How would health care delivery and coverage change in the Santa Clarita Valley, for good or ill, if the American Health Care Act becomes law?
That’s the official name of the House Republican bill that represents the first phase of the GOP’s plan to repeal and replace the Affordable Care Act, better known as Obamacare.
Final answers to that question remain unknown, as the political battle over the bill, released last Monday, has just begun. But it’s moving quickly, and has already cleared two House committees. The Congressional Budget Office is expected to release its analysis of the bill’s cost and impact on the federal budget on Monday. The Senate has yet to take up the bill.
Three themes emerged when The Signal asked local health care leaders for their initial reactions to the legislation: Don’t rush things, beware the impact of cutting Medicaid, and take advantage of this chance to reduce some of Obamacare’s regulatory burden on providers and payers.
“Do I think Congress can get all this done in three days or three weeks, or should try to? I do not,” said Haley Wiener, vice president of group benefits at LBW Insurance and Financial Services in Valencia. “There are too many moving parts.”
LBW manages health benefits for more than 250 employers with groups ranging from two to 300 employees. Wiener also manages health benefits for LBW’s 40-plus employees.
The first thing Wiener says she’ll tell employers wondering what will happen is that the changes are not going to be immediate. “It will take time to undo what has already been done,” she said.
The pace of change also concerns Roger Seaver, CEO of Henry Mayo Newhall Hospital. “When it comes to improving the health care system, we need to make great long-term decisions and then we need time to implement them,” he said. “The system cannot adapt well to short-term decisions. It’s too disruptive.”
Potential cuts in coverage are another issue of concern. The House bill “could have negative impacts on California hospitals and the patients they serve,” said C. Duane Dauner, president and CEO of the California Hospital Association, in a statement.
“In particular, CHA is concerned about the likelihood of a reduction in coverage that would result from this proposal. California leads the nation in expanding health care coverage, with 91 percent of all Californians now being covered. The plan’s proposal to restructure Medicaid will likely undo the important gains in coverage that have been made over the past few years.”
Cuts to MediCal would have a less severe impact in Santa Clarita than elsewhere in California, “because we have a lower percentage of MediCal patients than other parts of the state,” Seaver said. “We didn’t see a dramatic increase in our MediCal population, so that reduces the potential downside for Henry Mayo.”
The percentage of Santa Clarita residents living in poverty is 9.3 percent, according to the U.S. Census Bureau, compared to 16.7 percent for Los Angeles County as a whole.
More broadly, Seaver noted that “it’s practically unheard of to take away a benefit that has been enacted. I think they should be very careful about reducing coverage, because there will be unintended consequences that are not entirely desirable.”
Cuts in MediCal payments would likewise have “a significant impact” on Providence Holy Cross Medical Center, a major provider of outpatient services in Santa Clarita, said chief executive Bernard Klein, MD.
“But ultimately, we’ll be fine,” Klein said. “I’m more worried about the impact on smaller hospitals that are already in the red and are highly dependent on the subsidies that are part of ACA. They could be driven out of business and that would have a major negative impact on those communities.”
Klein would like to see greater flexibility in the range of services that health insurers must cover. He gave the example of a friend well past their child-bearing years who asked why they have to pay for maternity coverage.
Reducing plan costs to employees is another element Wiener would like to see. Under Obamacare, even the so-called bronze plan, meant to be the most affordable option, “has a cost factor that is burdensome for many employees, with a $5,000 deductible,” she said.
She’d like to see options that place a cap on annual benefits in exchange for lower premiums. “That would be good for our younger generation who do not want to pay for medical insurance.”
Whatever happens, there is general agreement that it needs time to work.
“I’ve been in the benefit business for 29 years, and the last five years have been very stressful for me, our staff and our clients,” Wiener said. “I would love some consistency for a few years without major changes to benefits. Leave the plans alone and figure out how to reduce premium cost.”