© 2023
Play Live Radio
Next Up:
Available On Air Stations

Bill Owens: Health Care Reform Or Chaos?

Let me begin by saying that I cannot comprehend the impact that the loss of health insurance will have for nearly 20 million Americans.  It will be a financial, health and psychological tsunami for our families, friends and neighbors.

The mantra of “repeal and replace” has been replaced for many Republicans with “repeal-delay-replace.” Four senators, led by Rand Paul, and five Republican governors, led by John Kasich of Ohio, have now raised concerns about repealing without immediately replacing Obamacare, including retaining the Medicaid expansion. What is motivating the concerns of the senators and governors?  For some, it may be real concern for constituents and their health care; more cynically, it may be the fear of disrupting 20 million people’s health coverage, which would likely raise a fire storm politically.  My congresswoman, Elise Stefanik, who happens to be my successor, wants a three-year delay while a replacement is conjured up.  Six years wasn’t adequate to figure out a replacement?  The president-elect is ambiguous about which mantra he will adopt.  President Trump has promised insurance for all, retaining children on their parent’s policies till age 26, covering pre-existing conditions and allowing negotiated drug purchases for Medicaid and Medicare, most of which are an anathema to Republicans.

The crafting of a replacement for Obamacare will be a complex process, and trying to provide coverage at affordable prices is likely to be even more elusive, particularly given the President’s proposals.   

What hasn’t been discussed, of course, is what the impact would be on the overall health care system.  It is clear from letters sent by the American Hospital Association and the Federation of American Hospitals that there is real concern about a repeal-delay-replacement strategy, much less a repeal-without-a-plan strategy which is really what repeal-delay translates to.  The Hospital Association, relying on a report from Dobson/DaVanzo, believes its members would lose $65.8 billion over five years, plus $289.5 billion from the reimbursement cuts imposed by Obamacare, among other funding reductions.  Will the Republican plan restore or continue those cuts?

Bad debt and uncompensated care will skyrocket, further negatively impacting hospital financial results.  Uncompensated care was estimated to be between $75 and $125 billion annually in 2009-2010. Some estimates say the current level of uncompensated care would be $100 billion per year.  These estimates were confirmed by the CBO last week. These costs arise because most states require that all hospitals treat anyone presenting, whether or not they have insurance or other capacity to pay their hospital bills.  Obviously, it is very difficult to determine, and best explained by an example.  Assume a patient arrives at the emergency room having a heart attack, will the hospital know if the patient has insurance or adequate assets to pay for the care.  Currently hospitals cannot ask about insurance or financial resources before treatment.  Thus it’s very easy to understand how uncompensated care will grow when so many more will no longer have health insurance.   

Will insurance companies withdraw from more markets, as they are driven out by uncertainty, and/or will premiums climb even higher? The latter was also confirmed by CBO last week. Numerous studies have indicated that, from 2003 to 2011, health insurance premiums and deductibles grew by at least nine percent annually.  If, in fact, there was an analysis which demonstrated that premium rates and deductibles rose more with Obamacare than without, then I would suggest that analysis would strengthen the Republican position, but the fact that the Republicans have not come forward with such data raises the question of whether the data would, in fact, refute their arguments.

I voted in favor of Obamacare, and probably voted 50 times to sustain it, much like I voted approximately 50 times to move the Keystone pipeline along, and against Dodd-Frank.  The purpose of this disclosure is to simply demonstrate that I was a moderate who evaluated each piece of legislation based upon facts and the impact upon my district, not based upon party loyalty and dogma. 

When I voted for Obamacare, I believed and continue to believe it would need to be modified, and that as we moved forward with its implementation we would find things that clearly needed adjustment.  The need came to fruition, but the willingness to make change rather than repeal has been completely ignored.  This is largely because the Republican mantra had been repeal and replace, until the reality was delivered to their doorstep in November, which caused the mantra to vacillate between repeal-delay-replace, repeal and replace, or—what?

Mr. Trump’s recent tweets about keeping the pressure on Democrats and making them bear the burden of Obamacare’s “collapse” is, in my view, another Trumpian sleight of hand, as Mr. Trump may well have recognized the risks that the current strategy creates for Republicans. 

The likely result from this chaos: communities like mine will lose health care providers and employers.

Mr. Owens is a former member of Congress representing the New York 21st and a Senior Advisor to Dentons.

The views expressed by commentators are solely those of the authors. They do not necessarily reflect the views of this station or its management.

Related Content