Catastrophic to Families and Children
Maybe the sobering realities involved in repealing the Affordable Care Act (ACA)--with or without a ready replacement--have begun to set in at 1600 Pennsylvania Avenue. But the ACA remains in jeopardy. Repeal would cause more than 18 million people to lose their insurance nationally within a year, including up to 1.6 million New Yorkers. Here at NYC Health + Hospitals, the nation's largest public healthcare delivery system, health insurance for 200,000 patients is at risk, as is coverage for 120,000 Medicaid recipients, and 169,000 members of our affiliated MetroPlus Health Plan. Last week the U.S. House leadership proposed significantly reducing the federal match for those insured under the ACA's Medicaid expansion. U.S. Health & Human Services Secretary Tom Price has championed eliminating Medicaid expansion altogether.
At least 3.7 million New Yorkers obtained health insurance through the ACA. NYC Health + Hospitals cares for many of these new patients every day. The ACA provisions for preventative care, mental health services and coordination among doctors and other providers help improve continuity of care for our patients. Repeal would roll back progress we are making to redirect care to community-based settings that promote wellness while reducing costly emergency room visits and unnecessary hospitalizations.
By mandating coverage for every American, the ACA is making health insurance more affordable for more individuals and families. It is ensuring that people with preexisting medical conditions are no longer discriminated against by insurers charging higher premiums or denying coverage altogether. The ACA is also driving the shift away from the old practice of doctors and hospitals getting paid for each test and procedure we conduct, to a more patient-centric model that incentivizes providers to improve patient health outcomes.
It must be said that not every provision within the ACA is helpful to our patients. Its exclusion of the undocumented from coverage while simultaneously gutting federal funding for indigent care has contributed to NYC Health + Hospitals' deep fiscal trouble. Whatever the final contours of ACA repeal, we are poised to lose $481 million over 10 years from Medicare ACA reductions and $289 million in Medicaid Disproportionate Share funding in FFY 2018 – rising to $462 million in FFY 2024. The end result will exacerbate our budget deficit, making much harder, the already difficult task of transforming our system and preserving our mission to care for all.
While the ACA-mandated cuts are alarming, hoping that politicians who seek to eviscerate the act will at the same time choose to restore funding for care provided to the poor and the disenfranchised is akin to believing in fool's gold. The overall harm caused by repeal would be so catastrophic to families and children that it must be opposed. Further, we continue to encourage those who are eligible but uninsured to get covered, through our MetroPlus Plan or otherwise. Modest investments in preventative care can reap enormous financial savings and the mitigation of untold patient pain and suffering resulting from unmet chronic care needs.
Even the most seasoned observers of healthcare policy don't know what comes next. Block grants for Medicaid? "Insurance for everybody," as the President vowed last month?
This much is certain: the voice of safety net and public healthcare must be raised. In partnership with Mayor de Blasio, healthcare professionals, elected officials, and the advocate community, we are committed to being heard loudly and clearly as the fight against ACA Repeal continues.
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Short Bio: Stanley Brezenoff is CEO & President of NYC Health + Hospitals, the nation's largest public healthcare delivery system.
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