 'immoral'

Healthcare is likely to remain a key part of discussions among 2020 presidential candidates as they vie for the nation's top post. 

Within healthcare, there are many policies for candidates to address, from "Medicare for All" and drug prices to the ACA and opioid crisis.

Becker's recently caught up with John Jay Shannon, MD, to see what issues he wants presidential candidates to address.

Dr. Shannon has served as CEO of Chicago-based Cook County Health, one of the country's largest public healthcare systems, since 2014.

His work primarily focuses on serving vulnerable populations such as the uninsured and people covered by Medicaid.

Medicaid DSH cuts

Given his system's patient mix, planned Medicaid disproportionate share hospital cuts is one issue of importance for Dr. Shannon.

The ACA adjusted Medicaid payments for hospitals that serve a disproportionate share of low-income patients, assuming uncompensated care costs would decrease as the number of insured people increased under the health law. A $4 billion reduction in DSH payments is scheduled for the Oct. 1 start of fiscal year 2020.

The House Committee on Energy and Commerce Committee voted July 17 to repeal the $4 billion in cuts in fiscal year 2020 and $8 billion in cuts in fiscal year 2021 as well as reduce the cut in fiscal year 2022 from $8 billion to $4 billion, according to America's Essential Hospitals. This means a total of $16 billion in cuts would be eliminated over the three fiscal years. However, a repeal of the cuts would still require full House and Senate approval.

In the end, Dr. Shannon is hopeful Congress will finalize a repeal of the cuts.

"This funding is important because the current administration has done everything it can to disempower the ACA, we've seen since … 2016 an increase in the uninsured" receiving care at Cook County Health, he said. Currently, 45 percent of the system's patients are uninsured, compared to 43 percent in 2018 and 35 percent in 2016.

Dr. Shannon also called the cuts "immoral."

"I'm not suggesting to take money away from somebody else, but we've got to find a different population to pick on than the vulnerable communities that are served both by Medicaid as a payer and by institutions that have a disproportionate share of uninsured and Medicaid population," he said.

ACA case, coverage

In addition to Medicaid DSH cuts, Dr. Shannon discussed the ongoing appeals court case regarding the ACA.

A three-judge panel of the 5th Circuit Court of Appeals in New Orleans heard oral arguments July 9 in a case over a judge's decision to strike down the ACA.

The appeals court is considering a decision by Judge Reed O'Connor of the U.S. District Court for the Northern District of Texas. In December, the lower court ruled in a lawsuit brought by Republican-led states that the entire ACA is invalid because Congress eliminated the health law's individual insurance mandate penalty under the 2017 tax law signed by President Donald Trump. 

Dr. Shannon said he can't predict the outcome of the ACA case, but he hopes strengthening the health law, rather than undoing it, will be a major issue in the 2020 election.

He said unsuccessful congressional efforts in 2017 to pass ACA replacement plans "showed us the public is increasingly supportive of coverage, and the public is increasingly frustrated by the fact that burdens of the cost of healthcare are being placed on them while reliability of coverage is threatened."

Dr. Shannon specifically stressed the importance of protecting coverage for mental health and opioid abuse services.

He said with the ACA, "we finally have coverage for mental health and substance abuse disorders. Turning the clock back on that coverage would create a whole new category of inequity."

Senate Republicans recently revived talks to establish a plan to preserve the ACA's protections for people with preexisting conditions and the health law's provisions allowing people to stay on their parents' health plans until age 26.

Under the ACA, marketplace health plans must cover mental health and substance abuse services as part of the law's protections for people with preexisting conditions.


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