Suver: stalled ACA repeal is good for IWV

Rebecca Neipp

News Review Staff Writer

While analysts speculate on the divide within congressional Republicans that ultimately led to the cancellation of last week’s vote on the American Health Care Act, health care advocates and executives are expressing relief that the failed initiative could make way for a more inclusive approach to reform of one of our country’s most critical, and controversial, services.

“To be honest, I think we dodged a bullet on this one,” said Ridgecrest Regional Hospital CEO Jim Suver.

“I’ve been very public about my concerns with the Affordable Care Act, and our need to reform the unsustainable aspects of providing health care.” But, he added, the proposed repeal would have been devastating to health care providers in general, and to rural communities like ours in particular.

Suver said that he had articulated his concerns about the local impact to staffers in House Majority Leader Kevin McCarthy’s office.

“I think that most people are in favor of healthcare reform,” said Suver. “I support the idea of trying to eliminate some of the taxing structures that are unachievable and finding ways to increase sustainability.

“And we saw that for many private users, the ACA was not an affordable solution.” For many small businesses, health care benefits were priced out of reach. Businesses that offered what had previously been considered modest coverage were subject to a “Cadillac tax.” Even insurance providers could not afford to stay in business.

Suver said that one of the major problems with both the ACA and the AHCA is that neither addressed the most critical problems that are driving up costs in health care — among those, the astronomical price tag associated with managing risk in an increasingly litigious landscape.

“We also have to acknowledge that there are some parts of managing health care the ACA got right,” he said.

By shifting toward a wellness model, the industry as a whole has incentivized healthy lifestyles in place of a system that makes money when people are ill. The most vulnerable populations now have better access for health care. In the long run, said Suver, both those elements will drive down costs.

“If you want to break it down on a financial level, it costs less money to keep people well than it does to treat them when they are already very sick.”

Most reports indicated that AHCA would have reduced broad access to health care. But it would also put at risk the current model for reimbursement for hospitals like RRH.

“President Trump had proposed changing the Medicaid funding program by converting the federal program to a state-by-state block grant program,” Suver wrote in a previous column on the subject. “Under this scheme, each state would be in total control of the Medicaid program, which is funded two-thirds by the federal government and one third by the state.

“This is a bad idea. California has seldom appropriately allocated healthcare program dollars. I dread thinking of what will happen to billions of federal dollars being put under direct control of the state and distributed by pressure from special interest groups and not necessarily what is best for patients — especially children.”

Right now, California pays RRH 8 cents on the dollar for outpatient services for Medi-Cal patients. State hospitals now get matching funds from the federal government to offset those losses.

“If absolute control of Medicaid funds goes back to the state, this matching program will disappear.” That equates to a $10 million loss annually to RRH.

McCarthy released a statement to the News Review indicating that the AHCA and subsequent emendments would address these deficits so that rural communities did not absorb a disproportionate share of uncompensated care.

However, he said that his concerns and opposition to the ACA remain — “broadly, that it created a mandate from the federal government to purchase health insurance, which affects the freedoms and liberties of individual patients; and more practically, that its insurance mandates, tax subsidies and unprecedented federal assumption of new Medicaid spending would unsustainably lead to higher premiums in the individual exchange market and higher taxpayer costs that will cripple our federal budget with deficits and debts for generations to come,” said McCarthy.

“I will continue to work to advance what I’ve heard from our neighbors for years – that we need to get rid of the federal mandates and taxes and look at more solutions that target lowering the cost of health care through increased competition, more patient choice and reducing the costs of defensive medicine.”

Suver said that moving forward, he hopes to see a plan that reflects broad interest and input from both parties, as well as those on the front lines of delivering care.

“We knew people were unhappy with ACA, and now we know people are unhappy about the proposed replacement. What we need is probably somewhere in the middle.”

Story First Published: 2017-03-31