OPINION: Be cautious with Obamacare, Maury Regional CEO says

Dec. 19--The Affordable Care Act, better known as Obamacare, was placed on life support after Donald Trump was elected president.

The law was a target of Republican angst after it was signed into effect in 2010, even though it provided rural patients and hospitals with relief. More than 30 million Americans have the coverage, more than 20 million of them newly insured.

Trump has promised to repeal and replace it. And with the GOP controlling the House and Senate, the new president has the power to shape health-care policy at his whim.

"The new administration needs to be very cautious in how it proceeds," Maury Regional Medical Center CEO Alan Watson told The Daily Herald.

Thousands of Tennesseans lack health insurance, and rural hospitals, such as Maury Regional, cannot go on forever providing services on a charity basis without feeling intense pain.

"If you totally dismantle the ACA and kick 20 million people off of insurance, it is going to be devastating, particularly to rural hospitals," said Watson, who is chairman of the Tennessee Hospital Association. "Rural hospitals have seen increases [in payments] with patients having coverage through the health-care exchanges. To lose that, suddenly, would be devastating to local, not-for-profit hospitals."

Right now, if you don't have insurance and walk into Maury Regional's emergency room, you cannot be denied care under federal law. But the care is far from preventative. Taxpayers wind up paying for expensive ER services when public hospitals write off bad debt.

"If a large number of people lose insurance and have nowhere to turn for care, they end up in emergency departments," Watson said. "Bad debt is going to increase dramatically for hospitals."

Hospitals will not be able to raise prices. Most of the prices are fixed by insurance companies or Medicare and Medicaid.

"There's really no where to pass it on," Watson said.

Since the start of Obamacare, bad debt at Maury Regional has dropped about $2 million per year, Watson said.

"We had been running $15.5 million to $16 million in costs of bad debt," Watson said. "This last year, we were down to $13 million. We started seeing folks getting insurance."

Though far from perfect and difficult to understand, Obamacare at least eliminated insurance companies' refusal to cover pre-exisiting conditions and provided a safety net for catastrophic illnesses. It also allowed insurance companies to balance their roster of those covered with the healthy and unhealthy.

Without Obamacare, there's a fear among insurers that the only people buying insurance will be the unhealthy, at-risk groups, who drive up the need and eventually the cost for care.

"Before they had insurance, people would wait until the last minute, until they had to go to the emergency department," Watson said. "With insurance, they were able to get preventative care."

Obesity and risk for heart attack remain the biggest issues facing southern Middle Tennessee patients. Without regular consultations with doctors, patients will be more vulnerable.

"The best way to control the cost of health care in this country is to improve our health," Watson said. "If you look at the U.S. versus to all other industrialized nations, we are the most unhealthy. That drives the cost of health care more than anything.

"There's all kinds of theories on why health care is so expensive. But, in my opinion, if we don't get control of the obesity epidemic in this country, we will never control the cost of health care," Watson added.

The American Cancer Society Cancer Action Network last week sent a letter to congressional leaders. It recommended adopting protections before repeal of Obamacare.

"When people get cancer, they have to know that they are going to have insurance," said Chris Hansen, president of the American Cancer Society's advocacy division. "There have been and are problems with the ACA, but we have to make sure that what is done and the way it is done is not going to leave people who have cancer or who may get cancer ... in the lurch."

Repeal of Obamacare would eliminate the taxes that provide billions to fund it. That begs the question: How would the GOP fund any replacement?

"If all Obamacare goes away, including its funding sources, where does the money come from to continue the insurance for the 20 million newly insured under the Affordable Care Act?" John Goodman from the Texas-based Goodman Institute wrote in Forbes magazine.

Trump selected Georgia congressman Tom Price to head the Department of Health and Human Services. The former orthopedic surgeon never liked the idea of dealing with government bureaucracy when he practiced medicine. He wrote and introduced a replacement for Obamacare six years in a row.

President Barack Obama's HHS secretary, Sylvua Mathews Burwell, issued a warning to Price in a CNN interview. She said repeal will be chaos.

"If your child is on your policy 'til 26, and it's repealed, that goes away," she said. "If you have a pre-existing condition -- asthma, cancer, diabetes, high blood pressure, any of those things -- you could be kept off of insurance if you had to make a move or a transition or were unemployed for a portion of time. The 20 million folks who have gotten insurance -- that would go away too."

Elimination of Obamacare might spur Tennessee legislators to take another look at Insure Tennessee. But it's doubtful. No GOP legislator seems willing to carry the ball for Republican Gov. Bill Haslam.

In the meantime, rural communities and hospitals sit and wait.

"From Maury Regional's perspective, we are concerned where this all is going to go," Watson said. "We are anxious to see the details about what the new administration wants to do."

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James Bennett is editor of The Daily Herald. Contact him at [email protected].

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