Skip to main content

The context you need, when you need it

When news breaks, you need to understand what actually matters — and what to do about it. At Vox, our mission to help you make sense of the world has never been more vital. But we can’t do it on our own.

We rely on readers like you to fund our journalism. Will you support our work and become a Vox Member today?

Join now

There’s a bipartisan plan to fix part of Obamacare. Really.

Mardis Coers/Moment Mobile

A bipartisan group of legislators is working together on Obamacare — not trying to repeal it, but trying to make the law work a little bit better.

On Thursday, four Senators — two Republicans and two Democrats — introduced legislation that would tweak an Obamacare program that is meant to improve patients’ medical care, but, according to recent research, might actually be making things worse for low-income patients.

It’s hard to know now whether this change will get any traction or, like the majority of bills right now, get trapped in the political process. Still, its a notable moment for the health care law, with Senators from both political parties making an apparently good faith effort to fix something in the law that doesn’t seem to be working quite right.

The problem: Obamacare punishes hospitals that serve the poor

The reform law tries to reduce avoidable hospitalizations, situations where patients turn up at the hospital a second time because something went wrong in their first trip. Under Obamacare, the government now penalizes hospitals when patients are readmitted within a month of discharge.

In theory, reducing readmissions is a great thing — avoidable hospitalizations are bad for patients and bad for health spending. But the story is a little different for safety-net hospitals, which are often located in urban centers and serve poor and vulnerable populations.

“We know that 16 to 20 percent of Medicare patients are likely to end up back in the hospital after 30 days,” said Ashish Jha, a professor of health policy at Harvard who has done extensive research on the topic. “Why do some people come back and others don’t? One of the other things we’ve known for some time is that poorer patients - people who live in communities with poorer health infrastructures and less social support — those people are more likely to end up back in the hospital.”

Medicare does have some ways of adjusting penalties to take into account the sickness (or health) of a hospitals’ patients. But there are still things happening outside the hospital — a lack of primary care providers, for example, or difficulty following discharge instructions — that can send lower-income patients back for a second visit.

As a result, safety net hospitals are about twice as likely to get slammed with big readmissions fines compared to other providers. Medicare is asking safety-net hospitals to work much harder — then penalizes them when don’t perform as well as everyone else.

The solution: Level the playing field across hospitals

On Thursday, Senators Joe Manchin (D-W.Va.), Roger Wicker (R-MS), Mark Kirk (R-IL) and Bill Nelson (D-FL) introduced the Hospital Readmission Accuracy and Accountability Act, which would require Medicare to account for socioeconomic status of patients when calculating penalties.

Perhaps the most surprising thing here is the fact that a bipartisan crew of politicians came together to act: on Obamacare. “The readmissions policy has been flawed from the beginning,” said Senator Kirk in a press release.

The new legislation itself won’t make Obamacare any more expensive. It’s been endorsed by the American Medical Association, the American Hospital Association, and a bevy of other provider groups.

Medicare might need to refine the way they handle this over time, but Jha cautions against letting the perfect be the enemy of the good. “The models we have for socioeconomic status adjustment are better than having no model at all,” he said. “We should do this — and continue working on new and better ways of doing it.”

More in Health Care

Health
Hantavirus will test if the world learned anything from CovidHantavirus will test if the world learned anything from Covid
Health

The hantavirus outbreak is still small. But it’s a huge test for a battered public health sector.

By Dylan Scott
Health
How worried should I be about hantavirus?How worried should I be about hantavirus?
Health

5 questions about the hantavirus cruise ship outbreak, answered.

By Dylan Scott
Good Medicine
Do health influencers actually know what they’re talking about?Do health influencers actually know what they’re talking about?
Good Medicine

Most health influencers don’t have real credentials — but they are more influential than ever.

By Dylan Scott
Health
A major new study found AI outperformed doctors in ER diagnosis — but there’s a catchA major new study found AI outperformed doctors in ER diagnosis — but there’s a catch
Health

An Open AI model posted impressive results in emergency care. But we still need human doctors.

By Dylan Scott
Health
Please don’t inject yourself with bootleg peptidesPlease don’t inject yourself with bootleg peptides
Health

Why Americans have gone wild self-experimenting with the hottest thing in wellness: Peptides.

By Dylan Scott
Health
RFK Jr. is in his influencer eraRFK Jr. is in his influencer era
Health

The real reason Trump’s health secretary is launching a podcast.

By Dylan Scott