Now that the U.S. Congress is considering a plan to repeal and replace the Affordable Care Act, leaders of hospitals and hospital associations across the country are monitoring progress and keeping an eye on their bottom line.
Many of the hospital associations interviewed for this story said that it’s too early to tell how a repeal would affect hospital revenue. Still, they are awaiting the fate of 2010 Affordable Care Act, also known as Obamacare. ACA became the most comprehensive piece of health care legislation enacted in decades, offering insurance exchanges and an expansion of Medicaid and Medicare – its revocation would force hospitals and hospital associations to again change the way they operate and how they calculate revenue.
Sean Hopkins, senior vice president of federal relations and health economics for New Jersey Hospital Association, said that whatever happens, New Jersey Hospital Association would like to see a replacement enacted simultaneously with a repeal.
“If the replacement doesn’t occur simultaneously with the repeal, Congress should restore the cuts hospitals absorbed in support of the ACA’s coverage expansion,” Hopkins said.
He added that New Jersey hospitals have contributed $1.4 billion between 2010 and 2017 in support of the ACA; post-acute providers in New Jersey have contributed $430 million.
The association has been doing all it can to educate its members about the various possibilities that could occur, including block grants and per capita cuts to the Medicaid program, Hopkins said.
“We continue to monitor the happenings in Washington on an hourly basis and are feeding as much information and insight to our members as quickly as we can,” he said.
About 1.8 million New Jersey residents are covered by the Medicaid program—20 percent of the state’s population—and 28 percent of all newborns in the state are covered by Medicaid, Hopkins said.
“We want to protect these residents,” he said.
A few Maryland hospitals contacted for this story deferred comment on how a repeal might affect their revenue to the Maryland Hospital Association.
Carmela Coyle, president and CEO of the Maryland Hospital Association, issued the following statement in response: “At this time, it would be premature to plan for federal changes without having details. During this national debate, hospitals need three things to help them meet their mission of care: broad-based, continuous health coverage; high-functioning insurance markets; and value-driven care incentives. No matter what policy is enacted, these will be essential to provide the right care, at the right time, in the right setting for Marylanders.”
Neil Meltzer, president and CEO of the Baltimore-based LifeBridge Health, said, “LifeBridge Health believes the access and affordability provided by ACA are vital to our patients and our community, and we hope, in whatever form health care is changed, both are maintained. In particular, we know that our partnership with the Centers for Medicare and Medicaid Innovation demonstrates the value of the Maryland Waiver in improving patient outcomes and managing costs.”
Wendy Burt, vice president of communications and public relations for Minnesota Hospital Association, said that Minnesota is one of the five states with the lowest uninsured rate, and believes that the ACA “could be repaired or improved.”
“That said, we would like to see replacement happen simultaneously if the ACA is to be repealed,” Burt said.
Uncertainty at the federal level affects current decisions being debated at the Minnesota state capitol, including the creation of a reinsurance program to stabilize the individual market and what to do with surplus funds in their Health Care Access Fund, Burt said.
MHA believes that future surplus should be used for health care coverage for low-income Minnesotans, because the state may have to pay a larger share if the federal match is reduced.
Minnesota is one of only two states with a basic health plan and 90 percent is paid by the federal government. A public option allowing Minnesotans to buy into MinnesotaCare, the basic health plan, is being considered by the legislature to stabilize the market, Burt said.
MHA would like to see all Minnesotans have health insurance coverage, have coverage that provides essential benefits (a component of the ACA that the association supports) and the enhancement of public health insurance programs, Burt said.
The group has not calculated the losses or gains in revenue if the ACA is repealed, she said, adding, “The Minnesota Department of Human Services estimates that Minnesota may lose as much as $2 billion annually in federal funding that is received for coverage of our Medicaid expansion population.”
“Charity care provided by hospitals and health systems decreased from $227 million in 2011 to $172 million in 2015. We would be concerned that uncompensated care will increase if people who currently have health insurance are uncovered,” Burt said.