Save our Safety-Net Hospitals Act of 2025
Summary
The "Save our Safety-Net Hospitals Act of 2025" (H.R. 5064) aims to amend Title XIX of the Social Security Act, specifically targeting disproportionate share hospital (DSH) payment adjustments under Medicaid. The bill seeks to modify certain limitations on these adjustments to better support hospitals that serve a large number of low-income patients. It allows states more flexibility in distributing unspent DSH allotments from prior years.
This legislation would remove certain restrictions on DSH payments, potentially increasing funding available to safety-net hospitals. It also allows states to retroactively modify their Medicaid state plans to utilize unspent funds from previous years, subject to certain conditions.
The bill includes provisions for reporting increased payment adjustments and clarifies the treatment of payments made under Title XVIII (Medicare) or applicable plans when calculating DSH payments.
Expected Effects
The primary effect of this bill would be to increase financial support for safety-net hospitals by modifying limitations on DSH payment adjustments. This could lead to improved access to healthcare for low-income individuals.
States would have greater flexibility in using unspent DSH funds, potentially leading to more efficient allocation of resources. The changes could also simplify the calculation of DSH payments by including Medicare and other plan payments in the calculation of hospital costs.
Potential Benefits
- Increased funding for safety-net hospitals, potentially improving their financial stability.
- Enhanced access to healthcare services for low-income and vulnerable populations.
- Greater flexibility for states in managing and distributing DSH allotments.
- Potential for retroactive adjustments to state Medicaid plans, allowing for increased payments to hospitals.
- Simplified calculation of DSH payments by including Medicare and other plan payments.
Potential Disadvantages
- Potential for increased federal spending on Medicaid, contributing to budget deficits.
- Possible administrative complexities for states in implementing the retroactive adjustments.
- Risk that increased DSH payments may not always translate into improved patient care or outcomes.
- The bill's effectiveness depends on state actions and their ability to efficiently manage DSH funds.
- There is a risk that some states may not have unspent DSH allotments, limiting the impact of the state option provision.
Most Disadvantaged Areas:
Constitutional Alignment
The bill appears to align with the General Welfare Clause (Article I, Section 8) of the Constitution, which grants Congress the power to provide for the general welfare of the United States. By aiming to improve healthcare access for low-income individuals through support for safety-net hospitals, the bill can be argued to promote the general welfare.
However, the Tenth Amendment reserves powers not delegated to the federal government to the states. Medicaid is a joint federal-state program, and this bill modifies aspects of its administration, which could raise federalism concerns if it unduly infringes on state autonomy. The bill's provisions allowing retroactive modification of state plans could also be viewed as potentially impacting state sovereignty.
Overall, the bill's alignment with the Constitution is moderate, contingent on the interpretation of the General Welfare Clause and the balance between federal authority and state autonomy in the context of Medicaid.
Impact Assessment: Things You Care About ⓘ
This action has been evaluated across 19 key areas that matter to you. Scores range from 1 (highly disadvantageous) to 5 (highly beneficial).