June 29, 2017 The Honorable Rob Portman United States Senator 448 Russell Senate Of?ce Building Washington, DC 20510 Dear Senator Portman: As major Medicaid providers in the state of Ohio, we write to you today to express our grave concerns about the Better Care Reconciliation Act (BCRA) under consideration by the United States Senate. As it stands now, the BCRA is not an acceptable replacement for the current Affordable Care Act (ACA). The Senate proposal is positioned to do more harm than good for low?income communities and the providers that serve them. We thank you for your opposition to the BCRA and request that you remain opposed to it for the following reasons: Medicaid cuts will be signi?cant and millions of Americans will lose coverage: We are strongly opposed to efforts to cap federal funding for the Medicaid program through per capita caps or block grants as well as reductions in support for the. Medicaid coverage expansion. These changes would severely undermine the health care safetynet and our ability to serve bene?ciaries, as well as shifting unsustainable costs to our state. The Congressional Budget Of?ce (CBO) report estimates more than $770 billion will be cut from the Medicaid program and approximately 22 million people will lose their health coverage. For Ohio, we would lose nearly $14 billion in federal Medicaid funding over the next decade: $8.6 billion under the BCRA proposed cap on federal ?nancing and $6.3 billion from the elimination of the enhanced federal funding under the coverage expansion. Moreover, we estimate over 700,000 Ohioans would have their coverage discontinued. The addicted population, a community about which we know you care deeply, would suffer greatly. The one-time $2 billion opioid treatment grant in BCRA will not adequately address this population?s complex medical needs Ohio alone spent $1 billion on the epidemic last year. This population, along with other vulnerable populations in Ohio, need access to comprehensive physical and mental services on a consistent and sustained basis. Medicaid in its current form can better meet this need for your constituents. Limited dollars being transferred to states that decided not to support their vulnerable populations: First and foremost, we support a delay in DSH cuts for all providers in every state. However, the BCRA makes a clear distinction in states who have expanded Medicaid and those who elected not to do so. We do not believe that the bill as currently written adequately protects states like Ohio that decided to expand Medicaid to bene?t its mentally ill, addicted and working poor populations. As an expansion state, we do not support our limited disproportionate share hospital (DSH) payments being sent to states that declined the opportunity to take advantage of the expanded model. The Senate proposal asks that expansion states take a $19 billion cut in DSH payments effective 2018. These cuts would be used to fund DSH payments in non- expansion states. This transfer of scarce resources from Ohio to other states is simply unacceptable. We are also concerned that if Medicaid expansion is dismantled more quickly within states, there is nothing in the Senate proposal that addresses how a state could work with the federal government to recalculate its DSH payment formula to account for a rise in uninsured populations and uncompensated care costs. The growth rate is not realistic: The growth rate assigned to the per-capita cap model is not realistic. It is not set to keep pace with the cost of caring for an aging and medically complex population in Ohio. Reductions in Medicaid spending would affect hospitals as the largest employers in many communities. The health care sector is an economic mainstay, providing stability amidst sluggish growth and ?scal challenges for rural and small town Ohio as well as the legacy cities we serve. The clear majority of spending on hospital care stays in the community where the hospital is located. This reduced spending will mean more job losses throughout our respective reglons. We know you understand the detrimental impact these provisions will have on Ohio?s low- income populations and our health systems. Furthermore, we share the concerns you have expressed about the proposed drastic changes to the Medicaid program as well as the lack of transparency in this process - transparency that we believe could have created a better bill. We thank you again for your opposition and urge you to remain steadfast unless our patients your constituents- and the providers they trust to take care of them are better protected. Sincerely, Manama; Mary Boosalis, President and CEO, Premier Health Akram Boutros, MD, FACHE, President and CEO, The MetroHealth System (Zak/9W Cliff Deveny, MD, Interim Presidentand CEO, Summa Health System WPW Richard Lofgren, MD, President and CEO, UC Health /f curry-14.1? (?fals- r5333} Tom Strauss, President and CEO, Sisters of Charity Health System