Health concerns

In the days since the presidential inauguration of Donald Trump, who made repealing his predecessor Barack Obama's health care legislation a priority of his campaign, Keene area providers, as well as their colleagues across the state, have waited with bated breath to find out the changes in store.

Since entering 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 calling for the law's "prompt repeal" and directing federal agencies to "minimize the unwarranted economic and regulatory burdens of the act." Likewise, the Republicanled Congress passed a budget reconciliation bill to dismantle financial components of the bill, while promising new legislation in its place.

But the exact form a replacement will take remains unknown.

At a Jan. 26 forum in Keene, officials of organizations that included 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. Küster, D-2nd District. An audience of about 30 attended, some rising near the end to voice their personal concerns with the act's potential repeal.

The panelists said the issues raised by repeal are wideranging. Chief among them are changes to the Medicaid funding system, which is split between state and federal contributions.

Republicans, including as U.S. House Speaker Paul Ryan, R-Wis., have called for a change in the federal government's state funding calculus, moving to a block grant model, giving states a set amount of money gets sent to states every year.

"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," Küster said.

Other panelists focused on specific parts of the ACA that would vanish with a repeal, such as the law's mandate that people under 26 can remain on a parent's health insurance plan or its provision that says providers must provide contraceptives and women's health services at the same rates as men.

And Dr. Don Caruso, president and CEO of Cheshire Medical Center, 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.

While Caruso, along with other panelists, said the ACA had plenty of flaws and wasn't a final fix to the health system, he maintained it had also brought some welcome improvements and that the current repeal plan is dangerous.

"Making the [ACA] go away without any plan of where we're going is probably almost a step back into the Dark Ages," he said. - THE KEENE SENTINEL