Senate version of Build Back Better axes DSH cuts to hospitals in non-expansion states

The latest version of a roughly $2 trillion social spending bill nixes nearly $8 billion in disproportionate share hospital cuts to facilities in states that don’t expand Medicaid.

The Senate Finance Committee released updated text on Saturday of the Build Back Better Act, a massive social spending bill that passed the House earlier this month. The legislation still could change before coming up for a vote in the Senate, but the latest text leaves out the DSH cuts.

Hospital groups have lobbied fervently to nix the reductions, which would have only affected states that did not expand Medicaid. The DSH program pays hospitals that serve a large number of uninsured and low-income patients.

The legislation would provide subsidies to residents in non-expansion states that would have qualified for coverage had their state expanded. The subsidies would be used for the eligible residents to buy coverage on the Affordable Care Act’s exchanges.

House Democrats had proposed the DSH cuts because hospitals in the affected states would see a lower amount of uncompensated care due to the coverage boost.

But hospital groups charged that the cuts, which could be as much as $7.8 billion over the next decade, could still hurt safety-net hospitals, especially as Medicaid doesn’t fully cover their costs.

America’s Essential Hospitals, American Hospital Association, Federation of American Hospitals and other groups signed on to a letter last month to congressional leaders decrying the cuts.

A source familiar with the Senate version told Fierce Healthcare that the cuts were dropped due to stakeholder feedback.

Senate Majority Leader Chuck Schumer has called for finishing work on the legislation by Christmas.

The Build Back Better Act is passing through the Senate via reconciliation, a procedural move that allows budget bills to pass the chamber via a simple majority vote. But to use reconciliation then the Senate needs approval from the parliamentarian that all of its provisions meet the procedure’s guidelines.

The parliamentarian is now reviewing the provisions in the legislation and could strip any that are not considered budgetary.