Vision 2017 Health leaders voice concerns about Obamacare – and how to repeal or replace it

Feb. 25--Johnstown-area health care executives are closely watching federal moves to replace the Affordable Care Act, commonly known as Obamacare.

While the hospital chiefs agree there have been problems with the complicated law, they warn that the overhaul must be carefully crafted.

"What we don't want to see is that it gets repealed and there is not a replacement," Conemaugh Health System President and CEO Steve Tucker said.

Not only would the repeal leave thousands of area residents with no insurance, such a move would leave the hospitals with massive shortfalls in compensation for caring for those patients, Conemaugh Chief Medical Officer Dr. Susan Williams said.

"With the Affordable Care Act, the way they funded that was to take away a lot of hospital subsidies," Williams said. "If we repeal the Affordable Care Act, we've now got 20 million people with no insurance. If we don't give back to the hospitals what was taken away, we don't have the ability to care for these people."

Those subsidies were also the primary vehicle for addressing public health issues, such as the opioid epidemic currently racking the nation, she added.

The same holds true in Windber, said Tom Kurtz, president and CEO of Chan Soon-Shiong Medical Center.

"The worst thing that could happen to us would be a repeal without a replacement," Kurtz said, pointing to federal reimbursement changes under Medicare and Medicaid.

But Kurtz says there must be some changes in health-care economics.

Under the Affordable Care Act, many families find themselves under policies with deductibles as much as $5,000 out-of-pocket, he said.

"We are seeing more and more coming through with those high deductibles," Kurtz said. Families chose the high-deductible policy because they can't afford a higher premium -- but they also can't afford the deductibles either, he said.

"We have to bill them $5,000," Kurtz said. "Our chance of getting all that, or a significantly large portion, is almost none."

Others either can't find affordable coverage or choose to pay the penalty and take a chance on not needing insurance. Of the 11,000 people who used Windber's emergency room last year, about 500 did not have any insurance, Kurtz said.

"Those 500 patients cost us $211,000," Kurtz said.

Somerset Hospital President Craig Saylor said he's seeing the same issues, and says the cost of care is affecting people's health.

"We are seeing runaway co-payments and runaway costs driven right back to the patient," Saylor said. "Right now, it is not an Affordable Care Act. It is an unaffordable care act because of the cost shifting form either employers or government back to the individual."

Many are putting off treatment because they can't afford the out-of-pocket costs in addition to the premiums, the executives say.

"When you are uninsured, you put off health care until you are really sick," Williams said. "Then you end up in a hospital, where it's the most expensive place to deliver care."

The hospital leaders admit solutions will be challenging.

Kurtz believes a single-payer system may not be as big a hurdle as many believe. With Medicare, Medicaid, veterans' benefits and government employee health care, the government already is paying for about 65 percent of the costs, Kurtz said.

Although having many insurance plans available gives consumers more options, that system complicates hospital billing.

"We deal with scores of different insurance companies here, and it's all administrative overhead," Kurtz said.

He knows an affordable, single-payer plan will be a tough sell.

"In the interim, an affordable plan that is geared toward working families is going to be the most accepted," Kurtz said.

The process of selecting a plan should be simplified, Williams said.

"It's almost too complex to understand if you are not in health care," she said. "Navigating your way through the exchanges is difficult. It's highly complex to figure out what plan is best for you."

Confusion may lead people to select plans that leave them on the hook for thousands of dollars in out-of-pocket expenses, she added.

"Something that might simplify options would be helpful," Williams said.

Any replacement for the Affordable Care Act should be well thought out, Tucker said.

"It's a complex issue," Tucker said. "Rolling out the Affordable Care Act took a long time. Making a change and having it cascade all the way through the country is going to take a long time."

Randy Griffith is a multimedia reporter for The Tribune-Democrat. He can be reached at 532-5057. Follow him on Twitter @PhotoGriffer57.

___

(c)2017 The Tribune-Democrat (Johnstown, Pa.)

Visit The Tribune-Democrat (Johnstown, Pa.) at www.tribune-democrat.com

Distributed by Tribune Content Agency, LLC.