Ohioans prepare to lose Anthem Medicaid at Mercy hospitals

Thousands of Ohioans are preparing to lose Medicaid insurance at Bon Secours Mercy Health hospitals as a dispute between the health system and Anthem Blue Cross Blue Shield appears no closer to resolution in the final hours.

Amidst a Friday night deadline for renewal of Anthem's Managed Medicaid, one portion of a contract that initially went through 2024 but may become officially terminated on Saturday, both parties are hopeful but seemingly pessimistic that a renewal will occur.

"With us being at the table and Anthem not being at the table, I am concerned," said Brian Gwyn, Mercy Health's Cincinnati market president, who said Anthem ended negotiations and hasn't returned as the final hours tick down. "I would appreciate if they would come back and negotiate with us."

Anthem meanwhile said Mercy laid out plans to terminate the existing contract that originally expired Jan. 1, 2025 early and instead imposed a July 1 expiration if the insurance company doesn't agree to increase charges for employer-sponsored and individual health plans at "rates that are three times the current hospital inflation rate."

"Unfortunately, Bon Secours Mercy Health still plans to no longer accept Anthem Medicaid members on July 1," Anthem spokesman Jeff Blunt said in a statement. "Eleventh hour agreements are not uncommon in these situations and we remain hopeful. However, this remains a concerning situation and one that should not arise 18 months before the current contract expires."

Mercy Health-Anthem negotiations: Mercy Health seeks more reimbursement or plans to end Medicaid contract with Anthem

Blunt said the current contract between the two "already acknowledges and addresses the rising cost of providing healthcare services," and is a "fair, mutually agreed upon contract."

An estimated 40,000 patients in Ohio would be affected if the contract were to expire this weekend. Around 6,000 patients use Anthem's Managed Medicaid at Mercy hospitals in southwest Ohio.

Why negotiations have stalled?

Mercy Health's move to seek more reimbursement comes amid a 6.8% increase in operating costs, Gwyn said. The health system insists it is being squeezed by inflationary costs and a 9.6% increase in labor costs.

"We feel like we're being drastically underpaid for the services we're providing," Gwyn said. "What they're proposing is unacceptable. It's laughable to look at those numbers that they're asking for. We know that they are making a lot of money and they're not passing that through to the actual provider that's doing the work."

But Anthem says it already has an agreed upon contract in place and contends Mercy is simply seeking more money at the expense of vulnerable populations of patients.

"Mercy Health is not seeking increased payment for our Medicaid members, they are terminating their contract to serve this vulnerable population in an attempt to force higher costs on our employer-based and individual plan members," Blunt further said. "We’ve asked them repeatedly to rescind this action, honor their contract and negotiate a new agreement at the appropriate time – when the current contract ends."

Reaction to the latest contentious negotiations

While prominent Catholic institutions, such as the Catholic Conference of Ohio, declined to comment on the matter, some individuals of Catholic faith have questioned how a move of this matter fits within the mission of Mercy Health, a Catholic health care ministry.

Brian Miller, a nonresident fellow at the American Enterprise Institute, a right-leaning think tank, criticized Mercy Health for what he said appears to be a health system putting profits above the people it serves.

"You're talking people on dialysis who have fixed income of like $12,00 a year," Miller said. "People who live in skilled nursing facilities, who are elderly and disabled and unable to care for themselves. Pregnant women. ... For a religiously-affiliated organization, how does this fit with your moral or ethical principles to serve the poor? Frankly, it's not very ethical."

Gwyn, however, pushed back on critics, saying any accusation of the health system putting profits over the people it serves is "so far" from reality.

"We are truly here to take care of patients," Gwyn said. "Our margin is negative right now. We're not making money as a ministry. So we're trying to lower our costs, but we have to be paid appropriately by the payers to even get back to break even."

The managed Medicaid contract is set to expire at 11:59 p.m. Friday.

This article originally appeared on Cincinnati Enquirer: Ohioans prepare to lose Anthem Medicaid at Mercy hospitals