Hospitals in Missouri are facing an increasingly tough financial situation with the failure of Congress to renew key federal programs. Four essential subsidies expired on October 1st.

Photo courtesy of the Centers for Medicare and Medicaid Services

The most well-known of them is the Children’s Health Insurance Program, or CHIP, which provides coverage for uninsured children in lower income families who are not eligible for Medicaid.  The program take care of almost nine million kids nationally, and close to 90,000 in Missouri.

Dave Dillon with the Missouri Hospital Association thinks the current debate in Congress over tax reductions could bring funding for CHIP under the microscope.

“To some degree the CHIP program is the first volley in that larger debate about, if they’re going to do tax cuts, where are they going to do tax cuts,” said Dillon.  “The idea is ‘the program is popular’.  But how they fund the program could be a very different portion of this debate.”

Charlie Shields is President/CEO of Truman Medical Centers in Kansas City, which has been called the state’s only true “safety net” hospital.  He’s hopeful that Congress will find the necessary dollars to keep CHIP and other important health care programs afloat.

“I know for a fact that within Missouri’s Congressional delegation, because we’ve been in contact with almost all of them, they are highly focused on this,” said Shields.  “This is not a partisan issue.  Particular our two Senators, Senators Blunt and McCaskill, are really on top of this and working to get this resolved for Missouri.”

CHIP itself enjoys strong bipartisan support.  It’s thought that three other expired health care programs could be renewed in the same spending package with CHIP.

One of them funds low volume facilities that treat small quantities of people, but whose patients are highly dependent on Medicare.  Another assists hospitals with a high volume of patients – more than 60% – who receive their care through Medicare.

And the third, known as the Disproportionate Share Hospital program, or DSH, helps providers that serve the biggest percentage of uninsured people.  It’s in an especially precarious position now because of cuts that are scheduled to be imposed.

The Affordable Care Act called for the DSH program to be downsized under the assumption the expenses would be offset by additional Medicaid coverage and participation in the health exchanges.

State such as Missouri that haven’t expanded Medicaid would take a major hit to their DSH funding under scheduled cuts.  Those cuts have been delayed numerous times by Congress, but there’s currently no framework to stop them.

Truman Medical Centers is the state’s largest provider of care for uninsured people, with 25% percent of its patients having no means to pay.  Truman CEO Shields says he’s being told through back channels that the that postponement of cuts to DSH would be attached to the CHIP re-authorization bill.

“There may be other vehicles that Congress can attached that to.  And there is a little bit of time because they would make it retroactive is they did that.  But the obvious vehicle, and the vehicle – the bill, that has to pass is CHIP re-authorization.”

Wednesday, House Republicans passed an an extension of CHIP financing at the committee level, partisan division over how to pay for it could further deal Congressional approval.

Truman CEO Shields is a former Republican state Senate President Pro Tem who spent 20 years in the legislature.