Safety net hospitals could lose $41 billion if ACA repeal lacks immediate replacement
America's Essential Hospitals says even if earlier repeal plan is enacted, hospitals still would face a $16.8 billion loss.
If Congress fails to replace the Affordable Care Act with a comparable plan, coverage losses and scheduled cuts to hospital funding would total up to $40.5 billion nationally for hospitals that fill a safety net role, a new study shows.
That number represents coverage lost from an ACA repeal and cuts to Medicaid disproportionate share hospital funding and Medicare from 2018 through 2026, the analysis by America's Essential Hospitals shows. The association represents nearly 300 of the nation's largest health systems that cater to low-income and other vulnerable populations.
Even if congressional ACA opponents followed their December 2015 repeal blueprint -- a plan that would have rescinded the Medicaid DSH cuts -- hospitals still would face a $16.8 billion loss over the same period, the association said in a new policy brief.
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Bruce Siegel, MD, president and CEO of America's Essential Hospitals, said in a statement that the losses would be "unsustainable" and would jeopardize access and various services.
America's Essential Hospitals also calculated that other funding shortfalls, such as below-cost Medicaid payments and losses from a standalone repeal of the ACA, would translate to $54.2 billion in uncompensated care costs for its members over 10 years, starting in 2019.
Siegel said that the association's members operate, on average, with a zero margin and provide nearly 20 percent of the nation's total uncompensated care.
America's Essential Hospitals recently released principles for healthcare reform in light of the repeal-and-replace debate. The association urged policymakers to pair a repeal of the ACA with a simultaneous, comprehensive replacement. Any action less than an immediate replacement also must reverse the ACA's cuts to hospital payments, the association said. Whichever direction policymakers take, they must ensure that patients can maintain coverage during the transition to a replacement plan, it added.
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