With Republicans in Washington, D.C., pledging to repeal the Affordable Care Act, or key parts of it, and a plan to replace it uncertain, hospital leaders in Washington state are trying to preserve what they see as a crucial benefit of the law known as Obamacare.
Hospital officials from Elma to Yakima say that by expanding Medicaid insurance to 600,000 lower-income Washingtonians, the Affordable Care Act (ACA) has allowed them to help more patients and innovate with care that could prove a boon in the long run.
There’s not a coalition with a name and letterhead, said Cassie Sauer, incoming CEO of the Washington State Hospital Association. But association members plan to meet with the congressional delegation in coming weeks, and hospitals hope to work with doctors and insurers to keep coverage for those who gained it through the ACA.
“This is where the interests of patients and hospitals align,” said Aaron Katz, principal lecturer at the University of Washington’s School of Public Health, about Medicaid expansion. “It doesn’t solve all problems for either group but it’s better than it used to be.”
Life expectancy in Grays Harbor County is three years less than the state average. The county has seen 13 percent of its population acquire health insurance through the ACA’s Medicaid expansion. That creates an opportunity to detect cancers, change diets and lifestyles, and address common conditions such as diabetes before they lead to costly crises.
“Why are we the sickest county in the state?” said Renee Jensen, CEO of Summit Pacific Medical Center in Elma. “We have to change the culture if we’re going to change their status. We can’t reach them if they don’t have health-care coverage, if we don’t have access to patients.”
Gov. Jay Inslee and state Insurance Commissioner Mike Kreidler sent a letter this month to GOP congressional leaders saying that repealing the ACA without an alternative for insuring lower-income Washingtonians would “seriously undermine our health-insurance market and our state’s economy.”
Inslee and Kreidler sent similar letters to members of Washington’s congressional delegation.
The Congressional Budget Office estimated that 22 million Americans would lose health-care coverage under a repeal bill President Obama vetoed this year.
State officials have created “What’s At Stake for Washington state” graphs and maps showing that the counties that rely most on the ACA’s expanded coverage tend to have supported Donald Trump for president. Grays Harbor and Yakima counties were among those with the highest percentage of adults acquiring coverage through Medicaid expansion.
In Yakima County, most of the newly insured are working-class men, said Russ Myers, CEO of Virginia Mason Memorial Hospital. Savings in uncompensated care (charity and writing off bad debt) led the Yakima hospital to shift funds to a network of clinics that aim to take pressure off emergency rooms by treating root causes of diabetes, obesity and other conditions.
Statewide, hospitals’ uncompensated care dropped by $466 million from 2013 to 2015, according to the Office of the Insurance Commissioner, as Washington’s ranks of the insured swelled.
But that hasn’t meant a windfall for hospitals, according to hospital officials. The reductions in uncompensated care are largely being offset by reductions in federal Medicare reimbursement, said Sauer and other executives.
It’s hard to point to evidence of success yet in Yakima County’s innovation, Myers said. “That culture change takes time,” he said of getting the newly insured to seek preventive care instead of their historical reliance on emergency-room visits.
But state data reveal an important improvement: With increased coverage, Washington has seen a 28 percent decline in adults delaying care due to cost.
Like others, Myers doesn’t know what Congress will end up doing. Some GOP leaders have vowed to repeal the ACA first, then work on replacing it. Others have called for “replace then repeal.”
There are widely acknowledged problems with the ACA, such as insufficient incentives for the young and healthy to buy coverage, higher deductibles that lead some people to cut back on needed care, and the unpopularity of the law’s individual mandate.
While the state hospital association does not officially endorse Obamacare, it does advocate ongoing funding for expanded health insurance through the ACA, which it considers successful.
“We obviously want to be a strong voice for maintaining access in the future,” Myers said, because of its potential impact on Yakima County. He said hospital officials have met with local legislators and U.S. Rep. Dan Newhouse, R-Sunnyside.
Ian Goodhew, director of government relations for UW Medicine, said he was recently in Washington, D.C., meeting with staff of the state’s congressional delegation. “Under any replacement, we don’t want to reduce services and the level of care we’ve been providing to patients,” Goodhew said. “And we need the same or similar level of federal and state reimbursement to pay for services.”
The Washington State Medical Association has supported Medicaid expansion in Washington and “is very much interested in protecting expansion efforts,” said the group’s CEO, Jennifer Hanscom. But the association also wants to see physicians better compensated through Medicaid, she said.
Medical-association leaders have not yet begun meeting with lawmakers to advocate for specific aspects of the ACA, Hanscom said. Board members of the physicians group will convene in early January to ratify policy positions, she said.
Groups such as Catholic Charities Spokane are also part of the hospital chorus. Catholic Charities has joined with Providence Sacred Heart Medical Center on a program that moves homeless patients out of expensive hospital beds — where they stay longer than average patients because they don’t have homes to recover in — and into dorm-style housing staffed by volunteer doctors and nurses.
Rob McCann, CEO of Catholic Charities Spokane, said he hopes this respite care will benefit from expanded Medicaid coverage for counselors and case managers who try to get patients medical treatment and permanent housing.
“Obviously, we in the social services world are praying for Medicaid expansion,” McCann said.