Hos­pi­tals warn against re­peal­ing Oba­macare

Say loss of cov­er­age would cre­ate ‘cri­sis’

The Washington Times Daily - - POLITICS - BY TOM HOW­ELL JR.

Amer­i­can hos­pi­tals warned Tues­day that re­peal­ing Oba­macare with­out a safety net for those who lose cov­er­age would spawn a “cri­sis,” dump­ing costs on clin­ics and hos­pi­tals that will be flooded with unin­sured pa­tients and rais­ing costs for health care over­all.

The Amer­i­can Hospi­tal As­so­ci­a­tion and the Fed­er­a­tion of Amer­i­can Hos­pi­tals said some 22 mil­lion Amer­i­cans could lose cov­er­age over the next decade if Con­gress scraps the ex­pan­sion of Medi­care, the in­di­vid­ual man­date and tax­payer sub­si­dies that push peo­ple to sign up.

“This re­ver­sal of cov­er­age would rep­re­sent an un­prece­dented pub­lic health cri­sis as in­di­vid­u­als would lose their in­sur­ance cov­er­age and no longer be able to fol­low their pre­scribed reg­i­men of care,” the lob­by­ing groups said.

Hos­pi­tals are re­quired to treat any­one who shows up seek­ing emer­gency care, in­clud­ing those with­out in­sur­ance. The lobby groups said they stand to lose $165 bil­lion be­tween 2018 and 2026 if they see an in­flux of unin­sured pa­tients af­ter an Oba­macare re­peal.

That anal­y­sis was based on a 2015 GOP re­peal ef­fort that would have gut­ted Oba­macare’s ex­panded cov­er­age pro­vi­sions, but re­stored cer­tain Medi­care and Med­i­caid pay­ments to hos­pi­tals that treat in­di­gent pa­tients.

Pres­i­dent Obama ve­toed that re­peal bill. Many hos­pi­tals are op­er­at­ing on thin mar­gins, the groups said, so a clumsy ap­proach to re­peal­ing and re­plac­ing Mr. Obama’s vi­sion would be cat­a­strophic.

“Losses of this mag­ni­tude can­not be sus­tained and will ad­versely im­pact pa­tients’ ac­cess to care, dec­i­mate hos­pi­tals’ and health sys­tems’ abil­ity to pro­vide ser­vices, weaken lo­cal economies that hos­pi­tals help sus­tain and grow and re­sult in mas­sive job losses,” the groups said in let­ters to Pres­i­den­t­elect Don­ald Trump and con­gres­sional lead­ers.

The anal­y­sis was the first sig­nif­i­cant warn­ing shot from the health care sec­tor to Mr. Trump and his Repub­li­can al­lies who are ea­ger to ful­fill cam­paign prom­ises to re­peal Oba­macare at the start of the new year.

House GOP lead­ers say they have no in­ten­tion of pulling the rug out from peo­ple who rely on Oba­macare cov­er­age now, though they haven’t said how they will ferry 20 mil­lion-plus Oba­macare ben­e­fi­cia­ries to a new sys­tem, lead­ing to hand-wring­ing among hospi­tal ex­ec­u­tives.

“It’s fright­en­ing. When I first heard ‘re­peal and re­place,’ my gut knot­ted up,” Joann An­der­son, pres­i­dent and CEO of South­east­ern Health in Lum­ber­ton, North Carolina, said on a con­fer­ence call hosted by the hospi­tal groups.

“We need to know what the re­place­ment is go­ing to be,” she added.

Hos­pi­tals pushed for Mr. Obama’s re­forms dur­ing the health care de­bate of 2009-2010, hop­ing its cov­er­age pro­vi­sions would cut the ranks of the unin­sured and slash the amount of “bad debt” fa­cil­i­ties have to carry from un­com­pen­sated care, while en­cour­ag­ing pa­tients to rely on pri­mary care be­fore they re­quire ex­pen­sive ER vis­its. The re­sults have been mixed, how­ever, with states that ex­panded Med­i­caid tend­ing to fare bet­ter, though even in those states, the pop­u­lar­ity of high-de­ductible plans on the ex­changes has left some pa­tients un­able to pay their bills.

Look­ing ahead, Chip Kahn, pres­i­dent and CEO of the Fed­er­a­tion of Amer­i­can Hos­pi­tals, said he is confident that the in­com­ing Con­gress will in­cor­po­rate their con­cerns into ef­forts to pull off a “soft-land­ing” for peo­ple al­ready cov­ered by ex­ist­ing law.

“At the end of the day, ev­ery com­mu­nity in this coun­try of any size needs to have a hospi­tal,” he said. “They are the core of health care in ev­ery com­mu­nity.”

For now, Repub­li­cans are shed­ding light on the first part of their re­peal-and-re­place strat­egy.

Se­nate Ma­jor­ity Leader Mitch McCon­nell on Tues­day said re­peal will be the first or­der of busi­ness when law­mak­ers re­turn from the hol­i­day on Jan. 3, while House Speaker Paul D. Ryan said vot­ers are counting on lead­ers in Wash­ing­ton to “de­liver re­lief” from Oba­macare, as cus­tomers face dwin­dling choices and ris­ing pre­mi­ums on its ex­changes.

“This law is hurt­ing fam­i­lies and it’s only go­ing to get worse,” he told re­porters Tues­day.

Set­tling on a re­place­ment, though, will be much harder. It will take 60 votes in the Se­nate, and the GOP can only count, at most, on 52 mem­bers of its own party.

Se­nate Democrats aren’t ea­ger to help out, say­ing Repub­li­cans re­fused to work to fix the law over the last six years, and now must pre­pare to do the heavy lift­ing on their own.

“If you break it, you own it, and that’s what Repub­li­cans are fac­ing,” Se­nate Mi­nor­ity Whip Richard Durbin, Illi­nois Demo­crat, said.

“I’m for us putting ev­ery­thing on the ta­ble in ne­go­ti­a­tions, in rene­go­ti­at­ing NAFTA and in ne­go­ti­a­tions [with other coun­tries] … what we don’t want to do is for com­pa­nies to say it costs this much to man­u­fac­ture it over­seas and sell it in the United States, and it costs this much in taxes and reg­u­la­tions and other bur­dens to man­u­fac­ture it here in the United States. We’ve got to put the Amer­i­can worker and Amer­i­can jobs first.”

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