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Op-Ed: ‘Do No Harm’ — Words to Remember as Congress Debates Future of ACA

Efforts to ‘repeal, repair or replace’ Affordable Care Act could affect all consumers, not just those covered by the controversial law

betsy ryan
Betsy Ryan

The oath every physician takes is to “Do no harm.” I think it’s an important credo for Congress and the Trump administration to bear in mind as they wrestle with the future of the Affordable Care Act.

There are countless stories of real people, with real healthcare worries, that have been helped by the ACA. They are the most poignant reasons to preserve a law that has helped people access better healthcare and has protected them from financial devastation if they are hit with a major illness or pre-existing condition.

Truth is, the potential for harm extends far beyond the 22 million Americans and 800,000 New Jersey residents who receive health insurance under the ACA. The impact could be felt in reduced coverage protections for all healthcare consumers, in financial hits that jeopardize healthcare providers that care for us all and in deep federal funding cuts that could punch a hole in our state budget — with potential reverberations for all residents.

Those of us in the healthcare community are watching the current debate over whether to “repeal, replace or repair” the ACA with the hope that Washington does no harm to an industry that is responsible for 17 percent of our nation’s gross domestic product.

The ACA has, quite frankly, changed the way our healthcare system operates. The healthcare community has moved aggressively since the law’s passage in 2010 to implement the component parts by enrolling uninsured individuals into Medicaid or an insurance plan; adopting more preventive health measures to keep people out of the hospital; and investing greatly in improved healthcare quality to prevent hospital readmissions and increase the value of the care we deliver.

Insurance coverage is critical to providing care to people in the right healthcare setting — that is, the setting where people can get the appropriate level of medical services at the lowest cost. It makes no sense to wait until you are very ill to come to an emergency department for care when a visit to a primary care doctor a week prior could have prevented that from happening.

I’m heartened to hear President Trump say that no one will lose coverage under a replacement plan. That’s critical to the people who are now covered under the law, and it’s also critical to the healthcare provider community in New Jersey. Why? There are two reasons.

First, the provider community — hospitals, health systems, nursing homes and others — absorbed $1.8 billion in cuts over an eight-year period to help pay for the ACA. Those cuts were offset because providers were caring for many more people with health insurance. If the coverage under the ACA erodes, our healthcare system could be staggered by a one-two punch: billions of dollars in cuts, plus the loss of payments from insurance companies.

Second, New Jersey law requires all of our hospitals to provide care to all people in all settings, regardless of their ability to pay. We’re proud of this commitment to caring for all of our communities here in the Garden State, but it comes with a steep cost. Prior to the ACA, hospitals provided more than $1 billion annually in charity care services to 1.3 million uninsured New Jerseyans. In exchange, hospitals received partial reimbursement from the state. The state kicked in $650 million for those charity care costs prior to the ACA’s coverage mandate, but that funding stream has now been reduced to $302 million as the number of uninsured diminished.

Gov. Christie made the right decision for our state to expand Medicaid to more individuals, and it has had a real impact. But if the ACA is repealed without an adequate replacement, the number of uninsured will spike. Hospitals will provide the care needed, but it will require a reinvestment of state dollars into the charity care pool to adequately pay hospitals for that care. If the reinvestment doesn’t occur, many New Jersey hospitals will struggle financially. It’s a simple, but alarming, formula: Fewer patients with insurance + less money to pay for charity care = a fiscal crisis for New Jersey’s healthcare community.

Our “ask” to Congress members is this: As you debate how to recast the ACA — whether a “repair” or a “replacement” — recognize the importance of health insurance for those 800,000 New Jersey residents and the healthcare providers that care for them. And then, remember that age-old oath and do no harm.

Elizabeth “Betsy” Ryan, Esq., is president and CEO of the New Jersey Hospital Association, a not-for-profit healthcare trade organization based in Princeton.

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