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A repeal of Obamacare would plunge community hospitals and vulnerable citizens into “chaos,” and elected officials should put ideology aside when it comes to health care, a bipartisan group of mayors warned Jan. 18.
“Hasty” decisions on the Affordable Care Act—President Barack Obama’s marquee legislation—are being made in the halls of Congress while institutions offering essential services and the poor, the mentally ill and those with substance-abuse disorders or pre-existing conditions stand to lose, mayors from more than two dozen cities said at the U.S. Conference of Mayors’ winter session in Washington.
If the ACA is repealed, city providers could be hit with an extra $88 billion in uncompensated care by 2019 from millions losing their insurance, according to estimates from the Urban Institute.
The group of more than two dozen mayors—from large metro areas like Boston, New York and San Francisco as well as small towns such as Mesa, Ariz.—said they wanted to send a message to leaders that getting rid of the controversial law would cause “chaos.” They asked fellow city leaders to join a national day of action Feb. 22 to protect the ACA.
“As mayors, we cannot stand by and let Congress put politics over people,” Boston Mayor Marty Walsh (D) said.
Kansas City, Kan., Mayor Mark Holland (D) Jan. 18 met with his senators, both Republicans, to discuss the impact the law has had on the working poor in his community—and to make the moral argument on behalf of people like Sue.
In his town, amid a largely conservative, rural state, one woman placed an emergency call and was picked up in an ambulance with bleeding in her chest. It was understood she had been a victim of a drive-by shooting—but it turned out upon arrival at the University of Kansas Medical Center’s emergency room she had late-stage breast cancer.
There was no insurance, no doctor screening for stage 2, he said, or treatment for stage 3. “Sue’s dead, so Sue can’t speak for herself,” Holland said.
Others echoed his sentiments.
The leader of a city in South Carolina, where more than 300,000 children live 200 percent below the federal poverty level and which faces high amounts of diabetes-related health problems, called a “reckless” repeal without a “responsible” replacement or transparent dialogue the equivalent of a death sentence.
“We’re talking about the difference between life and death,” Columbia Mayor Stephen Benjamin (D) said. “That needs to be made clear to folks.”
The Affordable Care Act, which the incoming Trump administration and a Republican-majority Congress are taking steps to repeal through a budget reconciliation process, aimed to cover more Americans through federal and state marketplaces that featured tax credits and an expansion of the Medicaid safety net. The changes extended coverage to more than 20 million Americans.
GOP leaders in Congress, who have long fought tooth and nail to buck the ACA, and President-elect Donald Trump are vowing to replace the ACA with patient-centered reforms and to at least provide access to programs that don’t contain the shortcomings they see in the law. They lament high, growing premiums and deductibles, loss of pre-ACA insurance plans and limited choices in providers.
Though some lawmakers have started to offer their own proposals, there is no set plan in place—a prospect many mayors decried.
“You can’t replace a program by simply repealing the current one,” said San Francisco Mayor Ed Lee (D). “Let us not replace with a repeal; let’s have a real plan and real details so we don’t have chaos in the lives of so many thousands of people.”
While efforts to take the law back plow full-steam ahead, New York City Mayor Bill de Blasio (D) said the mayors were one of the last bipartisan organizations still standing. With a “very unpainted canvas” as the backdrop, the city leaders have the chance to have a big impact “if we are strong and if we are organized,” he said.
“We have a chance to play a special role for that reason,” he said.
And he’s encouraging other cities and localities to ramp up their coverage outreach and enrollment, not tamp it down while they wait to see what will come next.
“The more people who invest in it, the harder it is to get rid of,” de Blasio said.
Mesa, Ariz., Mayor John Giles, one of a few Republican city officials to join the call to protect the ACA, said mayors are the “safety net of society,” so he was concerned about the tens of thousands of people insured under the law in his community.
He added that local hospitals also were “terrified” and asking for support from elected officials.
Health-care analysts said if the law is repealed, rising costs in uncompensated care, which could peak as high as a sixfold increase over the next 10 years, would likely weigh down struggling health-care providers, which would shoulder the burden, especially rural and community hospitals.
The vast majority of those who would lose insurance—82 percent—would come from working families, according to Urban Institute estimates. And over the next decade, that gap could lead to up to $1.1 trillion in extra uncompensated care, while state Medicaid and CHIP spending would plummet around $76 billion.
The question of Medicaid expansion repeal, as well as a loss of tax credits, adds extra layers to the puzzle.
“Because of the larger number of uninsured, financial pressures on state and local governments and health care providers … would increase dramatically,” a Dec. 6 Urban Institute report says.
Given this, the mayoral push to protect the Affordable Care Act makes “perfect sense,” a Washington-based policy analyst said.
“My fear is that congressional Republicans are pushing to repeal so quickly and moving through the budget process so fast that they’re not waiting to hear from the folks who rely on the care,” said Hannah Katch, a senior policy analyst with the Center on Budget and Policy Priorities. The center describes itself as a research group on budget policy decisions with an eye toward low-income Americans and policies that would reduce poverty.
That means low-income seniors, parents and children.
“Mayors are very closely in touch with the people they’re representing,” she said. “They see them every day; they work with them all the time. They’re seeing this potential wave of people … lose their health coverage and providers put in position where hospitals have to provide all this uncompensated care.
“It makes perfect sense for them to say, ‘Hold on a minute.’”
Away from all of the congressional debates and Washington technical jargon, families are getting lost in the conversation, Katch said. Also away from that spotlight, the push to protect the law likely won’t be partisan: More Republicans will likely join in.
She said she hopes Congress is listening to their concerns.
Giles, the GOP mayor from Mesa, Ariz., agreed.
He said there were “folks on the other side of this issue” who understood the importance of not going backward and rushing to a repeal. However, he told the mayors in a Q&A at a mayor’s panel that he had communicated with Arizona’s senators but not heard back from them.
Some Republican governors have also worried about what repeal and potentially a loss of Medicaid expansion might mean for their states (see related article) .
Senate Finance Committee members met Jan. 19 with Republican governors for input on the future of Medicaid, noting the likelihood of an ACA repeal.
Committee Chairman Orrin Hatch (R-Utah) said in a Jan. 19 statement governors have a “unique and important understanding” of how Washington policies affect states.
“As we work to repeal and replace Obamacare, hearing from our governors who administer the Medicaid program is a prudent way to gain the insight and input needed to help decide the best path forward,” he said.
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