Bill Overview
Title: HEART Act
Description: This bill permanently extends and otherwise revises the Medicare-Dependent Hospital program, which provides additional payments to certain small rural hospitals that have a high proportion of Medicare patients. The bill also temporarily extends certain increased payment adjustments for low-volume hospitals under Medicare's inpatient prospective payment system.
Sponsors: Rep. Arrington, Jodey C. [R-TX-19]
Target Audience
Population: Global rural and low-volume hospital patients
Estimated Size: 2000000
- The bill impacts the Medicare-Dependent Hospital program, which targets small rural hospitals with a high percentage of Medicare patients.
- Rural hospitals serve populations in less urbanized areas, which may include a large number of elderly and low-income individuals who are more likely to rely on Medicare.
- The bill also supports low-volume hospitals. Typically, these hospitals are critical in underserved areas with less access to larger healthcare systems.
- There are over 3,500 rural hospitals in the US that could be potentially impacted by changes in federal Medicare payment structures as described in the bill.
- Medicare currently covers around 65 million Americans; the population relying on the impacted rural and low-volume hospitals would represent a subset of this group.
Reasoning
- The HEART Act focuses primarily on rural and low-volume hospitals, many of which serve aging populations reliant on Medicare. Given the significant portion of the elderly and Medicare-dependent individuals in these areas, any changes in funding and payment structures could have a critical impact on healthcare access and quality.
- The $500,000,000 USD budget for the first year suggests an initial focus on infrastructure or immediate financial relief funding to support these vital hospitals.
- With a reach of 2 million Americans, precise targeting is required, concentrating primarily in areas where rural hospitals are most vulnerable, such as economically disadvantaged regions or those with high unemployment rates.
- Many beneficiaries are likely to see an improvement in healthcare services due to better financial standing of these hospitals, translating to enhanced wellbeing scores. However, the indirect nature of this benefit means perceptions might vary.
- There will be variation in impact based on individual circumstances, such as health condition severity, hospital access, and overall dependence on rural healthcare facilities. Consequently, some will experience lower changes in wellbeing than others.
Simulated Interviews
Retired (Southern Illinois)
Age: 72 | Gender: female
Wellbeing Before Policy: 6
Duration of Impact: 10.0 years
Commonness: 10/20
Statement of Opinion:
- I rely heavily on our local hospital for diabetes treatment. It's reassuring to know funding will support its operations.
- It's not just me; many in my community depend on this hospital for their Medicare services.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 6 |
| Year 2 | 7 | 6 |
| Year 3 | 7 | 5 |
| Year 5 | 8 | 5 |
| Year 10 | 8 | 4 |
| Year 20 | 7 | 3 |
Farmer (Western Kentucky)
Age: 45 | Gender: male
Wellbeing Before Policy: 5
Duration of Impact: 5.0 years
Commonness: 15/20
Statement of Opinion:
- I don't want to have to travel far for healthcare when we have an emergency.
- Making sure our hospital stays open is critical for us.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 5 |
| Year 2 | 6 | 4 |
| Year 3 | 6 | 4 |
| Year 5 | 7 | 3 |
| Year 10 | 6 | 3 |
| Year 20 | 6 | 2 |
Retired school teacher (Northern Arizona)
Age: 81 | Gender: male
Wellbeing Before Policy: 4
Duration of Impact: 10.0 years
Commonness: 8/20
Statement of Opinion:
- I've seen doctors struggle with limited resources at our hospital. This funding is a relief.
- Improvement in services will be a boon for us old folks here.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 4 |
| Year 2 | 6 | 3 |
| Year 3 | 6 | 3 |
| Year 5 | 7 | 3 |
| Year 10 | 7 | 2 |
| Year 20 | 6 | 2 |
Librarian (Upstate New York)
Age: 54 | Gender: female
Wellbeing Before Policy: 5
Duration of Impact: 5.0 years
Commonness: 12/20
Statement of Opinion:
- Our healthcare access is really poor. Any improvement would be noticeable.
