The House Republicans' plan to repeal and replace Obamacare threatens hard-won progress toward improving America's health while curbing health-care spending.
First and foremost, the new plan would back track on coverage. Under Obamacare (officially called the Affordable Care Act), more than 1.1 million Pennsylvanians benefited from new, more affordable ways to get their health insurance. Our state's uninsured rate fell by 40 percent. The Philadelphia area saw a similar decrease.
We are waiting for official details that outline coverage impacts, but our initial analysis of the House plan (officially called the American Health Care Act) shows that recent coverage gains are at risk of erosion.
Big changes to Medicaid will jeopardize coverage for more than 700,000 newly insured Pennsylvanians - most of them in working families with very low incomes - who have been covered through the Affordable Care Act's expansion of Medicaid.
Pennsylvanians who buy their insurance on the Health Insurance Marketplace also will be at risk. The tax credits put forth in the American Health Care Act are not sufficient to make insurance affordable for low-income Americans not covered through their jobs.
This unraveling of health coverage will threaten the health and financial sustainability of those on the losing end, and our nation as a whole.
Right now, Americans are less healthy than the citizens of other prosperous nations, but spend more on health care. Expanding coverage - giving as many Americans as possible access to good, affordable health insurance - is an important step in reversing that dynamic.
Common sense and studies in the Annals of Internal Medicine, Health Affairs, Journal of the American Medical Association, and the New England Journal of Medicine show that people with health insurance are more likely to:
- Get regular checkups and screenings and take prescribed medications
- Report that their health is the same or better than a year ago
- Have less stress about medical bills and fewer problems paying them
In short, people with insurance can better head off health problems before they become crises, avoiding intensive and expensive hospital care.
Hospitals bet big on this vision of a healthier America. They stepped up to help fund the Affordable Care Act's coverage expansion and insurance protections.
In Pennsylvania, hospitals are shouldering $16.5 billion in cuts to help provide the federal budget dollars needed to fund health insurance for more Americans with low- or middle-class incomes. To date, Pennsylvania hospitals have sustained $1.6 billion in these "cuts for coverage." An additional $14.9 billion are scheduled through 2026.
In Southeastern Pennsylvania, these payment cuts total $5.3 billion through 2026.
Pennsylvania hospitals accepted these cuts despite slim and sometimes negative margins. Last year, one in three hospitals in this region lost money overall.
Fortunately, we are seeing signs that these investments are paying off. More than 6.1 million Pennsylvanians have received regular checkups and other preventive care. Hospitalizations are down. Nearly half of all hospital care is now provided in outpatient settings.
What's more, we may be bending the famous health-care cost curve. The historic, and unsustainable, growth in what we, as a nation, spend on our health care is slowing - even though more Americans than ever have health insurance.
Since the Affordable Care Act's coverage expansion took effect during 2014, national health-care spending has grown less than 6 percent a year. In contrast, spending grew 6.5 to 8.5 percent in the five years preceding the Great Recession of 2008.
If we look at what we spend, on average, for each American enrolled in some kind of health plan, the picture is even clearer. The U.S. Council of Economic Advisers compared annual per-enrollee spending growth prior to the Affordable Care Act with annual per-enrollee spending growth since the law was enacted. For commercial insurance, per-enrollee spending growth has been cut in half, to just 1.5 percent. Medicare and Medicaid spending growth rates are in negative territory. For these insurance programs, the amount we are spending per enrollee is actually shrinking.
Hospitals wholeheartedly support this transformation of health care toward expanded coverage, better health and health care, and lower health-care spending. It's the yardstick against which we'll measure repeal and replacement efforts.
We eagerly await the nonpartisan Congressional Budget Office's analysis of the American Health Care Act. This detailed scoring will provide in-depth information about how much the proposed law will cost and how many Americans will, or will not, be covered.
Meanwhile, we urge the White House and Congress to go thoughtfully and carefully as they work to improve, repair, or repeal the coverage and care we have now. Let's be sure to maintain and support the progress we've already achieved.
Andy Carter is president and CEO of the Hospital and Healthsystem Association of Pennsylvania. Acarter@haponline.org