Rural hospitals could face ‘disaster’ under Affordable Care Act repeal

The Wolf administration warns that health coverage for nearly 700,000 Pennsylvanians is in jeopardy if President-elect Donald Trump and Republicans make good on promises to repeal the Affordable Care Act.

That’s sounding alarm bells because of the impact on those people who got coverage when the state expanded Medicaid last year, as well as rural hospitals.

“It would be a disaster,” if the government stopped paying for the Medicaid expansion, said state Rep. Gene DiGirolamo, R-Bucks.

Hospitals forced to treat thousands of patients who have no insurance and cannot afford to pay their medical bills would be devastated.

“I really believe you would see hospitals close,” DiGirolamo said.

He’s not the only one concerned.

The law known as Obamacare has sliced in half the portion of Pennsylvanians without health insurance, said Jeff Sheridan, spokesman for Gov. Tom Wolf.

At the same time, the federal government has dialed back payments to hospitals meant to help pay for uninsured patients, said Paula Bussard, chief strategy officer for the Hospital and Health System Association of Pennsylvania.

The hospital industry accepted those funding cuts because more patients had insurance coverage. If that balance changes – with no Medicaid expansion and nothing to replace it for uninsured patients – rural hospitals struggling to stay afloat could be swamped, she said.

“Pennsylvania is a vast state, and almost half of the rural hospitals are already losing money,” Bussard said. 

‘Not a partisan issue’

Those hospitals often are some of the biggest employers in their communities. Ratcheting up their financial pressures, she said, would have ripple effects across the areas they serve.

While hospitals warn about a large-scale impact of repealing the Affordable Care Act, DiGirolamo said it could devastate families, too.

“This serves people who are working but are making minimum wage. These are people we should be insuring,” he said. “This is not a partisan issue, this is something that has been working for people in all our (legislative) districts.”

DiGirolamo, who has served as chairman of the House Human Services Committee and hopes to lead it again next year, broke with his party three years ago to call on former Gov. Tom Corbett, a Republican, to expand Medicaid in Pennsylvania.

At the time, Corbett was pushing his own version of Medicaid expansion under the Affordable Care Act. He sought to require people to look for work in order to qualify for coverage.

Corbett lost the 2014 election to Wolf, a Democrat, who promptly dropped his health insurance plan in the trash bin and opted for a more straightforward expansion of Medicaid.

DiGirolamo, beginning his 12th term in the Statehouse in January, said he doesn’t oppose fixing the Affordable Care Act, but he thinks expanding Medicaid has been a success. 

‘Better’ health plan

A spokesman for U.S. Sen. Pat Toomey, who supports repealing the Affordable Care Act, said current proposals to do so call for retiring the Medicaid expansion in two years.

“Sen. Toomey has said repeatedly that taxpayer subsidies should be maintained for a period of time as we transition to a better health care system that gives families and individuals affordable choices in coverage, and takes Washington bureaucrats out of the doctor’s office,” said spokeswoman E.R. Anderson.

Toomey’s support for repeal has put him in the crosshairs of those who are lobbying to preserve coverage.

“There are 1.1 million people who could lose health insurance. There is going to be a backlash,” said Antoinette Kraus, executive director of the Pennsylvania Health Access Network. In addition to 680,000 people covered under Medicaid expansion, another 400,000 Pennsylvanians got health insurance through exchanges created by the Affordable Care Act.

Kraus’ network and similar groups plan to protest outside Toomey’s office on Thursday, the last day for people to sign up for insurance coverage on the Affordable Care Act exchanges for next year. 

Medicaid concerns

Sheridan, Wolf’s spokesman, said picking up the tab for those who lose federal assistance would cost the state billions of dollars.

But Republicans say, even without repeal, expanded Medicaid will soon be unaffordable for Pennsylvania anyway.

This is the last year that the federal government is paying the full freight. By 2020, the state will be covering 10 percent of the cost.

That burden, coupled with the rising costs of public pensions, will squeeze out other priorities such as school funding, said Stephen Miskin, spokesman for state House Majority Leader Dave Reed, R-Indiana.

Corbett’s now-scuttled alternative to Medicaid expansion, he said, was intended to control some of those costs.

“The Affordable Care Act is a flawed plan, and we were going to have to deal with it – whether they repeal it or not,” he said.

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