Les Hirsch, the CEO of the Saint Peter’s Healthcare System, knows the so-called “Big, Beautiful Bill” that recently passed in the House still needs to get approval in the Senate — and he’s confident the reconciliation process will lessen its impact on health care.
The highly regarded health care executive of more than four decades is certain about only one thing: Health services for the poor and needy are in danger.
“I don’t mind saying it: The safety net of hospitals in this country is under attack and under siege,” he told BINJE. “I know that the bill only passed the House by one vote, so there is not a lot of broad support. And I know that there is more push back in the Senate, but this ultimately could have very far-reaching effects — not just for the hospitals like Saint Peter’s, but on the entire patchwork of federal funding to support Medicare and, especially, Medicaid.”
Details are still being worked out, but Hirsch feels the bill ultimately may not only mean increased costs to states — that come from lower reimbursement rates — but provisions that would knock millions off the Medicaid rolls.
And, when you start with the fact that Medicaid reimbursement only accounts for about two-thirds of the cost of care, Hirsch said, the overall impact is huge.
“These are very sweeping impacts,” he said. “Medicaid, in and of itself, does not pay for the full cost of care. Over the years, the federal government has created a patchwork of other initiatives to help.
“Medicaid, by its nature, is a federal-state partnership.”
Some Republicans have said the cuts only combat waste and fraud in the system. Hirsch said he takes exception to that.
“Make no mistake about it,” he said. “There may be some criticism of some states doing things that might stretch the limits, but, the fact is, these programs rely on provider taxes and state-directed payments.
“Others may have referred to them as money laundering schemes — that is so inappropriate. This is the patchwork that has been put in place to address the safety net in this country. Everything has been passed in law by the Congress of the United States and signed into law by whomever the presidents were at the time.”
Hirsch said Saint Peter’s and the state could be crushed by these changes. But he acknowledged it could be worse in other places.
Hirsch not only has run hospitals in Louisiana and Colorado, but he is the only executive from New Jersey on the board of the American Hospital Association. Because of this, he knows how precarious the situation could be elsewhere.
“This is not just an urban issue,” he said. “When you think about the safety net in this country, rural hospitals are at significant risk.
“Here, we’re so dense, that geography and access are not an issue. But, if you look at geography and access in other parts of the country, it’s very substantial.”
That’s why the concern is so great, Hirsch said.
“When I say the safety net of hospitals and health systems in this country is under attack, I’m not just talking about New Jersey — I’m talking about the entire United States of America,” he said. “And the question that will come out of whatever the results of this legislation will be is this: ‘Is the safety net in this country going to be devastated?’
“That’s what remains to be seen.”
Hirsch said he remains hopeful. He has seen early signs that the Senate is not as strongly in support of these cuts as the House. The process, he said, is still playing out.
“There’s still a long way to go,” he said. “If this was a game of baseball, I’d say we’re in the fifth inning at best. There’s still a long way to go. But we’re tracking it very closely. And we’re very concerned.”
