As a Republican-controlled Congress and the Trump administration start discussing plans to dismantle the Affordable Care Act, the former chief executive of the American Hospital Association has some advice to offer.
“It isn’t the ACA,” said Rich Umbdenstock. “It’s health care that’s complicated. You can’t lay all of the problems on Obamacare.”
Umbdenstock, a part-time Spokane resident, spent eight years at the helm of the American Hospital Association before retiring at the end of 2015. In his previous job, he oversaw nine hospitals in Eastern Washington and Western Montana as president for Providence Services.
The ACA’s struggles are the same facing the U.S. health care system: How to provide high quality care at affordable rates to the entire population, Umbdenstock said in an interview Wednesday.
Hospitals, he said, have been at the forefront of that struggle.
The ACA has helped hospitals reduce charity care by expanding health insurance to millions of Americans. In Washington state, more than 700,000 residents have received health insurance under Obamacare. Uncompensated care costs in Washington have dropped from $2.3 billion to $1.2 billion, according to the state Insurance Commissioner’s Office.
But the law has produced mixed results for hospitals’ bottom lines, because Medicare and Medicaid reimbursements to hospitals also went down, Umbdenstock said.
Those programs pay for health care for the elderly and poor. Some of the Medicare and Medicaid cuts resulted from the ACA and were intended to be offset with revenue from newly insured patients, he said. Additional Medicare and Medicaid cuts were the result of later federal budget decisions, he said.
U.S. hospitals could find themselves in financial straits if millions of Americans lose health insurance coverage, and the Medicare and Medicaid reimbursements aren’t increased to help offset the resurgence in charity care, Umbdenstock said.
In Washington, cuts to hospital reimbursements have totaled about $3.5 billion over 10 years, according to the Washington State Hospital Association.
The association is lobbying members of Congress to produce a replacement to ACA that keeps people insured before any repeal legislation is passed.
Requiring people to have health insurance will be key to keeping it affordable, Umbdenstock said.
“Everyone wants to have access to health care when they need it,” he said. But to keep insurance premiums down, “the costs have to be spread over the largest possible pool. … Healthy people have to be contributing.”