Next year promises to be a fascinating one in Washington, D.C. Despite some deep partisan differences, it appears that both political parties agree on at least one thing: the need to focus on reducing the federal budget deficit. And that’s quite a feat, given that we now have a divided Congress – the House being a Republican majority, and the Senate being a Democratic majority. Many are predicting gridlock as a result.

Of course, you can’t think seriously about reducing the federal deficit without looking at the Medicare program – it’s a major part of federal spending. One of my favorite Web sites from the Kaiser Family Foundation displays an excellent side-by-side comparison of the six (yes, six!) different deficit and debt reduction proposals in terms of the Medicare program. None of them have broad-based political support, but the concepts will begin to find their way into various proposals. One thing that I would ask public policymakers to remember as they mull over these changes is that the hospital industry took $155 billion in cuts over 10 years to achieve national healthcare reform. For New Jersey’s hospitals, this translates into $4.5 billion in Medicare cuts over the next decade. We must tread lightly when it comes to further Medicare reductions. Hospitals already “gave at the office” in 2010 – and will continue to give over the next 10 years. If we want to ensure future access to good quality hospital care, we must find other funding sources to donate to deficit reduction.

Now that the mid-term dust has settled in Washington, D.C., thoughts turn once again to the issues before us. And one of those burning issues is the future of healthcare reform.

Healthcare reform was a factor in how voters cast their ballots, according to a new poll conducted by the Kaiser Family Foundation. And as you know, the mid-term elections left us with a divided government – the House is now solidly Republican, and the Senate remains in Democratic control. And, of course, President Obama is still the President of the United States.

The Kaiser poll showed that about 17 percent of respondents cited healthcare reform as one of their top voting issues, following the economy/jobs, party preference and voters’ views of the individual candidates.

But what struck me as even more interesting in the poll were the opinions on the future of healthcare reform. The respondents were sharply divided on how Congress should proceed on healthcare reform. Roughly 21 percent favored expansion of the reform law, 19 percent wanted the law to remain as is, and 24 percent preferred to see the law repealed.

I recently read in the Philadelphia Inquirer that one conservative commentator said the GOP strategy around reform is to “defund, delay and debunk.” Here at NJHA, we’ve long said that the Affordable Care Act isn’t a perfect solution, but that something must be done to reverse the spiral of rising healthcare spending, the growing number of uninsured and inadequate reimbursement for healthcare providers that threatens an access-to-care crisis.

But I’d like to hear where you stand on healthcare reform. Should we stay the course and see where it leads us? Repeal it entirely? Refine the law to correct trouble spots? Click below to weigh in – I’m eager to hear your opinions.

You can’t turn on a television news channel anymore without hearing a story about the latest poll numbers in key congressional races around the country. Who will win? In Nevada, Harry Reid or Sharon Angle? In Delaware, Chris Coons or Christine O’Donnell? There’s plenty of prognosticating on whether the House of Representatives will move from a Democratic majority to a Republican majority under new Speaker-hopeful John Boehner. Most pundits agree the House will move to a substantial Republican majority, while the Senate is projected to remain – just barely – under Democratic rule.

What will it all mean for action on Capitol Hill, and what will it mean for healthcare reform? First, it likely will mean gridlock with little meaningful legislation unless there is bipartisan support among both parties. I haven’t noticed much of a bipartisan spirit in D.C. lately, but that may change. Second, I think there will be action on deficit reduction. That’s an issue the American people feel strongly about, so I think the parties will agree to work on it.

As for healthcare reform, I think it will be tough for anything to proceed aside from minor fixes to the law. Why? First of all, it will be near impossible to get a repeal bill through the Senate if the predictions hold true. Second, President Obama will still be President, and he isn’t going to sign a repeal bill. Expect a veto of any bill that makes its way out of Congress, and neither house will have the numbers to override a presidential veto. Third, the law responds to genuine needs. We have 1.3 million uninsured residents in New Jersey alone, and the reform law is expected to provide coverage to about 923,000 people over a nine-year period. That’s a good thing. And finally, the law actually saves the government money through its provisions to increase efficiency. Repealing certain provisions may actually cost the federal government money. With the focus on deficit reduction, that will be a problem.

