"Telling your story is absolutely critical," said American Hospital Association (AHA) President and CEO Rick Pollack in a conversation with WHA President and CEO Eric Borgerding at WHA’s Advocacy Day on March 20.
Pollack, who has been with the AHA since 1982 and has served as its top leader since 2015, and its Executive Vice President for Advocacy for more than 20 years before that, said he has seen a lot over his many years advocating for hospitals, but that the current atmosphere of divided government at the state and federal levels, sustained government reimbursement challenges, and motivated adversaries pushing policies that would harm hospitals makes it more important than ever to effectively communicate the important work hospitals do.
Rick Pollack and Eric Borgerding
One of the biggest challenges hospitals deal with on a daily basis, Borgerding noted, is inadequate Medicare reimbursement. He mentioned that Wisconsin's aging demographics mean more people move off commercial insurance and onto Medicare every day, leading to a natural decline in hospital reimbursements as our state ages. "Wisconsin has one of the oldest populations in the country…We've seen Wisconsin's Medicare portion of the payer mix jump ten percentage points in the last ten years," Borgerding noted.
Pollack added that despite Medicare already underpaying hospitals, and despite hospitals dealing with that natural decline in payment, the AHA has had to play defense against issues like "site-neutral" payments, which would propose to pay hospitals even less. While those cuts are off the table for now, Pollack warned they could come up again after the elections as lawmakers deal with an extension of the debt ceiling and many expiring end-of-year programs. "On the Medicare front, given the fact that the chickens will come home to roost as a country as it relates to deficit reduction, there's going to be a lot of talk about sustaining Medicare for the future after the elections, and we have to give politicians the courage to bring about reforms that don't result in mindless cuts to providers," said Pollack.
Borgerding recalled that hospitals had gone from being seen as heroes during COVID to being in a kind of hangover since, with several groups at the state and federal levels now behind proposals that would harm health care providers. Pollack said the AHA has witnessed a number of motivated adversaries who have sought to undermine public trust and confidence in the US health care system to advance their own advocacy agenda and improve their place in the market, noting that health insurers stood to benefit from the site-neutral cuts they advocated for lawmakers to support.
Similarly, Pollack added that drug makers don't like 340B because it forces them to provide discounted drugs. Pollack said he was pleased to see hospitals prevail in AHA's lawsuit against HHS unlawfully cutting payments for hospitals 340B drugs. Hospitals have also seen encouraging signs in some states that have passed legislation to stop drug companies from unlawfully denying discounts at contract pharmacies, but drug companies continue to attack health care providers by filing lawsuits to block that legislation and prevent the federal government from enforcing the law.
The good news, Pollack said, is that while these groups may be trying to undermine support in Washington, the public still greatly supports hospitals. "The people love their community hospital. Compared to insurers and drug companies and unions and all that, we're still in very good shape," said Pollack. He added that this is exactly why it's important for hospitals to come together on a day like Advocacy Day and talk to their lawmakers about the positive stories they have and all the heroic things hospitals do. “That's not as easy as it sounds because the media loves controversy," Pollack continued. "But we've got to keep pounding away at that and that's part of your message to legislators."