As the GOP-led Congress convenes this week with the repeal of the Affordable Care Act (ACA) in their sights — and a president-elect presumably more amenable to such a move — some who work in the healthcare industry are expressing worry.
Last month, the American Hospital Association and the Federation of American Hospitals collaborated on an open letter to senior leadership in the House and Senate. Carefully measured, the dispatch nonetheless stresses the negative repercussions healthcare facilities will face if President Barack Obama’s signature piece of legislation is repealed without an adequate substitute ready for immediate implementation.
“Repeal and replace” has long been the battle cry of Republicans opposed to the ACA, but the “replace” portion of that plan has always been a little nebulous. There’s been speculation that any replacement legislation could be delivered in a piecemeal fashion or even delayed altogether, maybe for years.
A video monitor sits in front of the statues of, from left, former Vice President Hannibal Hannibal of Maine, former Representative and Senator Daniel Webster and former Arizona Sen. Barry Goldwater in Statuary Hall on Capitol Hill in Washington, Tuesday, Jan. 3, 2017 as the 115th Congress begins. (AP Photo/Cliff Owen)
In the letter from the hospital organizations, the authors call attention to reports created by Dobson | DaVanzo, a consulting firm specializing in healthcare economics. They speculate that eliminating the ACA without having a replacement in place could cost hospitals $165.8 billion over the eight years immediately following the end of the existing legislation’s supports.
The letter also highlights major losses hospitals would face as other financial protections are knocked asunder by a repeal of the ACA.
“Dobson | DaVanzo also finds that hospitals would lose $289.5 billion in inflation updates if the payment cuts in the ACA are not restored,” the letter continues. “Finally, Dobson | DaVanzo finds that the full restoration of the Medicare and Medicaid DSH payment reductions would amount to $102.9 billion. 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 hospital organizations also jointly offer to be active participants in the development of any new legislation.
Perhaps compounding the uncertainty over whether or not healthcare organizations will be in the room where new legislation happens, there are internal, highly public disputes over how supportive to be of various signals from the incoming Trump administration as to how they will approach healthcare. Most notably, the American Medical Association’s quick endorsement of Rep. Tom Price to head the U.S. Department of Health and Human Services was countered by angry physicians. Thousands of healthcare practitioners co-signed the open letter originally written by University of Pennsylvania physicians Manik Chhabra, MD, Navin Vij, MD, and Jane Zhu. MD, MPP.
“We believe that in issuing this statement of support for Dr. Price, the AMA has reneged on a fundamental pledge that we as physicians have taken — to protect and advance care for our patients,” the letter states.
It’s likely that the facilities hardest hit by any dramatic change will be those that disproportionately serve underprivileged communities.
The New York Times recently reported on concerns voiced by Temple University Hospital and others that are similarly considered safety-net hospitals. According to the article, leadership at Temple estimates they could see losses of as much as $45 million per year after repeal of the ACA.
“We are the de facto community hospital in one of the poorest neighborhoods in the country,” Robert Lux, the senior vice president, treasurer and chief financial officer of Temple University Health System, tells the Times. “Any kind of change like this would not only push Temple University Hospital into financial extremis, it would do the same thing for our entire system.”
As it currently stands, the uncertainty over how the next few years will play out may be toughest part for the healthcare industry. Though battles consistently raged over the ACA since the beginning, the stalemate between the White House and the Republicans promised some level of consistency in the regulations hospitals and other medical facilities needed to follow. One thing’s clear as 2017 gets underway: that consistency is no more.
Filed Under: Industry regulations + certifications