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January 9, 2017

Obama: ACA 'repeal and delay' could endanger hospital jobs, services

Daily Briefing

President Obama argues that Republican plans to repeal the Affordable Care Act (ACA) without immediately passing a replacement proposal are "reckless," in an opinion piece published Friday in the New England Journal of Medicine (NEJM).

Obama's opinion piece comes after Republicans last week introduced a budget resolution that initiates the process of repealing the ACA through the reconciliation process. Senate Majority Whip John Cornyn (R-Texas) said Republicans would like to work with Democrats on a replacement plan after completing the repeal process.

Obama lambasts 'repeal first and replace later' plan

"What the past 8 years have taught us," Obama writes in NEJM, "is that health care reform requires an evidence-based, careful approach, driven by what is best for the American people. That is why Republicans' plan to repeal the ACA with no plan to replace and improve it is so reckless."

Obama writes that despite Republicans' stated plans to replace the ACA after it is repealed, they have yet to introduce a "'replacement bill,' hold a hearing on it, or produce a cost analysis—let alone engage in the more than a year of public debate that preceded passage of the ACA."

He contends, "This approach of 'repeal first and replace later' is, simply put, irresponsible ... resulting in uncertainty and, in some cases, harm beginning immediately." For example, Obama argues that repealing the ACA without a replacement plan could:

  • Spur hospitals "to cut back services and jobs in the short run in anticipation of the surge in uncompensated care that will result from rolling back the Medicaid expansion";
  • Deter physician practices from exploring new approaches to care coordination;
  • Discourage insurers from participating in exchanges in 2018 and spur them to "significantly increase prices to prepare for changes; and
  • Lead employers to halt hiring or cut raises to accommodate increasing health care costs.

Moreover, Obama writes that "there is no guarantee" that Republicans would have the votes to pass a replacement plan. He adds that while "'replace and replace' is a deceptively catchy phrase," in practice, "health care reform is complex, with many interlocking pieces, so that undoing some of it may undo all of it."

For instance, Obama points out that while President-elect Donald Trump said he wants to maintain insurance protections for individuals with preexisting conditions, Republicans in Congress have said they want to repeal law's individual mandate. However, according to Obama, that mandate, coupled with insurance subsidies, "is the only proven way to provide affordable, private, individual insurance to every American." He contends, "Maintaining protections for people with preexisting conditions without requiring individual responsibility would cost millions of Americans their coverage and cause dramatic premium increases for millions more."

Obama urges lawmakers to "take a responsible, bipartisan approach to improving the health care system." Reforming health care "isn't about a nameless, faceless 'system,'" he writes, "It's about the millions of lives at stake," and "policymakers should therefore abide by the physician's oath: 'first, do no harm."

Obama: I'd support replacing the ACA with a 'demonstrably better' plan

In related news, Obama in an interview with Vox on Friday said that if Republicans could "in fact put a plan together that is demonstrably better than what Obamacare is doing, I [would] publicly support repealing Obamacare and replacing it with [their] plan."

However, he said that he "suspect[s] that will not happen," adding, "If you want to provide coverage to people, then there's certain baseline things you have to do" (Lederman/Lucey, AP/Sun Herald, 1/6; Obama, New England Journal of Medicine, 1/6).

The 12 keys to hospital and health system success in 2017

The 12 keys to hospital and health system success in 2017

No matter what happens to the Affordable Care Act, to succeed in the next era of health reform, you'll need more consumer-focused service, more accessible care, and more risk. So how can you accomplish all of these goals without sacrificing your bottom line?

Learn the 12 keys that hospital and health systems leaders need to know to provide more consumer-friendly care while meeting your population health and risk-based payment goals.


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