Finance

Teaching Hospitals in Particular Will Suffer Under Plan to Repeal ‘Obamacare,’ Critics Say

March 14, 2017

Teaching hospitals that care for disproportionate numbers of poor, elderly, and disabled patients would be particularly hard hit under a Republican health-care bill that the Congressional Budget Office estimated on Monday could leave 24 million more Americans uninsured by 2026.

The plan, proposed by Republican leaders in the U.S. House of Representatives, would repeal parts of President Barack Obama’s health-care law, often called "Obamacare." It would also phase out an expansion of Medicaid that has provided coverage to 11 million people who didn’t have it before, eliminate a penalty for people who don’t have health insurance, and end income-based tax credits that helped people pay for coverage.

The nonpartisan Congressional Budget Office and the staff of the Joint Committee on Taxation estimated that, by next year, 14 million more people could be uninsured. On a more positive note, they estimated, the bill could reduce the federal deficit by $337 billion over 10 years.

Darrell G. Kirch, president of the Association of American Medical Colleges, released a statement on Monday evening warning of dire consequences for the nation’s health and less money for medical education if the legislation passes.

“America's teaching hospitals will continue to care for these vulnerable patients, but will be forced to absorb the resulting uncompensated care costs, threatening their ability to support and advance their research and education missions.”
"These are people, not numbers — who all too often will be left without access to regular care, putting their health at risk," he wrote. "Many of them will come to our nation’s teaching hospitals, but they may wait until they are in crisis and the costs and complexity of treatment have increased."

He said that while some lawmakers may be pleased with the projected cost savings, the people who lose coverage will still get sick. "America’s teaching hospitals will continue to care for these vulnerable patients, but will be forced to absorb the resulting uncompensated care costs, threatening their ability to support and advance their research and education missions."

That result, Dr. Kirch said, would weaken, not strengthen, the overall health of the nation.

‘A Burden’ on Hospitals

Teaching hospitals, which handle some of the most complex medical cases, often operate on razor-thin margins. They also have an important safety-net mission, treating people whether or not they are insured.

Under the Obama-era Affordable Care Act, the percentage of people without insurance dropped from 18 percent to 11 percent, an official with the American Hospital Association said in an interview with National Public Radio. If the number of uninsured patients rebounds, "it will be a burden on the hospitals to have the additional uncompensated care," said Tom Nickels, the association’s executive vice president for government relations and public policy.

Late Monday, Rick Pollack, the group’s president, released a statement expressing concern about the projected impact of the proposed legislation.

“Any changes to the ACA must be guided by ensuring that we continue to provide health-care coverage for the millions of people who have benefited from the law.”
"As we said in our letter to Congress last week, any changes to the ACA must be guided by ensuring that we continue to provide health-care coverage for the millions of people who have benefited from the law," he wrote. "We cannot support a bill that the CBO and others clearly indicate would reduce coverage for so many people."

The letter he was referring to was also signed by the medical-colleges association, which includes about 400 teaching hospitals, as well as other hospital groups.

AAMC-member teaching hospitals represent just 5 percent of hospitals in the United States, but handle 25 percent of Medicaid hospitalizations and 34 percent of hospital charity care, according to the association.

Republicans, including members of the Trump administration, have already begun questioning the new estimates of the impact of a bill that the president had promised would be "a thing of beauty."

Katherine Mangan writes about community colleges, completion efforts, and job training, as well as other topics in daily news. Follow her on Twitter @KatherineMangan, or email her at katherine.mangan@chronicle.com.