The latest Senate GOP bill to repeal and replace the Affordable Care Act could spark healthcare job losses, stifle innovation and force hospitals to shut their doors if it were enacted, three industry trade association leaders warned Tuesday.
Less than a day after a third Republican senator came out against the Graham-Cassidy bill, likely killing its chances of passing the Senate, the American Hospital Association, Catholic Health Association and Association of American Medical Colleges united against the proposal that would cut Medicaid funding.
More than 20 million individuals would lose their health coverage by 2026 under Graham-Cassidy, according to a KNG Health Consulting analysis conducted for the AHA. The proposal would result in $275 billion less in federal funding to states.
That cut would hit academic medical centers hard, as they care for many low-income and uninsured individuals, according to Dr. Atul Grover, AAMC's executive vice president. Less funding could curtail the centers' research work as well as the services they offer, he said.
"If we have to put more and more money into caring for patients that aren't covered because of this legislation, that means fewer investments not only in the care we're already doing, but in training the next generation of providers and in making sure we have cures that will benefit you and your children," Grover said.
Rural hospitals could also feel the squeeze as they continue to operate on razor-thin margins, according to Sister Carol Keehan, CEO of the CHA.
"These are places where very small numbers can tip the balance," Keehan said.
Shrinking Medicaid funding also could affect staffing. Medicaid expansion has been cited as a key reason for an increase in healthcare industry jobs.
If expansion ends, it seems those jobs would disappear, Keehan said.
A January 2017 analysis by the Commonwealth Fund bolstered Keehan's concern. It found that repealing Medicaid expansion and premium tax credits could lead to 2.6 million jobs being lost, one-third of that total in the healthcare industry.
While Sens. Susan Collins (R-Maine), John McCain (R-Ariz.) and Rand Paul (R-Ky.) have all come out against the Graham-Cassidy bill, but with it not officially dead, the industry trade associations said Tuesday they felt it was critical to get the word out on what the legislation would mean for access to care. Hours later, GOP leadership declared there would be no vote on the bill.
But not everyone saw Graham-Cassidy as a financially tough sell for hospitals. On Monday, Sen. Bill Cassidy (R-La.) said his bill actually would be a boon for hospitals in nonexpansion states.
The bill would convert the ACA's funding for premium and cost-sharing subsidies and Medicaid expansion into $1.2 trillion in state block grants through 2026 and let states design their own systems, with few limitations. There is no provision for funding the block grants after 2026.
States that expanded Medicaid and saw robust ACA marketplace enrollment would suffer the biggest financial losses. Many of those states, such as Ohio and West Virginia, are represented by GOP senators whose votes are needed to pass the bill.
Keehan said she was dubious of Cassidy's claim. Even though states must spend the money on healthcare, there is nothing in bill that indicates those funds need to go to help hospitals care for uninsured and Medicaid individuals. As such, the states could direct the money to school or prison-related health initiatives.
"There is no sense, no direction in the bill that the funds have to go towards hospital care," Keehan said.
