With the clock ticking down before a number of big reimbursement changes kick in Oct. 1, the Tennessee Hospital Association is engaging in equal parts advocacy, alarm bell ringing and CYA. The industry group on Monday said the payout cuts — some from the Affordable Care Act, others from broader budget measures adopted last year — will endanger some facilities' and cost each Tennessee county an average of 250 jobs in the coming year.

“We’ve said all along that cost containment is essential to the long-term best interest of our country, but the speed and manner in which these drastic changes are imposed will make the difference between life and death for some hospitals,” Becker said.

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“Frankly, in our circles, nobody talks about wanting to repeal Obamacare,” says Craig Becker, executive director of the Tennessee Hospital Association. “They want to see individual coverage. That’s really been our Achilles heel.”

THA President Craig Becker said the group's board agreed to ask Gov. Bill Haslam and the Legislature to extend a hospital "assessment" fee, enacted last year, for an additional 12 months. In addition, hospitals have agreed to raise the fee, now at 3.52 percent of hospitals' net patient revenues, to 4 percent or a little more, Becker said. It currently raises about $290 million annually, and the increase would push that to $400 million or $430 million per year, Becker said. The money would be used by the state to draw federal matching funds — providing a total of about $1.2 billion for the estimated $8 billion program. Nothing is final yet, Becker said.

3. No regrets about working on the reform law. With mounting opposition to the healthcare reform law, including in his own state, Mr. Becker has no regrets that he and other hospital leaders worked with Congressional Democrats on the reforms. The law will cut hospital funding by $155 billion over 10 years, including a 0.25 reduction in the hospital update this year, which translates into an overall cut for some hospitals. "The system could not continue the way it was going," he says.

Hospitals “kind of feel like we’ve already bailed out the state,” Becker said. “To tack on another $120 million ... there’d probably be some resistance on that. We’ll figure it out when we get a little bit closer.”