The threat of a repeal of the Affordable Care Act doesn't only put health insurance coverage for millions of people in jeopardy. It will also come at a huge financial cost to hospitals in bad debt and threaten innovative programs they've put in place to improve patient care.
And it’s more than just the money they’ll lose through uncompensated costs for caring for patients without insurance. Industry experts told NPR that the financial incentives Medicare provides for hospitals to try new approaches to improve patient care are also in jeopardy.
Timothy Ferris, M.D., an internist and medical director of the Mass General Physicians Organization told the publication that he worries that the “progress we've made over the past five years would be threatened."
The progress includes programs through the accountable care organization (ACO) at Massachusetts General Hospital, such as experiments with video consultations and home hospitalization programs. Ferris said that politicians don’t realize how long it takes to make significant improvements in delivery of care and that it takes time to see the savings.
Dennis Keefe, head of Care New England in Rhode Island, told NPR that he is concerned about the future for Integra, an ACO that includes primary care physicians, specialists, urgent care and after-hour providers, labs, clinics and inpatient facilities across Rhode Island that put the patient at the center of care.
Indeed, hospitals and healthcare systems that have spent the last six years trying to create programs that support value-based, patient-centered models as part of the ACA want the federal government to continue supporting those initiatives. This week, 120 organizations sent a letter to President Donald Trump and Vice President Mike Pence urging them to not roll back progress they have made.
Hospitals also stand to take on more bad debt under the ACA repeal. The Urban Institute recently released a report that found even a partial repeal of the health reform law would increase the amount of uncompensated care that hospitals and healthcare systems provide to the uninsured at a free or reduced rates by $1.1 trillion over a 10-year period.
A December report from the American Hospital Association put that figure at $165 billion if a repeal reinstates rollbacks on Medicare and Medicaid payments that were included in the ACA. The outlook is more dire if those reductions are not restored, according to the report, as hospitals would suffer an additional loss of about $289 billion during that same time period.