Leaders from rural hospitals look at what’s coming out of the incoming Trump administration and worry.

By Thomas Goldsmith

Joann Anderson, CEO of Southeastern Health in Lumberton, served as a national voice for rural health care Tuesday as two U.S. hospital associations made a case against the proposed repeal without prompt replacement of the federal Affordable Care Act.

Southeastern Regional Medical Center main campus in Lumberton.
Southeastern Regional Medical Center main campus in Lumberton. Image courtesy SRH.

There’s significant momentum for repeal of the ACA in the early days of a new U.S. Congress. But repeal would mean a projected loss of hundreds of billions of dollars to hospitals over 10 years, representatives of the American Hospital Association and the Federation of American Hospitals told reporters during a teleconference sponsored by the groups.

Anderson heads the 325-bed Southeastern Regional Medical Center in Lumberton, county seat of Robeson, where the ACA has had a significant impact. She said repeal of the act would be catastrophic for health care in Robeson County, recently hit hard by Hurricane Matthew, as well as in other rural areas across the country.

“Robeson was one of the most effective counties in getting people to enroll,” Anderson said.

“It was very positive for this area. People who had never had coverage succeeded in getting it.”

She said that before the law, people “had paid very little attention to their health because they didn’t have money to fund it.”

Southeastern Regional already operates a range of services, including rural health clinics, at a low margin of revenue compared to expense, Anderson said. Further cuts would likely mean the loss of services such as inpatient and outpatient behavioral health care, as well as neonatal intensive care and obstetrics services.

Southeastern Regional CEO Joann Anderson said she worries that changes to certificate of need laws would undermine her hospital's financial stability.
Southeastern Regional CEO Joann Anderson said told national reporters she is concerned about her hospital’s viability in the face of a repeal of the Affordable Care Act without a prompt replacement. Photo credit: Rose Hoban

“When I first heard ‘repeal and replace’ my gut kind of went into a knot,” she told reporters representing outlets from the New York Times to the Huffington Post.

“To think about going through another rapid change … is gut-wrenching. We need to know what the replacement is going to be. I don’t think we are significantly different from other areas across the United States. We cannot take additional cuts.”

Ryan: “We’ve got to repeal and replace”

Opposition to the ACA, sometimes called Obamacare, served as a popular campaign talking point for President-elect Donald Trump. House Speaker Rep. Paul Ryan has called repeal of the act Republican legislators’ first priority when Congress returns to Washington in January.

“We’ve got to repeal and replace Obamacare because that is really hurting families,” Ryan said on CBS News’ 60 Minutes program Sunday.

The incoming administration has not offered details of a replacement for the ACA, but Ryan said during the 60 Minutes interview that Republicans will develop a new approach involving  “patient-centered health care that gets everybody access to affordable health care coverage, so that they can buy whatever they want to buy.”

Hospital Groups: Loss of ACA Would Create Deep Holes

The hospital associations asked health-economics analysts Dobson | DaVanzo to study the effects of repealing the ACA. The firm based its projections on provisions of the GOP-sponsored bill HR 3762, passed in 2015, but vetoed by President Barack Obama.

Specifically, the trade associations’ report described a need for restoration of specific funding sources that were reduced under the ACA. These included Medicare and Medicaid payments to hospitals, inflation-based updates to Medicare hospital payments, and disproportionate share payments to hospitals that provide care for large patient populations with low incomes, no insurance and/or disabilities.

Rick Pollack, American Hospital Association president, and Chip Kahn, president of the Federation of American Hospitals, urged Congress, if it repeals the ACA, to provide equivalent coverage to the millions of people who would otherwise lose insured care.

Leaders of the hospital groups made several mentions of Anderson’s projections of what repeal of the ACA would mean for Robeson, whose citizens have among the lowest incomes and worst health indicators in North Carolina.

As is the case in other primarily rural communities, the local hospital, Southeastern Regional, is not only the county’s chief health care provider, but also one of its leading employers.


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Thomas Goldsmith worked in daily newspapers for 33 years before joining North Carolina Health News. Goldsmith is a native Tar Heel who attended the UNC-Chapel Hill, and worked at newspapers in Tennessee...

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