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Uncertainty over changes to ACA leaves hospitals concerned

Maneuvering in D.C. keeps medical analysts guessing as to next step

For seven years, Americans have heard the Republican Party call for “repeal and replace” of the Affordable Care Act. The pledge was established shortly after then-President Barack Obama enacted the ACA in 2010, and the mantra has stuck—along with the other name for the act, “Obamacare.”

In late July, Republicans held a vote to undo the bill, requiring 60 votes to pass to end the filibuster. But the results were 57-43, and the proposal failed. In addition to the full repeal bill, Republicans also put forth a partial repeal amendment and a “skinny” repeal amendment, but neither passed.

While Senate Republicans have tried to come up with a concise plan to repeal and replace Obamacare, they have yet to present a clear-cut strategy. For now, President Donald Trump and conservative Republicans are holding off on any further action to eliminate the ACA.

With repeal and replace up in the air, local health care companies are keeping a close eye on changes, and there is escalating concern about treatment costs for patients and access to health care coverage. Some local employers, however, have less to worry about when it comes to the ACA.

“The ACA really does not affect us, because we are under the threshold,” says Lori Abraham, account manager for Pathfinder Engineers & Architects LLP. “The compliance for the ACA is 50 or more employees. We have fewer than that, so we haven’t had to deal with any of the compliance issues.”

But Butler/Till, a media company with more than 120 employees, hasn’t noticed any impact on its employees’ health care either.

“When Obamacare was first passed, it was not even a ripple for us,” says Melissa Palmer, CFO and COO of Butler/Till. “We are in the business services arena and that’s what we sell, our people. With our status as a (benefit) corp., we’re passionate about providing generous benefits and substantially paying for most of the medical benefits for our employees.”

As for the future of repeal and replace, Palmer does not foresee much activity.

“Quite honestly, once the Senate rejected the repeal and replace bills, I don’t anticipate much happening on that front,” says Palmer. “I know the Senate is out now on break, but I don’t think in their current state they have the votes to pass repeal and replace.”

Local health care systems like the University of Rochester, however, have growing concerns about repeal and replace. According to Chip Partner, associate vice president and director of external communications, UR has been monitoring the process and is waiting for something definite to happen with health care before taking any measures.

“We’re not being circumspect about this,” says Josh Farrelman, associate vice president for government and community relations at UR. “Like every other provider in the country, we’ve been closely monitoring and following this debate. There have been several bills that have been put forth for consideration in Congress, and we’ve been actively engaged and enjoy a very strong working relationship with every member of our congressional delegation.”

According to Farrelman, if any of the three repeal and replace bills passed in July, it would have had an overwhelmingly negative effect on providers and patients, including losses of $800 million from the Medicaid system and coverage loss for anywhere from 21 million to 32 million people.

The prospect of repeal and replace has been particularly hard-hitting on the UR health system because the hospitals and medical centers are already under-reimbursed for their services, so removing this coverage would force UR to “reevaluate our services, our operations and our programs,” says Farrelman. UR Medicine is committed to treating anybody who walks through the doors of any of its facilities, so treating patients with adequate health care coverage allows providers to give the best and most extensive services for patients.

When the ACA was first established, the UR health system took on more risk, and system integration became pertinent. UR was able to expand to the Southern Tier and villages in Livingston and Ontario counties—areas that would be among the most affected if repeal and replace follows through.

After the ACA was implemented, UR Medicine moved from a fee-for-service type of payment  approach toward a focus on population health management for the 15 counties it serves.

“As the safety net provider, UR Medicine provides care to anyone that’s in need of urgent care,” says Partner. “With coverage, they can have relationships with primary care physicians and preventive care and visit urgent care clinics” before something requires a trip to an emergency room. “That preventive care and some of the services that aren’t life or death or aren’t extremely critical, that’s where you see a great challenge in maintaining that level of service in rural areas.”

Farrelman adds that research has shown that rural areas have the highest level of Medicaid patients, so abolishing this coverage will hurt the people in those communities. Furthermore, health care systems are often the companies with the most employees in rural regions, so losing coverage would be a difficult blow to many people in places like Dansville and Canandaigua.

But nothing is certain at this point, so UR Medicine has yet to make any tangible plans for the possibility of losing the ACA.

“It’s not at the point where we are necessarily executing a plan,” says Farrelman. “We’re remaining actively engaged in an advocacy campaign and national associations and working with our congressional delegations to educate them on the concerns and the impacts that repeal and replace would have on our community.”

[email protected] / 585-363-7031

(c) 2017 Rochester Business Journal. To obtain permission to reprint this article, call 585-363-7269 or email [email protected].

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