NMC Commentary

Will the Affordable Care Act Be Replaced?

It is still too early to tell exactly what will happen regarding healthcare legislation at the Federal Level, but there is certainly significant activity regarding an emerging proposal to repeal and replace parts of the Affordable Care Act (ACA). I continue to be concerned about the impact that changes could have on access to care and am hopeful that a workable and sustainable approach can be identified. At the same time, our focus here at Northwestern Medical Center continues to be on bending the cost curve through prevention of health problems, integrated approaches to care, and elimination of duplication in our systems.

The possible replacement of the Affordable Care Act is a complicated subject and difficult to track with all of its parts and the ongoing changes as it moves through the legislative process. Here is a summary from March 9 from the American Hospital Association, which monitors the work in Washington, D.C. very closely: “The House Committee on Ways & Means early this morning reported out its part of the House legislative package to repeal and replace parts of the Affordable Care Act, while the House Energy & Commerce Committee this afternoon completed the markup of its piece of the legislation – collectively known as the American Health Care Act. The Ways and Means bill would repeal the ACA’s employer and individual mandates to purchase health coverage and replace the law’s means-tested advance premium tax credits and cost-sharing reductions with tax credits that vary by age and income. The Energy & Commerce bill would end the enhanced Medicaid federal funding for future expansion populations, beginning in 2020, and transition the program to a per capita cap funding model.”

These are significant changes that are raising concerns and discussions as we all work to interpret the meanings and project the impact on our communities. The Vermont Association of Hospitals and Health Systems has issued a strong statement of concern regarding aspects of the proposed changes. “Since its passage in 2010, the Affordable Care Act [ACA] has made health care more accessible and affordable for Vermonters and brought the state closer to covering all residents. Due in large part to the ACA, the uninsured rate in Vermont is among the lowest in the nation. On behalf of Vermont’s hospitals, VAHHS opposes plans to substantially reduce Medicaid spending, which hurts vulnerable people and families. The current ACA replacement plan put forward in the House of Representatives would do that, as well as limit subsidies available to help middle-class people afford health insurance for their families. VAHHS and our 16 non-profit hospital members have always believed the ACA is a starting point and a law that, like any major public policy, needs constant improvement. The GOP [Republican] plan to replace the ACA could have wisely focused on repairing what is broken; instead the plan scraps an entire system that is working to help millions obtain the coverage and care they need. VAHHS and our members remain committed to health care delivery reform, and we will continue to provide care to anyone seeking it. We will work with our legislators and Congressional delegation to ensure that Vermonters continue to have access to affordable health care and our entire nation has a compassionate, sustainable system.”

Our team at NMC continues to work to live our mission of providing exceptional care for our community with a focus on excellence and value. The results of our efforts are clear. NMC recently earned national recognition as one of the Top 100 Rural & Community Hospitals in the United States from the National Rural Health Association’s Rural Health Policy Institute! That is an incredible tribute to the work of our team, as it comes from an independent analysis that shows we are “achieving higher quality, securing better outcomes, increasing patient satisfaction, and operating at a lower cost than their peers” according to the report. At NMC, our ‘cost per adjusted admission’ has actually gone DOWN over the past four years and we are among the four leaders in the state in that important measure of cost efficiency. It is an incredible challenge to maintain strong access and high quality while containing costs – and it is a challenge that NMC strives to meet and exceed every day. I am very proud of their efforts.

Going forward, we must ensure that any changes in the healthcare system – at the Federal level or here at the State level – do not compromise access or quality as we continue to press for greater efficiency and invest in prevention to reduce demand for avoidable costly medical services. There are a lot of moving parts and conversations that we will try to stay abreast of. The answers and impacts are not clear as I write this. This is a significant time for healthcare. Yes we need to reduce the cost while at the same time ensuring access to the right care for all. Easier said than done with the increasing pressure on how this care will be paid for.  This has our full attention.

— Jill Berry Bowen, NMC’s Chief Executive Officer