Thursday, December 8, 2016

Hospitals would be imperiled by "repeal and delay"

Republicans' plan to repeal the Affordable Care Act and give themselves three years to come up with something to replace it -- the so-called "Repeal and Delay" plan -- simply will not work.     First, their idea of "replacement" comes nowhere near providing equivalent service.

Second, they don't seem to have grasped the fact that the ACA is a balance of many parts.   If you remove some of them, the whole thing collapses.   That's the only way the Obama administration could come up with a plan that would work, even as well as this one has done.

Specifically, here's one good example that makes repeal and delay not work.    A bargain was struck with hospitals over how to get reimbursed for at least some of the services provided for people who can't pay.   As explained by Jeffry Young of Huffington Post:

"Hospitals traded billions of dollars in Medicare and Medicaid payment cuts for expanded health coverage under the Affordable Care Act, reasoning it would be good for hospital finances to have fewer uninsured patients who don’t pay for their care.   [But now] Congressional Republicans are leaning toward a plan that would repeal the law early next year, but delay enacting a new system for up to three years.

"That won’t work, according to two influential hospital lobbying groups. . . .  [Hospital groups] are demanding that legislation repealing the law and creating an alternative pass simultaneously, or that Congress and the incoming Trump administration restore the funding cuts from the law. . . . 

Repealing the ACA while leaving its Medicare and Medicaid cuts in place will have huge implications for hospitals and the patients they serve.  Losses of [that] 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 sustain and grow, and result in massive job losses.”

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We've already seen that happen in states that did not take advantage of the Medicaid expansion available under the ACA.     Before the ACA, there was another law that provided some federal funds directly to hospitals to offset their charity work.   As part of the ACA bargain, those funds were eliminated, to be offset by the expansion of Medicaid, which would pay for their care.

But politics ensued.  Some states (all but one with Republican governments, including Georgia) sued to block the incentive built into the ACA for states to agree to the Medicaid expansion  SCOTUS agreed with them and overturned that portion of ACA.   As a result, the other funding had been cut;   now states wouldn't get the increase Medicaid coverage either, if they didn't expand Medicaid.

What happened?   Some rural hospitals couldn't sustain themselves and had to close;  others reduced their services to Emergency Rooms only.   Others are just managing to hang on.   In my home town of Sandersville, they passed a local tax increase to keep the hospital alive.   Otherwise, it would not have been able to survive.

It's a basic difference in how conservatives and progressives see the role of government.  Conservatives see it as government forcing something on them they don't want;   progressives see government as a much needed safety net being taken away, leaving a lot of people to suffer, and die.

Why don't we just go back to privatizing police protection and fire departments as well?   When there's major storm damage, conservatives are all too happy to have FEMA come in and pay to rebuild their homes and businesses.  Is health care less vital than these other services?


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