The Odessa Record -

By Adam Cancryn
Reporter for the Politico news media organization 

Hospital lobby skips repeal battle, focuses on ACA replacement


Hospitals have spent six years promoting the benefits of Obamacare’s sweeping health reforms, but the powerful Washington lobbying isn’t coming to the law’s rescue.

Hospitals are steering well clear of the battle over repeal, seeing Obamacare’s unwinding as an inevitable conclusion after Donald Trump’s election. They are instead laying the groundwork for the high-stakes debate that comes next: the Obamacare replacement.

The focus on replacement, rather than fighting repeal itself, has disheartened some Democrats who hoped the hospital lobby would throw its considerable weight behind Obamacare. Congress is just starting to wrangle with the initial step of repealing the health law, a path that’s already proved tougher than expected for Republicans.

“We are at a point where the outside game is going to be very important,” Rep. Elijah Cummings (D-Md.) said. “If the hospital-side people and the health people are going to get what they want, they’ve got to be a lot more vocal.”

But among hospital groups, the dominant view is that the repeal fight is already over – and Obamacare lost. Provider groups have instead spent the last several weeks quietly lobbying lawmakers on this economic message: If you’re going to repeal Obamacare, give us our money back.

Providers agreed to $155 billion in Medicare and Medicaid reimbursement cuts over a decade in exchange for Obamacare’s guarantee that insurers would cover more people. Eliminating the law’s coverage mandates and subsidies while retaining its cuts would turn an already tough financial situation into a crisis, state and national hospital associations warn. Underfunded health systems would face a rush of newly-uninsured patients.

“In the next 10 years, you have these productivity cuts that are really unsustainable,” said Jeff Cohen, executive vice president of public affairs at the Federation of American Hospitals. “Coverage masks the pain of these productivity cuts.”

The lobbying effort has been loosely coordinated so far and purposefully low-key. Providers are intent on forging alliances within the GOP-controlled Congress and therefore wary of being linked to any anti-repeal efforts.

“We think this is too much of an opportunity to fix some of the issues that needed to be fixed over the years,” said Steven Summer, CEO of the Colorado Hospital Association.

Instead, providers are sending the message that they can get on board with Republicans’ replacement effort, as long as it meets certain standards. They want the bill to protect coverage for as many of the 20 million who’ve been insured through Obamacare as possible, but at the very least, they want hospitals’ Medicare and Medicaid funding restored shortly after repeal.

“I wake up at 3 a.m. thinking about repeal and delay,” said Roberta Rakove, the senior vice president of strategy and external affairs for Chicago-based Sinai Health System, where roughly 70 percent of patients are covered by Medicaid. “The idea that you would repeal and then not know what’s going to happen in a year, or two years, or three years is very disruptive to the ability of health systems to plan.”

The Federation and the American Hospital Association weeks after Trump’s election took the lead in opposing “repeal and delay,” a strategy that Republicans have since largely abandoned. The hospital groups at the time published a joint study estimating repeal without a replacement would cost hospitals more than $165.8 billion by the middle of the next decade, triggering an “unprecedented public health crisis.”

Some state hospital associations followed that by commissioning their own economic impact studies detailing the district-by-district consequences of keeping Obamacare’s cuts but not the law’s coverage gains.

Those projections are serving as the centerpiece in private conversations with lawmakers, in a bid to hammer home the message that if Congress passes a bad bill, lawmakers will have to answer directly for the hospital closures and layoffs back home.

“There are lots of [payment] reductions tied to the ACA, and we want to be certain that we don’t find ourselves without expansion and with no coverage,” Summer said. “We have some rural hospitals that are clearly wondering about their sustainability if we’re not able to breach this transition from the repeal to the replacement.”

Representatives from the national association’s various state associations held member meetings in Washington this week and visited their respective congressional delegations.

America’s Essential Hospitals, which represents safety-net providers, has its own member fly-in scheduled for late February.

“If Congress doesn’t immediately replace the ACA, it must restore that law’s damaging cuts to hospitals – including Medicaid and Medicare disproportionate share hospital payments – and ensure that all people now insured can maintain coverage until a permanent and comprehensive replacement occurs,” said Beth Feldpush, senior vice president of policy and advocacy.

Hospitals are seeing some encouraging early signs. Republicans have increasingly backed off their initial calls to repeal Obamacare on day one of the Trump administration, and urged caution in rolling back the law without a clear plan for keeping hospitals and insurers stable. Sen. Johnny Isakson (R-Ga.), a member of the Finance Committee overseeing Medicare and Medicaid, said Congress should look at boosting providers’ reimbursement rates.

“I think every aspect that applies to revenue that was generated to pay for Obamacare, and that’s one of them, needs to be looked at,” he said.

But providers are warning Republicans that they need to make clear how they will replace Obamacare, or risk suffering both the political and economic fallout.

“We continue to hammer that message home with every member of the delegation,” New Jersey Hospital Association CEO Betsy Ryan said. “I worry very much about the consequences. About 65 percent of a hospital budget is labor – clearly there are going to be some consequences.”


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