040617 Health care: Uncertainty remains for providers after failed repeal vote
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Tom Price, right tours Georgetown Memorial in 2014 as a congressman advocating repeal of the ACA. He’s now secretary of Health and Human Serivces.
Tanya Ackerman/Coastal Observer

Health care: Uncertainty remains for providers after failed repeal vote

By Charles Swenson
Coastal Observer

The failure of Congress to repeal and replace the Affordable Care Act did nothing to end the uncertainty for health care providers. “It absolutely did not,” said Bruce Bailey, CEO of Tidelands Health and a trustee of the American Hospital Association. “There’s plenty of concern about what executive orders could do to change things.”

The decision of House leaders to pull a replacement bill before a vote last month brought cheers from proponents of the ACA, better known as Obamacare, and caused shares of publicly-traded hospital corporations to rise. For Tidelands Health, a nonprofit that runs Waccamaw Community and Georgetown Memorial hospitals, the response was more muted.

South Carolina rejected the offer from the federal government to expand Medicaid, the health care program for the poor. “The reason that the for-profit company shares went up is that without the repeal you still have a lot of states that expanded their Medicaid programs, reducing the uninsured in those states, therefore you’re reducing the bad debt and charity care that those for-profit hospitals try hard to provide in those states,” Bailey said. “We never expanded Medicaid, therefore we didn’t have the benefit of that.”

Since the ACA took effect in 2013, enrollment in health care plans grew from 1,470 to 3,501 this year, according to data compiled by the Palmetto Project, a nonprofit that receives federal funds to promote enrollments. “There’s definitely been pretty huge coverage increases,” said Shelli Quenga, director of programs for the nonprofit. And nearly 90 percent of those who now have coverage in Georgetown County are eligible for tax credits to help cover the cost of premiums.

“There was that benefit, but we didn’t see the greatest benefit that could have come with Medicaid expansion,” Bailey said. The immediate concern following the failed effort to repeal Obamacare is the fate of the insurance exchanges, he noted. There were initially four companies that issued insurance in South Carolina under the ACA. There is now one. “The good part is, it’s the biggest one we have,” said Quenga. And that company, Blue Cross-Blue Shield, this year brought the Medical University of South Carolina on as a care provider of specialty care. “That had previously been a problem,” she said.

The American Hospital Association was the first major industry group to come out against the repeal-and-replace bill. In addition to highlighting the need to maintain or increase coverage, the association, in a letter to Congress, said “If coverage is not maintained at the current level, those resources need to be returned to hospitals and health systems in order to provide services to what will likely be an increased number of uninsured Americans.”

As part of the negotiations for funding Obamacare, Bailey explained, the hospital industry agreed to cuts in reimbursement for Medicare, the federal insurance program for the elderly and disabled. “The theory being, if we didn’t have as many uninsured patients, then we would be able to afford the cuts in Medicare payments to pay for the coverage of those uninsured,” he said. “The hospital industry in South Carolina mostly just experienced the cuts, we didn’t get the benefits of the coverage. So now, when you talk about going forward, that’s one of our principal talking points.”

Those will come into play in any discussion about shifting the form of Medicaid payment to block grants or capping payments. Under those scenarios, “we’d be facing massive cuts,” Quenga said. “For a poor state like ours, it’s a serious threat.”

“In the end, we all need to remember the patient, the community member who is looking to have access to care,” Bailey said. “They need to be able to engage with their doctor, their health care provider, in a way that they don’t have to worry about affordability.”

That includes people who don’t receive their health coverage from the ACA, because they are the ones who wind up paying part of the bill. “I would argue that employers, taxpayers, would want everybody to have coverage,” Bailey said. “Somebody’s going to have to cover the cost of that uninsured care.”

The Palmetto Project estimates there are 123,000 people in the state who are eligible for care under the ACA, but don’t have it. Most of those without coverage are men who are too poor to buy health insurance and don’t qualify for Medicaid, Quenga said. There have already been cuts in funding to promote Obamacare. A proposed rule from Health and Human Services Secretary Tom Price would cut the enrollment period in the coming year from three months to six weeks. The grant to promote enrollment is also in jeopardy, she said, which will mean hospitals and insurers will have to take on a larger share of that work. “There are just so many more people than any one group of us can handle,” Quenga added.

Regardless of the policy debate, hospitals are required to provide care. “We’re going to care for you. Our mission requires that of us. The law requires that of us. So that’s what we’re here to do,” Bailey said. “But somebody’s got to pay for it.”

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