ACA Repeal and Replace by the Numbers / by Joe Furia

Greg Vigdor, President and CEO, of AzHHA

Greg Vigdor, President and CEO, of AzHHA

The presidential election was a turning point for America’s healthcare industry. With the election of President Trump and a Congress now under Republican control, we braced for a new Administration  sure to be the antithesis of the last. Nowhere did we expect a bigger transformation than in the area of healthcare.

To be clear: the Arizona Hospital and Healthcare Association (AzHHA) is not in the business of politics. Our job is to take care of people and patients, and to advocate for policies that do the same.

To that end, AzHHA has been vocal in expressing our willingness to work with the Trump Administration and congressional leaders toward a thoughtful replacement for the Affordable Care Act (ACA). Obamacare is not perfect, and there are changes that could be made to improve choice and address increasing costs within the system.

So, when it comes to suggestions and solutions for improving health care, we’re “all ears” – with two conditions: First, any talk of “repeal” must be accompanied by “replace.” Second, health coverage must continue in some useful form for the millions of Americans and hundreds of thousands of Arizonans who obtained it through the ACA.

Ensuring broad healthcare coverage comes with multiple societal benefits. It increases financial security for Americans who otherwise face debilitating costs – including bankruptcy – in the face of unanticipated medical emergency. Coverage has also proven to improve overall patient health by providing access to regular preventive care that helps minimize the likelihood of more expensive treatment or hospitalization down the road.

Case in point: managing diabetes through insulin is far preferable and much less costly than managing heart attacks, strokes, amputations or other consequences of leaving the condition untreated.  Even better is avoiding the onset of diabetes altogether through better lifestyle choices and primary care.

People with healthcare coverage are also less reliant on hospital emergency rooms for primary care. This is good for both patients and hospitals. By law, hospitals must treat all patients who come through our doors – but we all know the care provided isn’t really “free.” These costs end up being passed along to patients with health insurance in the form of higher premiums – a hidden healthcare tax – or shouldered by hospitals themselves. Escalating costs for uncompensated care weighed heavily on Arizona hospitals before our state expanded Medicaid coverage in 2013. Thankfully, costs have fallen 60 percent statewide in the years since then.

But all of the progress we’ve made together in this area is now threatened as Congress contemplates an $880 billion reduction in federal Medicaid support between now and 2026. This is just one of multiple major shortcomings of the U.S. House proposal: the American Health Care Act.

According to the nonpartisan Congressional Budget Office, about 24 million Americans would lose coverage in the coming decade under this plan.  While we don’t have a precise estimate of the losses in Arizona, our state’s Medicaid program – formally, the Arizona Health Care Cost Containment System –in recent days estimated up to 383,000 people would fall off our Medicaid rolls by fiscal 2023. That just accounts for Medicaid enrollees. The overall loss of healthcare coverage in our state would likely approach 600,000 or more.

Unfortunately, Arizona knows what happens when large numbers of our citizens lose coverage. It happened after Medicaid enrollment was frozen during the Great Recession, which negatively impacted patient health and led to the rapid escalation of uncompensated care that threatened hospitals statewide.

Simply put, the ACA “replace” bill currently being debated by Congress is bad for Arizona patients, bad for Arizona health care and bad for the Arizona economy.

Again, none of this is to suggest there are not ways to greatly improve upon the ACA model. For example, the health exchanges established through the ACA have major and well-documented design flaws. Fourteen of Arizona’s 15 counties have only one insurance provider on the exchanges, and this is not the kind of choice that Americans were promised. AzHHA stands ready to support solutions to these and other shortcomings of the ACA, but the proposal now before Congressdoes more harm than good.

Thankfully, many of Arizona’s elected officials and community leaders understand these issues and are giving voice to our concerns and those of patients. Governor Ducey, in particular, has consistently indicated he opposes any federal actions that will “pull the rug out from under” Arizonans depending on access to care, and we thank him for his advocacy on this issue.

In the meantime, AzHHA will continue working with our national partners and Arizona’s congressional delegation and other leaders until we achieve healthcare reform that truly puts patients and communities first.