The doors of America’s teaching hospitals are open to all, 24 hours a day, 365 days per year. Few other industries can make the same claim. We promise our patients that we’ll provide them with the very best care during their time of need, day or night, and regardless of who they are and whether or not they can be counted among those with access to affordable health insurance. However, it is not a promise that we can fulfill alone.
As CEO of the University of Pennsylvania Health System, one of the largest integrated health systems in the country, I have seen the devastating effects that a lack of health insurance can have on individual families and on the nation’s health-care system as a whole. The direction health-care reform discussions have taken in Washington would set us down a disastrous path as a nation, with costs we cannot bear socially or financially.
The real-world impact of proposals under consideration would be stark. According to the Congressional Budget Office, the recently passed House American Health Care Act would increase the number of uninsured Americans by 23 million and make $834 billion in cuts to Medicaid, which provides coverage for low-income families and the disabled, by 2026. This would hit states like Pennsylvania and New Jersey particularly hard, squarely on the nearly two million people — including many children and individuals with preexisting conditions — who obtained affordable health insurance over the last four years through insurance exchanges and changes to Medicaid eligibility.
In addition, provisions in the plan related to tax credits to support insurance premiums (in lieu of current subsidies) and underfunded high-risk pools would not adequately protect older and sicker individuals. The middle class would face untenable financial strain. Middle-aged, preretirement Pennsylvanians, for instance, could be responsible for $16,100 in annual health-care premiums alone. That’s a nearly tenfold increase in coverage costs under the Affordable Care Act (ACA), for which this group pays around $1,700 annually.
Access to care is critical for improving patients’ health and lowering the costs of care. Physicians and other health professionals in our hospitals spend much of their time developing strategies to keep our patients out of our hospitals, and manage their needs in outpatient clinics and through telemedicine — mobile-device health apps, for example — which can help to manage care more efficiently and at a lower cost. This is particularly true for patients with chronic disease, for whom regular office visits and monitoring offer a path to keeping up with medication regimens and getting ahead of complications before they result in a trip to the hospital.
Patients who lose health insurance are sure to forgo or delay this necessary care. The ripple effect will create instability across the health-care delivery system. Rather than receiving care in an appropriate, low-cost setting, patients will land in our hospital emergency rooms, the safety net for our most vulnerable patients. Once again, costs for uncompensated care of uninsured patients will soar. Repealing the ACA without an appropriate replacement could devastate many hospitals and the communities they serve.
With just a few weeks left before the July recess, the Senate is in position to set our nation’s course on health care for generations to come. I urge senators to avoid searching for a political solution for a social problem. Cancer, car accidents, and heart attacks do not choose sides: Democrats and Republicans alike will rely on and reap the benefits of a robust, equitable health-care reform plan. Both have friends and loved ones who are at risk of becoming one of the millions of Americans without access to affordable health insurance.
First, I call on our federal elected officials to set the bar higher:
Start with a goal of covering more people over the next 10 years. Cutting Americans off from lifesaving care is anathema to our American value system. Although more than 20 million people gained insurance through the ACA, there are still 28 million Americans without health insurance. This is neither acceptable nor sustainable.
Second, we must protect the most vulnerable among us, by safeguarding Medicaid recipients and those with preexisting conditions.
Finally, we must encourage greater cost-savings innovation in health care overall. There are many ways to bend the cost curve that do not rely on excluding a large group of Americans simply because they are too sick, or poor, or old. Innovation is a cornerstone of American medicine throughout history, which has propelled generations of discoveries and cures. We must continue that proud tradition.
As you read these words, the doors of our hospitals are open, with doctors, nurses, and other medical staff at the ready. Congress, help us keep our promise.
Ralph W. Muller is CEO of the University of Pennsylvania Health System.