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The agreement came from the , the and the . Most of the spending cuts would come through lower Medicare  andMedicaid reimbursements. The president of the , which has been activelt involved in negotiationswith Congress, said hospitals agreed  to the cuts in order to stem even deepee cuts — $265 billion  that the Obama administration had proposed. Hospitals  were also eager to play a role in shaping the national  debate on healthcare reform. “Hospitalx are supportive of healthcare reform,” MHA President  Carmela Coyle said. “The current system is unsustainable.
 ” But Coylee said the cuts represent a paradox in the health care  Lawmakers want to extend health care accesw to the uninsured yet are proposinvg spending cuts on care for thesr verysame people. Just because  you have an insurancecard doesn’t mean you can accese a primary care physician. ”As all of this  you want to makes sureyou don’t cut too  Coyle said. “The implications for patient care will be very  The cuts would not impact Maryland hospitalsdirectlyg — at least not  Maryland is the only state  that sets its own Medicare and Medicaide payments and is granted this waiver on the condition  that its rates do not exceed the nationak average.
  But the national cuts will mean that the statde could look at cutting the rates that Maryland hospitalx can charge inthe future, Coyle   
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