Cleveland's major hospitals warn of harm from Obamacare repeal

The city's biggest hospital systems warned Sunday that if Congress repeals Obamacare without a sound replacement, patients will suffer and the hospitals could face financial losses.

The cost to Northeast Ohio's economy could be steep, they said, and require job cuts. Statewide, an analysis for the American Hospital Association warns of Ohio hospital losses totaling $15 billion between 2018 and 2026.

"At University Hospitals, repeal will cut hundreds of millions of dollars we rely on to serve our patients," said a statement from Heidi L. Gartland, vice president for government and community relations. "Such drastic cuts will limit our ability to provide critical services, threaten patients' ability to get the care they need and potentially result in job losses here in Cleveland."

MetroHealth Medical Center, the Cleveland Clinic and the Sisters of Charity Health System -- which along with UH represent numerous medical centers and hospitals across Northeast Ohio -- all warned the consequences of repeal could be dire, with big gaps in patient coverage and harm to the greater Cleveland economy. 

Healthcare is a major economic driver in the region, and the area's biggest employer, according to the city of Cleveland.

"This is about people, millions of them, who will suffer needlessly if they go without health care," said Dr. Akram Boutros, president and CEO of MetroHealth.

The hospital executives' warnings came at a forum with U.S. Sen. Sherrod Brown. Brown, an Ohio Democrat, has long defended the Affordable Care Act, or Obamacare, and until now his party could thwart Republican efforts to repeal it. But with President-elect Donald Trump, a Republican, about to take office, succeeding President Barack Obama, a Democrat, the White House as well as both chambers of Congress will be in GOP hands.

On Thursday, the Senate passed a budget measure to start the repeal. The House of Representatives followed Friday. More steps must follow -- and Trump and congressional leaders insist they will replace Obamacare with something they say will be far better. Democrats are highly skeptical.

Repeal and replace? Here's where things stand.

Will the sky fall under Republicans' plan to repeal and replace Obamacare? It depends on some assumptions, but the number of insured people will likely drop.

Republicans say that although Obamacare provided health insurance to millions more Americans, it did so at too steep a cost.

Obamacare required insurers to provide a fuller array of coverage and assured that a customer's pre-existing conditions could not be used to deny coverage or charge higher premiums. It assured that many people who previously could not afford insurance could now get it, providing many with taxpayer subsidies.

It helped 964,000 Ohioans get coverage, said Brown's office, citing a study by Policy Matters, a left-leaning think tank. If it is repealed without a replacement, projections for the number of people who could lose coverage nationally range from 22 million to 30 million, according to various national projections.

Obamacare's mandate for most Americans to have insurance, and its requirement that insurers provide a full suite of coverage, meant consumers were robbed of freedom of choice, Republicans say.

By requiring fuller coverage and disallowing the market to determine whether older and sicker patients could be charged significantly higher premiums, Obamacare wound up prompting insurers in some markets to jack up premiums overall, a way of balancing out their risk, Republicans say. Even then, real or potential financial losses prompted some insurers to leave entire markets or to impose more restrictions on the doctors and hospitals a patient could seek.

Did Obamacare really push up Ohio premiums by 91 percent?

Ohio Lt. Gov. Mary Taylor used a controversial measure again to state how expensive Obamacare is. Mathematically, she appears right. Qualitatively, it's a different matter.

Obamacare, kicking in fully in 2014, was supposed to have a mechanism to compensate insurance companies facing those kinds of losses until the markets settled. But Republicans in Congress, saying the government should not prop up a failing system, were able to use their power of the purse to stop that program from making payments.

With the November election putting the White House as well as Congress in Republican hands -- Trump will be sworn in Friday -- the question no longer is whether Obamacare will be repealed in the coming months. Is it whether there be a new and full set of healthcare rules or policies to replace it, as Trump promises.

For example, Obamacare provided federal funding for states to expand Medicaid if they wished to, and Ohio Gov. John Kasich -- a Republican -- embraced that opportunity. Medicaid serves low-income families, and Kasich, bucking some in his party, portrayed expansion as a moral imperative.

Will that expansion go away? If so, the 700,000 Ohioans added to Medicaid rolls under Obama could lose coverage.

How Ohio's uninsurance rate went from 14 percent to 6 percent

The prospect of the repeal of Obamacare during Trump's presidency is causing anxiety for those who might lose coverage, and the hospitals who treat them.

"Preserving and expanding coverage that is high quality, affordable, and helps improve access to care should always be the focus of policymakers," said Kristen Morris, chief government affairs officer of Cleveland Clinic. "To this end, expanding Medicaid coverage to low-income workers has benefited many Ohioans, by providing access to treatment and preventive care."

She said it is "critical" that the coverage be preserved.

Republicans are discussing turning Medicaid into a block grant program so states could decide what to spend the money on. Democrats worry that Republicans will cut overall funding.

Similarly Republicans say they might start a high-risk insurance pool for patients with pre-existing conditions. That has been tried before, but never with enough federal money to serve the patient demand.

Hospitals face another, distinctive problem with repeal. The government pays them to provide care for patients on Medicare, which most senior citizens are covered under. But Obamacare scaled back the rate at which Medicare payments were to be raised each year. And Obamacare cut Medicare payments to hospitals that used to see a disproportionate share of uninsured patients.

Hospitals agreed to forego the larger payments because under Obamacare, they would stop losing so much money -- and stop turning to the government -- when caring for those patients. The patients would now be insured.

Will Trump and Republicans in Congress be able to assure the hospitals are made whole?

Legislatively, this could be tricky because repeal alone won't restore the money. Republicans say they'll work on new legislation to reduce or eliminate harm.

If so, their efforts could be cheered by some hospitals. Cleveland Clinic CEO Toby Cosgrove, for one, has criticized the red tape and industry restructuring that have gone hand in hand with Obamacare, while praising its ability to insure millions more people.

But Democrats say that while repealing Obamacare might be easy, replacing it will be exceedingly hard.

And so hospitals today are pleading.

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