Much has been written about the who gained health insurance under the Affordable Care Act, and to these patients if the ACA is repealed without a replacement. But some people don鈥檛 realize that hospitals nationwide could take a big financial hit on several fronts, too.
First, it鈥檚 likely that fewer patients would be able to pay their hospital bills, health policy analysts say, so the institutions would be stuck with that bad debt, as they were before Obamacare.
鈥淚f the Medicaid expansion goes away wholesale, and things go back to the way they were before this expansion was in place, a lot of those hospitals would see an increase in their uncompensated care costs,鈥� said聽, an analyst with the Kaiser Family Foundation. The American Hospital Association estimates that hospitals across the U.S. could more than $160 billion from the reduction in Medicaid revenue and the increase in unpaid medical bills.聽(KHN is an editorially independent program of the foundation.)
Then there鈥檚 this: The ACA has used financial incentives to encourage hospitals to experiment with ways to improve their care of patients, while reducing health care鈥檚 cost. That sort of experimentation has included a sizable upfront investment by many hospitals.
Massachusetts General Hospital in Boston, for example, signed with physicians and insurers to create , in hopes of saving money in the long run. With an ACO, insurers pay doctors for making sure the patient is getting the best and most appropriate care, instead of paying for every test and procedure a doctor does.
鈥淲e have now more than 20 different programs,鈥� said聽, an internist and medical director of the Mass General Physicians Organization. 鈥淰ideo visits, electronic consultation with specialists, home hospitalization, [and] programs for patients with diabetes and heart disease. I would be worried that a repeal of the ACA would undermine our ability to invest in services for our patients.鈥�
Ferris acknowledged that most of those experiments saved money. But they need more time to work out the kinks safely, he said.
鈥淥ne of the things that it鈥檚 difficult for people outside of health care to appreciate 鈥� particularly politicians 鈥� is how long it takes to make significant improvements in the delivery of care,鈥� Ferris said. 鈥淵ou have to be very careful when you make changes.鈥�
Ferris said the threatened repeal of the ACA makes him worry 鈥渢hat the progress we鈥檝e made over the past five years would be threatened.鈥�
Many other have invested in accountable care organizations 鈥� often overhauling their medical records systems, hiring staff and creating new services. , head of a large hospital chain called in Rhode Island, said he, too, worries about the future of his ACO, .
鈥淚 think, if there鈥檚 a real change in direction away from these alternative payment models, we will be assuming risk to care for a population,鈥� Keefe said. 鈥淲e have invested enormously to be successful in this area.鈥�
But these seismic changes in the way hospitals do business were predicated, he adds, on long-term support from the federal government 鈥� support that might disappear if the ACA is repealed.
This story is part of a partnership that includes , and Kaiser Health News.