Viewpoint: ACA repeal could wreck Colorado’s health care and economy

Health care spending accounts for 18 percent of the U.S. economy. The actions of Congress to de-fund the Affordable Care Act (ACA) without a way to finance a replacement will have significant negative consequences for Colorado businesses, individuals, government and the economy. Colorado hospitals will be hard hit as the number of uninsured seeking emergency room care skyrockets. An Urban Institute analysis of a 2016 repeal bill shows insurance marketplaces for individuals and small businesses would likely collapse due to loss of premium supports from the ACA.

Before the ACA, hospital emergency rooms were overcrowded with patients who could not afford to go to a doctor. The federal anti-dumping law requires hospitals to treat anyone seeking emergency care. Since passage of the ACA in 2010, more than 22 million of the uninsured have gotten coverage with preventive care, allowing them to get treatment sooner from community physicians, reducing needless ER visits that generated financial losses for hospitals.

The ACA financed health care expansion by taxing profitable health care corporations, including drug, insurance and medical device companies. It raised the Medicare tax on people making more than $250,000 a year, extending Medicare’s solvency by 10 years.

A 2016 repeal bill eliminated the individual and employer mandates (which removes the incentive for young and healthy people to get insurance), leaving the insurance pool older and sicker. It eliminated the Medicaid expansion and taxes on high wealth individuals. Congressman Paul Ryan wants to cap Medicaid spending and turn responsibility over to the states, making it impossible to cover increased numbers of people who lose their jobs in the next recession and increasing the financial burden on cities and states.

These taxes were crafted as part of a grand bargain among all sectors of the health care system, negotiated over many months. Hospitals and physicians agreed to forego payments for uncompensated care in exchange for the Medicaid expansion. If the Medicaid expansion is repealed, all hospitals will see their uncompensated care skyrocket with no offsetting federal aid. Rural hospitals are even more vulnerable to such drastic cuts.

The Urban Institute estimates the number of uninsured Americans will double by 2019, from 29.8 million to 58.7 million. States, local governments and health care providers will be at risk for an extra $1.1 trillion in uncompensated care over 10 years.

Ryan and President-elect Trump propose allowing insurance companies to sell policies across state lines. This has failed in the past. The New America Foundation found this approach “would lower premiums for the healthiest Americans, but it would raise premiums and reduce coverage options for everyone else.”

Those with health problems “would have to pay more or go without coverage.” Moreover, the Colorado Insurance Commissioner would have no supervision over these out-of-state plans, leaving citizens and companies open to insurance company abuses.

Similarly, the Republican plan to allow everyone to create Health Savings Accounts (HSAs) has been shown not to help those previously uninsured. The Medicaid expansion allowed individuals making as little as $15-20,000 a year to get coverage. The working poor make too little to benefit from tax credits and HSAs.

The ACA has made it possible for Coloradans to start new companies without fear of losing their health care. Such entrepreneurial ventures consistently boost employment and the economy in Colorado.

Efforts by Congress to abolish the funding for millions to receive health care will cause major disruptions in the economy and will probably increase the death rate. Prior to the ACA, 40 million Americans were uninsured. A 2009 study by Harvard Medical School and the Cambridge Health Alliance found that working aged adults without insurance have a 40 percent higher risk of death and 45,000 working aged adults died prematurely every year due to lack of access to health care to treat their cancer, hypertension and diabetes at earlier stages.

Colorado and the nation should not go backwards in health care. Our economy and citizens will suffer needlessly from a hasty-repeal that does not finance a sustainable system that truly gives working American citizens the health care they deserve.

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