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.
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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 President-elect 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.
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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.