Hospitals worry about caring for newly uninsured in GOP plan

FORT LAUDERDALE, Fla. (AP) — When Colorado expanded Medicaid coverage under former President Barack Obama’s health care law, the largest provider in the Denver region hired more than 250 employees and built a $27 million primary care clinic and two new school-based clinics.

Emergency rooms visits stayed flat as Denver Health Medical Center directed many of the nearly 80,000 newly insured patients into one of its 10 community health centers, where newly hired social workers and mental health therapists provided services for some of the county’s poorest residents. Demand for services at the new primary care clinic was almost immediate.

The hospital system, like others around the country, now is facing enormous uncertainty under the health care overhaul proposed by congressional Republicans.

The GOP plan would scale back the Medicaid expansion and take away direct federal subsidies to help consumers pay their health insurance premiums, replacing them with age-adjusted tax credits.

Denver Health could see revenue losses between $50 million and $85 million by 2020, which is between 5 and 9 percent of their annual revenue, according to the hospital’s chief financial officer. Adding to the financial anxiety is that Denver Health and many other hospital systems and medical providers across the country still would be required to care for many of the same patients, even if they lost their health coverage. That would leave hospitals, state and local governments, or privately insured patients to foot the bill.

“If it’s full removal of Medicaid expansion, we would have to make cuts on our system, and I really think that those cuts would roll back our progress and could paradoxically increase the cost of care by driving care back to where it shouldn’t be — in the emergency rooms,” said Dr. Bill Burman, interim chief executive for Denver Health.

Similar sentiments are being shared by hospital CEOs across the country as President Donald Trump and congressional Republicans make good on their promise to undo the Affordable Care Act.

The Republican plan would limit the amount of federal money available to states that opted to expand Medicaid, the state-federal program that provides health coverage to the poor and lower-income people. It also would overhaul the framework of Medicaid generally so that in the future states would receive a limited amount per person based on enrollment and costs. Health care advocates have said such a change would mean less Medicaid money for the states.

The Republican proposal would boost one revenue stream for hospitals that had been cut under Obama’s plan — a pool of money helping hospitals that care for a disproportionately high share of uninsured patients. But hospital CEOs say that money will not come close to making up for the revenue lost if large numbers of people lose their health coverage.

The American Hospital Association, which represents nearly 5,000 institutions nationwide and the Catholic Health Association of the United States, the nation’s largest not-for-profit health provider, wrote Congress warning that the bill would lead to significant cuts in a program that provides services to the most vulnerable.

“We are likely looking at situations where hospitals would close down service lines, shorten clinic hours and lay off staff,” said Beth Feldpush, a senior vice president at America’s Essential Hospitals.

The Affordable Care Act sought to get more people covered and give them access to primary care doctors, theoretically increasing the number of paying customers for hospital systems while diverting those people away from emergency rooms where they are more expensive to treat. About 22 million people have gained coverage through Medicaid and by buying private health insurance in the government-sponsored marketplaces that offer plans with subsidized premiums.

The national uninsured rate is below 9 percent, a historic low.

Moody’s Investors Service said it expects that the legislation’s provision to cap federal Medicaid payments to the states, starting in 2020, will cause states to reduce payments to hospitals. The legislation also would saddle hospitals with more unpaid bills and uninsured patients, particularly older ones who could now face much-higher premiums, according to Moody’s.WHAT OTHERS ARE CLICKING ON: