ACA repeal and replace unknowns put community health centers, safety-net providers in a holding pattern

Although all hospitals will feel the impact of a repeal of the Affordable Care Act, community health centers and safety-net facilities could suffer more than most.

The healthcare reform law provides funding for safety-net providers. If a replacement plan doesn’t improve or provide continued funding, organizations fear they will lose revenue and may not be able to provide care that has kept patients out of emergency rooms.

“It would be felt on a daily basis,” Erin O’Malley, director of policy for America’s Essential Hospitals, told California Healthline. “Our mission will not be changing, but the challenges will be mounting, … especially if we have a ‘repeal’ without a comparable ‘replace.’ ”

San Mateo Medical Center in California is one of the many safety-net providers that is bracing for the impact. Before the ACA, 48% of its patients were uninsured, according to the article. Since the implementation of President Barack Obama’s signature legislation, only 17% of its patients are uninsured. Fifty-seven percent now have Medi-Cal, the state’s version of Medicaid.  

The hospital and its clinics receive $166 million annually from Medi-Cal, about 60% of its budget. Chester Kunnappily, CEO of San Mateo Medical Center, estimated the organization could lose $50 million if the ACA is repealed. If the newly insured now lose their insurance, he said they will likely delay care until they become sicker, and their care will be more expensive.

The country’s 1,300 community health centers are also unsure what a future without the ACA means, according to an article from Colorado Public Radio. These centers have treated an additional 5 million patients since 2010. Many are federally qualified health centers, which makes them eligible for federal grants and a higher reimbursement from Medicaid and Medicare. These grants have allowed many of these centers to expand their facilities and add services, such as urgent care and behavioral health.

A repeal and replacement of the ACA may limit the future growth of Adelante Healthcare, which operates nine clinics in Phoenix, and strain its existing resources and staff, Robert Babyar, M.D., Adelante's assistant chief medical officer, told the publication.

Half of Adelante’s 70,000 patients have Medicaid or KidsCare, Arizona’s version of the Children’s Health Insurance Program. The state’s decision to expand Medicaid in 2014 provided coverage to more than 400,000 people and placed a bigger demand on the community health centers’ services, he said.

"All the progress we made with those patients to stay and be healthy—that can fall apart really quick," Babyar told the publication.