So my prediction is the reform law will remain largely intact, with tweaks along the way. Stay tuned to see if my crystal ball is correct.

New Jersey’s hospitals could be forced to shoulder an additional $120 million in Medicare cuts next year under a federal budget proposal put out by the Centers for Medicare and Medicaid Services, within the Department of Health and Human Services.

The looming cut is grim news for hospitals and their patients. New Jersey hospitals are already slated to lose $4.5 billion in federal funds over the next 10 years in the sweeping healthcare reform law. Plus, Medicare currently pays New Jersey hospitals at a rate of just 91 percent of their costs for caring for the state’s senior citizens. The proposed cuts for 2011 will further undercut those already inadequate rates and jeopardize hospital jobs, services and continued access to healthcare services in our state.

NJHA is working hard to oppose these proposed cuts, which will take effect Oct. 1 unless CMS changes its proposal. As part of national health care reform, our nation’s hospitals agreed to cuts totaling $154 billion over a 10- year period. The hospital community believes that we need to be part of the solution to move national healthcare reform forward, but the $120 million in additional cuts was not contemplated for New Jersey hospitals. These cuts would fundamentally harm our state’s hospitals.

The healthcare reform cuts are sealed in law, but the proposed rate cuts for 2011 must still be approved by CMS. NJHA is airing its concerns directly with CMS and also is working closely with members of the state’s congressional delegation to encourage CMS to amend the proposal and blunt the impact on hospitals. We are also working very closely with our national association, the American Hospital Association, to ensure these cuts are not enacted. The N.J. hospital community’s financial woes have been well-documented: 10 New Jersey hospitals have closed in the last five years, and six have filed for bankruptcy. Of the 73 acute care hospitals that remain in the state, about 40 percent are losing money.

Additional cuts could force struggling hospitals to cut services or close altogether, further eroding access to healthcare services for the state’s residents. That is not reform, that is just plain wrong.

Like it or not, the healthcare reform bill is now law. Many presidents have tried to achieve reform, and they paved the groundwork for President Obama. But what does reform really mean?

This is a complex plan that will be implemented over multiple years. It offers both promise and concern moving forward. In the “promise” category, I would list the 32 million additional Americans that will have health insurance once the law is fully implemented. In New Jersey, that translates to approximately 920,000 of the 1.3 million New Jerseyans who currently lack insurance. That is a positive step forward.

In the “concern” category I have a couple of thoughts: The broader coverage comes from expanding Medicaid and providing coverage by yet-to-be-created State Insurance Exchanges. I worry about Medicaid because some physicians won’t accept Medicaid right now; will the newly insured be able to find a doctor to provide care? And will there be enough physicians to see all of the newly insured since several projections show we are on the verge of a physician shortage? The news media is full of stories regarding access problems once Massachusetts implemented its reform plan. According to the stories, the good news is that Massachusetts residents now enjoy broad insurance coverage. The bad news is that it now takes six months to get a doctor’s appointment.

Another concern I have with the Medicaid component of the coverage is the burden it will place on all state governments. Here in New Jersey, Medicaid is a program that is funded 50 percent by the state and 50 percent by the federal government. As Medicaid is expanded, it will cost every state more money. With so many states in fiscal crisis – including New Jersey – how will they respond to this new demand? In the short term, the federal government is providing an enhanced rate for Medicaid to each state, and that is a very good thing. But what happens when that enhanced rate goes away?

One final concern that continues to nag me as I look to the future under healthcare reform: Hospitals will sustain reimbursement cuts to the tune of approximately $155 billion over the next 10 years as the law becomes fully implemented. That’s a great deal of money, and NJHA is working closely with New Jersey’s congressional delegation to ensure that these cuts are carefully calibrated to roughly match the number of newly insured patients hospitals and physicians will be treating. We’ll also be working closely with the State of New Jersey, because much of implementation (the creation of the insurance exchanges, for example) will take place on the state level.

The law’s implementation bears a very close examination moving forward. But no one said it would be easy. As Health and Human Services Secretary Kathleen Sebelius told the National Press Club recently, “There will be bumps along the way. There will be twists and turns. It will not be easy. But, after decades of standing still, we are finally moving forward.”