While the House-approved bill to replace the ACA would have a devastating effect on the U.S. healthcare system, the Senate's Better Care Reconciliation Act could be "even more problematic," Kenneth Davis, MD, president and CEO of New York City-based Mount Sinai Health System, said during an interview with PBS.
In particular, Dr. Davis said, "[T]he glide path to per capita or block grants is going to produce a lower reimbursement for the states than was even in the House bill."
The BCRA would create a myriad of issues for both patients and hospitals without addressing the core issues that belie the U.S. healthcare system's cost issues, according to Dr. Davis. Here are three insights Dr. Davis shared during the PBS interview.
Financially vulnerable hospitals will suffer. "All of them collectively, particularly for hospitals that have a reasonable number of Medicaid patients, are pretty difficult," said Dr. Davis. "There are substantial cuts. For instance, the public hospitals — the Health and Hospital Corporation in New York City, they can't possibly sustain these cuts to the Medicaid budget. Other hospitals that have a large number of Medicaid patients have a very tiny margin. That margin evaporates with this bill."
Cutting Medicaid will have broad negative effects on enrollees' health and well-being. "The largest provider of payment for addiction services is Medicaid," said Dr. Davis. "Twenty percent of all Medicaid recipients, at the very least, have mental health problems. To take that out of the equation is very, very destructive. And to think that we're not having a positive influence — because the only thing we really directly affect and that we can measure short-term is improvement in mental health — is a little demeaning to our psychiatrists."
Future healthcare policy changes should address the factors that make the U.S. healthcare system unsustainably expensive. "If they were truly interested in the question of why is our system so expensive, this would be a bill about how we move away from fee-for-service medicine, in which physicians and hospitals get paid for everything they do, and moving more toward value and risk, in which patients, providers are all aligned, such that everyone wants you to stay well and out of the hospital," said Dr. Davis. "We would have more incentives for readmission penalties. We would have incentives for shorter stay. We would have more incentives to bring care to a less expensive place, like the ambulatory setting. But those issues aren't being addressed in this bill."
Read the full interview here.