Conservatives hate Obamacare (Affordable Care Act) so much they don’t seem to care about the fallout of repealing the program and what impact that will have on the health coverage of over 20 million persons signed up and needing it. However, they will not be able to so cavalierly ignore the hospital and insurance lobbies which last week issued clear warnings to members of Congress that repealing Obamacare without a replacement will leave both industries facing serious financial uncertainties.
Republicans in Congress are insistent that they will repeal Obamacare as one of their first acts in the new Congress. However, since they can’t immediately replace it for next year’s coverage year, so they are talking about a delay in the effective date of the repeal, perhaps int0 2019 beyond the next Congressional elections. Hospitals, insurance companies and economists are warning that without a more immediate replacement, uncertainty would cause massive disruption in the health and insurance markets. Some of the most outspoken opponents in Congress though want to replace it as soon as possible and not wait three years.
Democrats meanwhile are saying that the Republicans have had years to come up with an adequate replacement and haven’t done so because the Affordable Care Act is carefully balanced to require all persons to be enrolled in coverage so that there is a pool of younger, healthier people to help finance the insurance coverage for all when needed. This larger pool also helps to pay for those who have pre-existing conditions and are required to be covered which they weren’t before the Affordable Care Act.
Insurance companies and hospitals have been re-organizing with the idea that many more patients would provide a much higher volume of customers, so they agreed to accept some cutbacks in Medicare and Medicaid reimbursements. Now if those enrolled in Obamacare won’t have a guarantee of insurance in the limbo after repeal that Congress is talking about the revenues for these two industries will go down. One estimate by a hospital association was that hospitals could lose $165 billion with a repeal without an adequately funded replacement.
Republican members of Congress cannot avoid the fact that in many rural districts, hospitals are the major employers. Even in a mid-size city like Albany, the Albany Medical Center employs over 7600 and is the largest employer after state government. The hospitals are also key drivers of economic development in their communities as well. Albany Med has spearheaded a redevelopment of the entire South Park neighborhood in Albany with new offices and apartments for their workers. On a smaller scale hospitals are playing the same role in smaller, rural areas. Indeed, the hospitals and schools or “meds and eds” as is said in lobbying circles, are the major source of middle class jobs in smaller population areas.
Hospitals, their unions and the insurance industry are also major campaign donors to state and Congressional candidates. It may well be that they will have more to say about the fate of Obamacare that the patients. A grand alliance between patients and health insurers and providers could make it very difficult for Congress to repeal Obamacare and replace it with something which offers less coverage for patients and less dollars for the hospitals and insurance industry.