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Westchester hospital executives alarmed by possible Obamacare repeal without replacement

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The Affordable Care Act may not be perfect, but health care providers are increasingly worried over the effects its repeal could have, especially if the 2010 law is not immediately replaced.

That was the message from a group of health care executives, representing hospitals from each of the major health care systems operating in Westchester County, at a roundtable discussion on Feb. 13 at White Plains Hospital. The discussion was organized by U.S. Rep. Nita Lowey and marked the first time that representatives from Montefiore Health System, Northwell Health and Westchester Medical Center Health Network gathered to discuss possible changes to the Affordable Care Act, often referred to as Obamacare.

President Donald Trump and a Republican-controlled Congress point to rising premiums under the Affordable Care Act and vow to repeal it. But Republicans have not yet offered a comprehensive plan for what would replace the law.

That concerned many who were at the roundtable. Lowey pointed out the possible ramifications in New York if the law were repealed. The Harrison Democrat, who is a ranking member of the House Appropriations Committee, said repeal could strip coverage from 2.7 million New Yorkers and lead to more than 130,000 job cuts.

“Let me be perfectly clear: this Republican attempt to dismantle the Affordable Care Act could jeopardize the financial security of New York families and put lives at risk,” Lowey said.

Susan Fox, president and CEO of White Plains Hospital, a member of the Montefiore Health System, said that health care providers bought into the goals of the Affordable Care Act when it was first discussed and passed: access, higher quality care and a plan to lower costs. She said hospitals have been taking on some of the costs of the act by investing in a higher quality of care, with the thought that more people would be insured, bringing more dollars in.

“So when we talk about repeal and replace, we cannot repeal without replacing,” Fox said. “Because the dollars would go out of our institutions.”

Hospital executives also fretted over the potential loss of the expanded Medicaid dollars under the Affordable Care Act. Anthony Mahler, senior vice president of strategic planning at Westchester Medical Center, said the hospital is “very dependent” on government funding, including $400 million a year in Medicaid revenue.

“It’s not the only thing we do, we are about a $1.2 billion hospital just in Valhalla, but the Medicaid is core, and it’s also core to our mission,” Mahler said.

Any cuts to Medicaid, he said, could have serious consequences for the hospital.

“Our margins are, to call them thin, I think, is even generous,” Mahler said.

Kevin Dahill, president and CEO of the Northern Metropolitan Hospital Association, said the Affordable Care Act, while not perfect, did help an “inefficient” commercial health care market. He said the federal mandate requiring people to buy insurance, as well as government subsidies, helped grow the base of people covered.

“That part of it has worked. Growing the risk pool, there still is some work to be done,” Dahill said. “But if there is just a wide repeal, the insurance market could get thrown into an upheaval.”

Mark Geller, CEO of Nyack Hospital, a member of the Montefiore Health System, also sounded alarms about the impact of any repeal of the law without a replacement.

“If there is repeal without replace, patients in Rockland County are going to lose access,” Geller said. “We’re not going to be able to provide the services that we have historically. …Absent a replacement process, there will be significant diminution in the volume of services and in the ability of the hospitals to stay open.”

Joel Seligman, president and CEO of Northern Westchester Hospital in Mount Kisco, part of Northwell Health, said it was also important to highlight how the law helped shift the focus for hospitals. Provisions in the law incentivized hospitals to move from a fee-for-service model to a value-based system. He described what that looked like.

“Focus on prevention, focus on wellness, focus on continuity of patient care,” Seligman said. “The idea of keeping patients out of our hospitals, out of our emergency rooms, home safely, living longer and healthier lives. There’s been tremendous progress in that regard, and no one is talking about that side of it.”

With the Affordable Care Act still in place, sign-ups have surged on the New York State of Health marketplace, the Business Journal reported. More than 3.6 million people signed up for health insurance during the open enrollment period that ended on Jan. 31, according to the state Health Department, an increase of about 26 percent from a year ago.

In closing remarks, Lowey gave a defense of the Affordable Care Act and expressed doubt that her Republican counterparts would provide a thorough replacement plan if the act was repealed.

“No one is saying the system is perfect,” Lowey said. “But it’s really quite extraordinary when you evaluate the impact of the Affordable Care Act in New York and the devastating consequences to New York. To just repeal the Affordable Care Act without replacing it in a thoughtful way is outrageous, and, frankly, Republicans don’t have a substitute.”

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