Leadership Health Care News

September 21, 2023

LHC in DC: ‘Repeal and replace’ drives conversation on first day

LHC in DC: ‘Repeal and replace’ drives conversation on first day


Hospitals group leader ‘hard pressed’ to find real beneficiaries, analyst sees some potential tailwinds

Editor’s note: This is the first post from the Nashville Health Care Council’s 2017 Leadership Health Care Delegation to Washington. Look for more content in the coming days.

The recently introduced American Health Care Act was the hot topic of the opening sessions of Leadership Health Care’s annual delegation to Washington, D.C. On Monday, a group of more than 100 health care leaders from Nashville gathered near the White House in the W Hotel to hear expert perspectives on key health policy and political matters. Speakers largely focused their commentary on the AHCA, which was introduced by Congressional republicans just seven days prior — discussing everything from the bill’s provisions and potential impacts to the political process surrounding the legislation and its likelihood of becoming law.

“If this [passes], we’re going to have a lot more uninsured people,” said Chip Kahn, president and CEO of the Federation of American Hospitals in a conversation with Nashville Health Care Council President Hayley Hovious. Pointing out that the bill could have negative consequences for both hospitals and consumers, he said he is “hard pressed to find anybody who is going to be better off” as a result of the legislation, except perhaps Republicans who can say they fulfilled their promise to repeal and replace the Affordable Care Act.

Kahn spoke after the delegation’s opening briefing from Michael Ramlet, co-founder and CEO of Morning Consult, who provided an overview of the bill’s contents against a backdrop of his organization’s market research showing growing support for the Affordable Care Act after the presidential election.

In general, speakers acknowledged the growing anxiety among health care providers and the public that the bill will greatly reduce the number of insured Americans via repeal of the individual mandate, changes to the Medicaid program and the replacement of the current income-based subsidy program with age-based tax credits.

As of the delegation’s afternoon sessions, the Congressional Budget Office had not yet scored the bill, though multiple speakers discussed the expectation that the CBO’s analysis would predict large numbers of Americans losing their coverage under the Republican plan.

Bill Hoagland, senior vice president of the Bipartisan Policy Center and moderator of a panel on what’s next for repeal and replace, estimated the loss of coverage at between 8 million and 10 million Americans, with young, old and poor Americans hit hardest.

The CBO estimate released Monday afternoon, just as the delegation’s afternoon sessions concluded, overshot Hoagland’s figures. The agency’s report estimates 52 million people will be uninsured in 2026 under the Republican plan, compared with 28 million who would lack insurance under the current law. The difference — 24 million more uninsured Americans — would largely come from changes in Medicaid enrollment.

Jay Perron, vice president of America’s Health Insurance Plans — which has not taken a formal stance on the legislation — cautioned that the CBO estimates “haven’t been exactly accurate in the past.” And Kahn said the White House and Congressional Republicans may refute the CBO report as “fake news.”

To provide some outside perspective, the afternoon’s sessions closed with a panel on investment insights from financial experts. Kevin Fischbeck, managing director with Bank of America Merrill Lynch, said the bill won’t be good for hospitals, but that there will be enough good and bad in the legislation that it will be manageable for the industry. Similarly, he thinks there will be a balance between good and bad for insurers.

But there are potential “tailwinds,” Fischbeck said. “I think at the end of the day, we’ve always been driven by, ‘You can’t take away too much coverage and expect to get re-elected.’” So from that perspective, Republicans need the bill to work.”

But will it become law? If it passes the House of Representatives, it will likely face a fight in the Senate, according to Karen Summar, health policy director for Sen. Chuck Grassley (R-Iowa). A unified Republican vote is critical for the bill to pass that chamber, but at this point several GOP senators have come out against the measure.

“At this point, it’s going to be an interesting exercise,” Summar said.


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