At forum, local health care providers concerned, uncertain over Obamacare repeal

Jan. 30--The room brimmed with expertise, as leaders from local health care organizations gathered in Keene recently to discuss potential changes to health laws with the new presidential administration.

Certainty, however, was harder to come by. In the days since the presidential inauguration of Donald J. Trump, who made repealing his predecessor Barack Obama's health care legislation a priority of his campaign, local providers have waited with bated breath as to the changes in store.

"We've run a deficit, and we have for the past few years, but it's because we feel strongly that these programs will continue," said Cathy Sorenson, president and CEO of Home Healthcare Hospice and Community Services in Keene, speaking on the expanded Medicaid funds the Affordable Care Act provides.

"I am fearful about what will happen to our ability to continue that if things change dramatically."

Since coming into office, Trump has taken direct, if symbolic, action against the Affordable Care Act, also known as Obamacare. He signed an executive order on Inauguration Day reavowing his commitment to the law's "prompt repeal" and directing federal agencies to "minimize the unwarranted economic and regulatory burdens of the act." And the Republican-led U.S. Congress has passed a budget reconciliation bill to dismantle financial components of the bill, while promising new legislation in its place.

Critics of the Affordable Care Act have said it's a major strain on the federal budget that has failed to keep insurance premiums down and created a burden on small businesses. Trump's election paved the way for Republicans to take away some of the more unpopular aspects of the act, such as the individual mandate that imposed a fee on those who didn't sign up for coverage.

But the exact form a replacement will take remains unknown. At the forum in Keene Thursday, leaders of organizations such as Cheshire Medical Center/Dartmouth-Hitchcock Keene and Phoenix House expressed worry at what the gap in policy will mean for their operations.

The providers were gathered by U.S. Rep. Ann M. Kuster, a representative for New Hampshire's 2nd Congressional District and a Democrat. An audience of about 30 attended, some rising near the end to voice their personal concerns with the act's potential repeal.

For the health care leaders on the panel, the issues raised by a repeal are wide-ranging. Chief among them are changes to the Medicaid funding system, which is split between state and federal contributions.

Republicans such as U.S. House Speaker Paul Ryan, R-Wis., have stated their desire to change the federal government's state funding calculus, moving the amount from a percentage model where the federal government provides a proportion of funds, to a block-funding model where a set amount of money gets sent to states every year.

Many Republicans argue the approach, which is favored by the president, allows states to have more control over the federally provided Medicaid funds while still providing a sufficient share of money on a state-by-state basis.

But many Democrats, including Kuster, have said the proposed change to the system amounts to an overall cut that they say will make health care services more difficult to keep viable, particularly if the Medicaid expansion included with the Affordable Care Act is rolled back.

"The problem is the block grant will not be sufficient funding, and then what you'll have is a big scrum where everybody will be feuding over insufficient funding," Kuster said, citing concerns raised at a meeting with the N.H. Hospital Association.

Many of the representatives on Thursday's panel agreed.

"The block grant (proposal) is so detrimental to collaborative partnerships in our community, which the Monadnock Region has a rich history of, (such as) providing connections to access to care," said Maryanne Ferguson, executive director of Monadnock Collaborative, a nonprofit regional health care planning organization, speaking from the audience. "A block grant provides nothing in terms of sustainability."

Other health care leaders focused on specific parts of the Affordable Care Act that would vanish with a repeal.

Amelie Gooding, New England program director of the Phoenix House, a drug and alcohol rehabilitation center with a site in Keene, said that the Affordable Care Act had done wonders in helping sign young people up for insurance, by forcing insurance companies to allow those under 26 to use their parents' health care plans. Under the Affordable Care Act, Gooding said, 56 percent of her organization's patients were 26 or younger.

Jennifer Frizzell, vice president for public policy at Planned Parenthood of Northern New England, praised what the act had done toward removing gender inequities in health care costs. Frizzell said by forcing providers to include contraceptives and women's health services at the same rates as men -- and to stop excluding women because they use those services -- the act had put women on an equal playing field.

And Dr. Don Caruso, president and CEO of Cheshire Medical Center/Dartmouth-Hitchcock Keene, said that the act's introduction of a value-based Medicare reimbursement system for hospitals -- where hospitals were given financial incentives to meet certain metrics for better patient outcomes -- had changed the hospital culture for the better and spurred innovation.

Before that introduction, such Medicare reimbursement schemes followed a volume-based model that favored hospitals that shuttled the most patients and operations in the shortest period of time.

The reimbursement approach brought in by the act, as well as the expansion of Medicaid funds overall, had encouraged hospitals to start finding ways to improve the population health of their region, rather than stacking their staffs with specialist surgeons that could provide lucrative, but not always top-priority, procedures, Caruso said.

Caruso -- and other panelists -- said the Affordable Care Act had plenty of flaws and wasn't a final fix to the health care system. But he maintained it had also brought some welcome improvements and that the current repeal plan is dangerous.

"Making the (Affordable Care Act) go away without any plan of where we're going is probably almost a step back into the Dark Ages," he said.

Ethan DeWitt can be reached at 352-1234, extension 1439, or edewitt@keenesentinel.com. Follow him on Twitter at @EDeWittKS

Ethan DeWitt can be reached at 352-1234, extension 1439, or edewitt@keenesentinel.com. Follow him on Twitter at @EDeWittKS

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