- I hope this means quicker response and better services for us.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 5 |
| Year 2 | 6 | 5 |
| Year 3 | 6 | 5 |
| Year 5 | 6 | 4 |
| Year 10 | 5 | 4 |
| Year 20 | 5 | 3 |
Veteran (Central Florida)
Age: 38 | Gender: male
Wellbeing Before Policy: 6
Duration of Impact: 3.0 years
Commonness: 7/20
Statement of Opinion:
- Counseling services have been consistent, but any disruption would hurt.
- Maintaining our hospital operations is critical for my therapy sessions.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 5 |
| Year 2 | 6 | 5 |
| Year 3 | 6 | 5 |
| Year 5 | 6 | 4 |
| Year 10 | 5 | 4 |
| Year 20 | 5 | 3 |
Retired factory worker (Eastern Ohio)
Age: 66 | Gender: female
Wellbeing Before Policy: 5
Duration of Impact: 7.0 years
Commonness: 10/20
Statement of Opinion:
- I'm glad this ensures we won't be forced to travel further for emergency help.
- Our town needs this hospital to stay open, especially for the kids.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 5 |
| Year 2 | 6 | 5 |
| Year 3 | 7 | 4 |
| Year 5 | 7 | 4 |
| Year 10 | 6 | 3 |
| Year 20 | 5 | 2 |
Barista (Rural Oregon)
Age: 29 | Gender: other
Wellbeing Before Policy: 6
Duration of Impact: 3.0 years
Commonness: 5/20
Statement of Opinion:
- It might be difficult for hospitals to cater to specialized needs.
- I hope this funding helps us feel seen in rural health initiatives.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 5 |
| Year 2 | 6 | 5 |
| Year 3 | 6 | 5 |
| Year 5 | 5 | 5 |
| Year 10 | 5 | 5 |
| Year 20 | 5 | 4 |
Small business owner (Northern Michigan)
Age: 62 | Gender: female
Wellbeing Before Policy: 5
Duration of Impact: 5.0 years
Commonness: 9/20
Statement of Opinion:
- It's hard running a business and caring for a sick husband.
- Every bit of help to our hospital counts; we need fewer disruptions.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 5 |
| Year 2 | 6 | 4 |
| Year 3 | 7 | 4 |
| Year 5 | 6 | 3 |
| Year 10 | 5 | 3 |
| Year 20 | 5 | 2 |
Retired (Rural Mississippi)
Age: 73 | Gender: male
Wellbeing Before Policy: 6
Duration of Impact: 8.0 years
Commonness: 11/20
Statement of Opinion:
- I feel more secure knowing our local hospital can improve.
- This makes me less anxious about potential hospital visits.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 6 |
| Year 2 | 8 | 5 |
| Year 3 | 7 | 5 |
| Year 5 | 8 | 5 |
| Year 10 | 7 | 4 |
| Year 20 | 7 | 3 |
Teacher (Southwestern Texas)
Age: 50 | Gender: female
Wellbeing Before Policy: 5
Duration of Impact: 5.0 years
Commonness: 8/20
Statement of Opinion:
- Health services are critical for our family, and rural areas often lack them.
- Federal support like this helps us catch up in care.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 5 |
| Year 2 | 6 | 5 |
| Year 3 | 6 | 5 |
| Year 5 | 6 | 4 |
| Year 10 | 5 | 3 |
| Year 20 | 5 | 3 |
Cost Estimates
Year 1: $500000000 (Low: $400000000, High: $600000000)
Year 2: $505000000 (Low: $405000000, High: $605000000)
Year 3: $510050000 (Low: $410050000, High: $610050000)
Year 5: $520304502 (Low: $420304502, High: $620304502)
Year 10: $551792812 (Low: $451792812, High: $651792812)
Year 100: $1500000000 (Low: $1200000000, High: $1800000000)
Key Considerations
- Rural hospitals are often financially vulnerable, and this policy aims to strengthen their operations, which is crucial for maintaining healthcare access in underserved areas.
- The permanence of the Medicare-Dependent Hospital program suggests ongoing fiscal liability.
- Temporary extensions of payment adjustments might face political challenges for renewal, impacting future costs.
- Implementation and monitoring may involve additional administrative expenses.