The final House “Manager’s Amendment to Reconcilliation” provides $400M for hospitals located in counties in the lowest quartile of Medicare spending, adjusted for age, sex and race but not income. Coupled with annual cuts of $10B in DSH and $1.5B for readmissions, this is bad news for the poor and the hospitals that care for them. Mayo wins!
Note that adjustments cannot be based on counties. Urban counties are too big and economically varied. When the extremes of wealth and poverty are averaged, mean household income is 128% of average in Washington DC, 113% in LA and 108% in Chicago (Cook County), all with dense and costly poverty ghettos. Without any poverty, mean household income in Olmsted County (home to Mayo) is the same as in LA. Very few truly poor counties will qualify for such payments. This is another example of the truism that “Poverty is the Problem; Wealth is the Solution.”