Senate Republicans' healthcare bill, the Better Care Reconciliation Act, would undo many major provisions of the ACA, including Medicaid expansion, the individual mandate and nearly all of the current law's revenue-generating taxes.
The nonpartisan Congressional Budget Office estimated the BCRA would reduce the federal deficit by $321 billion, a 170 percent improvement over the House-approved American Health Care Act. Reduced federal spending on healthcare would largely be attributable to decreased funding to Medicaid — an updated analysis from the CBO says the BCRA would cut Medicaid funding by 35 percent over the next 20 years.
Several organizations — including the American Hospital Association, the American Medical Association and the Institute for Healthcare Improvement — have come out against the BCRA. A major area of worry is the proposed repeal of Medicaid expansion, the ACA initiative that enabled millions of previously uninsured Americans to gain coverage. The CBO estimates if Medicaid expansion is undone, 22 million more people would be insured by 2026, compared to the current law.
Richard Afable, MD, executive vice president of Providence St. Joseph Health Southern California Region-Orange County/High Desert and president and CEO of Irvine, Calif.-based St. Joseph Hoag Health, recently spoke with Becker's about his concerns regarding the BCRA and how the health of Orange County residents would be affected by a repeal of Medicaid expansion.
About one-third of Orange County residents are on Medicaid, including 50 percent of children.
Note: Responses have been lightly edited for length and clarity.
Question: What's your general opinion of the Better Care Reconciliation Act?
Dr. Richard Afable: There's certainly nothing better about it [than the American Health Car Act], so we can start with that. The most important element of the BCRA is the tremendous change and decrease in access to care for millions of people. As a healthcare provider organization, that is not good. That cannot be good. There is no way to dress it up and make it appear that [the bill] would be good for the country, because it will not.
Putting the affordability piece of it aside and putting the improvement of care and care management aside — both of which need to be improved upon — tens of millions of people who were provided access to healthcare [through Medicaid expansion], who never had access before … taking that away from them is going to affect the health of our country and the health of individuals and families in our communities.
Q: What parts of the bill are you most concerned about?
RA: Medicaid is my No. 1 concern. Individuals have become much more engaged in healthcare delivery because they now have access and for the first time can actually think about prevention and how to take preventive measures. If people lose insurance and access to care, they'll revert away from prevention and staying healthy to thinking, 'I hope I don't get sick.'
Q: If enacted, what effects do you anticipate in your health system?
RA: We would have to go back to a time when we were reacting to healthcare needs in our community rather than proactively working to help improve the health of our community. We would be waiting for people to get sick and then treat them, when it is our very explicit preference to work with people and prevent them from becoming sick in the first place. In our environment, we know we are doing our best jobs caring for the community when there is an ever-decreasing need for the emergency room and hospitals.
Q: How do you think the BCRA would affect the health of the communities you serve?
RA: Any time we take away access to care and move people in the community away from a mindset or desire to improve their health and prevent illness, what we're doing is we're taking people out of an environment in which wellness and health is the focus, instead of merely the absence of illness. When we take away prevention and wellness, the community suffers. And this can be measured. At the very highest level, it would be things like trends in infant mortality going in the wrong direction. In specific communities, the number of people with diabetes who have it under control could decrease. People will not be seeking preventive measures or focus on the state of their diabetes if they don't have health insurance. The actual and measured health of our community will be reduced because of a lack of access to care, which is what the BCRA intends to do.
Q: If you could send a direct message to Congressional Republicans who are working on the legislation, what would you say?
RA: I would ask them to not look at healthcare as a political issue, but instead think of it as a health issue that is reflective of and affects the health of our communities and our country, and subsequently make the health of our country and communities the highest priority. I am not neglecting to recognize the importance of affordability, and I think this is something that as a physician and a health system executive, we are more than willing to work on this proactively to improve.
Lastly, we would like to be part of the debate and the decision-making process. We are willing to be held accountable for the necessary improvements to make healthcare more affordable, accessible, safer and of the highest quality. Today, we are not part of the debate or discussion in what's happening in Washington