What Happens if the Affordable Care Act is Repealed?

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What Happens if the Affordable Care Act is Repealed?

The impact on nurses, patients and hospitals

By Working Nurse
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Eliminating ACA Could Cost Hospitals Over $165 Billion

In the wake of the election, Republican opponents of the Affordable Care Act (ACA) have been sharpening their axes. However, two leading hospital groups warn that repealing the ACA could be financially devastating for U.S. hospitals.

Worst-Case Scenario

In an open letter to congressional leaders on December 6, the American Hospital Association (AHA) and the Federation of American Hospitals (FAH) expressed their fear that the drive to repeal “Obamacare” may create a worst-case scenario for hospitals, leaving them to bear most of the financial burdens the ACA imposes without any of the benefits.

Among the ways the ACA seeks to rein in healthcare costs is by limiting Medicare and Medicaid payments to hospitals, including capping inflation adjustments; imposing reimbursement penalties for readmissions and hospital-acquired conditions; and reducing Disproportionate Share Hospital (DSH) payments for facilities that serve many low-income patients.

The silver lining for hospitals is a big increase in the number of patients with some form of health insurance, whether through the subsidized exchanges or expanded Medicaid. More insured patients means more revenue and greater chances that a hospital will be paid for the services it provides. If that expanded coverage goes away, hospitals may still face the same payment caps and penalties, but without the additional revenue.

“Massive Job Losses”

That’s exactly the scenario hospitals would have faced with Congress’s last attempt to repeal the ACA: H.R. 3762, which President Obama vetoed last January. That bill would have eliminated all of the ACA’s coverage expansions, but the only hospital payment cut it would have rescinded was the reduction in Medicaid DSH payments. A Dobson | DaVanzo study commissioned by the AHA and FAH estimates that enactment of H.R. 3762 — or a future bill just like it — would mean a net loss to hospitals of $165.8 billion between 2018 and 2026.

If the repeal legislation did not restore Medicaid DSH payments, those losses would rise to $210.8 billion. “Losses of this magnitude,” declared AHA President & CEO Richard J. Pollack, MPA, and FAH President & CEO Charles N. Kahn III, MPH, in their letter to Congress, “cannot be sustained and will adversely impact patients’ access to care, decimate hospitals’ and health systems’ ability to provide services, weaken local economies.

 

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 America’s Uninsurable

Preexisting conditions could make 52 million uninsurable

If Congress repeals the Affordable Care Act (ACA), health insurers may once again be able to deny coverage for patients with preexisting conditions. A recent analysis estimates that more than 52 million Americans have conditions that would make them uninsurable under pre-ACA rules.

Coverage Denied

In 2016, about 155 million Americans had health insurance through their employers. Prior to the ACA, employer group policies were often the only way for people with preexisting conditions to obtain health coverage. On the individual market, many insurers refused to sell policies to patients with “declinable conditions” like cancer, diabetes, epilepsy or lupus.

The ACA put an end to those exclusions and gave Americans with preexisting conditions new options for obtaining coverage. In the event of repeal, patients may once again be at the mercy of state underwriting laws, some of which even allow insurance companies to deny coverage based on a preexisting condition that was never previously diagnosed.

An issue brief from the Henry J. Kaiser Family Foundation, released December 12, offers a sobering estimate of how many Americans adults under age 65 have one or more declinable conditions: 27 percent, or about 52.2 million people — including almost 5.9 million Californians.

Other Barriers

The brief’s authors are quick to note that this “conservative” estimate considers only declinable conditions. It doesn’t address other obstacles such as premium surcharges for policyholders with preexisting conditions or riders that exclude any treatment for a specific condition. (California law prohibits such health insurance “elimination riders,” but many other states allow them.) The Congressional Budget Office, the RAND Corporation and the consulting firm Dobson | DaVanzo have estimated that if the ACA is repealed, 20 to 22 million American adults now covered by Medicaid or marketplace plans will lose their insurance. For newly uninsured patients with preexisting conditions, finding new coverage could be an uphill battle. 

This article is from workingnurse.com.

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