Atlantic Health CEO: Trumpcare will mean less care for poor, more burdens on hospital emergency rooms

Brian Gragnolati, president and CEO of Atlantic Health. Photo courtesy of Atlantic Health
Brian Gragnolati, president and CEO of Atlantic Health. Photo courtesy of Atlantic Health
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Look for millions of angry, uninsured Americans and more overcrowded hospital emergency rooms if the Senate approves the American Health Care Act.

So predicts Brian Gragnolati, president and CEO of Atlantic Health, the parent company of Morristown Medical Center.

He said this week’s Congressional Budget Office report confirmed his concerns about the AHCA, also known as Trumpcare, the Republicans’ proposed replacement for the Affordable Care Act, a.k.a. Obamacare.

Morristown Medical Center. Photo by Kevin Coughlin
Morristown Medical Center. Photo by Kevin Coughlin

“We’re going to go from a situation where those who had access to insurance won’t have access to insurance,” Gragnolati told MorristownGreen.com.

 
“This will create quite a bit of angst…you’re going to see a really big outcry.  If the bill passed by Congress passes [in the Senate], there will be people who have insurance today who won’t have it tomorrow. And they won’t be happy.”
 
The CBO report released Wednesday analyzed the bill narrowly approved by the House earlier this month. It predicts the measure would insure 23 million fewer people after a decade, while saving $119 billion.
 
Younger, healthier citizens would pay lower premiums. Some older citizens would see giant increases and many people with pre-existing conditions simply won’t be able to afford coverage, according to the report, which predicts “unstable markets” for health insurance in some states under this bill.
 
Obamacare’s expansion of Medicaid, the federal program for the poor, would end. The GOP bill would cut Medicaid spending by $800 billion, paring 14 million people from the program over a decade, the CBO estimates.
 
Savings largely would benefit medical companies and the wealthy, who were taxed to subsidize Obamacare.
 
House Speaker Paul Ryan (R-WI).
House Speaker Paul Ryan (R-WI).

Groups opposing the GOP plan include the American Medical Association, the Consumers Union, the Children’s Defense Fund and labor and teacher unions.  Trumpcare would be a  “devastating step backwards,” contends the New Jersey Hospital Association, of which Atlantic Health is a member.

 
House Speaker Paul Ryan, who had pressed for a vote before getting the CBO analysis, defended the numbers.
 

“This CBO report again confirms that the American Health Care Act achieves our mission: lowering premiums and lowering the deficit,” Ryan said in a statement.

Rep. Rodney Frelinghuysen (R-11th Dist.), who chairs the House Appropriations Committee, did not respond to a request for comment. 

ALL YOU NEED IS LOVE? Rep. Rodney Frelinghuysen (R-11th Dist.) says it would help. Photo by Kevin Coughlin
Rep. Rodney Frelinghuysen (R-11th Dist.). Photo by Kevin Coughlin

Frelinghuysen opposed a prior version of the bill, but defended his yes vote earlier this month, saying Obamacare is failing,  “doing nothing is not an option,” and he anticipated the Senate would improve the “imperfect” replacement adopted by the House.

Gragnolati said he expects charity care visits to his five hospitals will climb once more, after trending downward under Obamacare to about 30,000 charity cases annually.
 
“We are the safety net for those who cannot receive care anywhere else…it’s not the most effective or best way for those people to receive care,” Gragnolati said.
 
Pre-Obamacare, members of the New Jersey Hospital Association were providing around $1.3 billion of charity care per year. That’s down to $480 million, the NJHA said in a March letter to the state’s Congressional delegation.
 

Hospitals only get reimbursed for about half of that, yet their bottom lines and quality of care have improved because they are treating more insured patients under Obamacare, the association asserts.

Statewide, 800,000 residents joined the insurance rolls under Obamacare. A half million were covered by the Medicaid expansion that was part of that program. Medicaid caps proposed by House Republicans would imperil coverage for 1.8 million Jerseyans, according to the association.

A PRIVILEGE, OR A RIGHT?
 
At a healthcare forum in Morristown this month, Thomas Howe, an M.D. and former state medical director for Aetna, said the national debate boils down to this:
 
Is healthcare a privilege, or a right?
 

“We’ve got a large chunk of this electorate that does not believe healthcare is a right: ‘It’s okay for me, but I don’t want my taxes paying for somebody else’s. They should have been healthier! Why’d they get sick? Why am I paying for that?’ 

Thomas Howe, M.D., a former NJ medical director for Aetna, addresses forum in Morristown, May 18, 2017. Photo by Kevin Coughlin
Thomas Howe, M.D., a former NJ medical director for Aetna, addresses forum in Morristown, May 18, 2017. Photo by Kevin Coughlin

“We have congressmen saying this kind of nonsense,” Howe told the forum, sponsored by the Morris Township Democratic Committee.

“Every other industrialized country has recognized that healthcare is a right. Everybody’s better off with this coverage.”

 
Neither Trumpcare nor Obamacare tackles the root problems of America’s soaring healthcare costs, which account for 18 percent of the nation’s gross domestic product, compared with 9 percent in Germany and 3 percent in Japan, Howe said.
 
Other advanced nations control healthcare prices and have single payer systems–anathema to conservatives here who insist that free markets are the answer, Howe said. Yet free markets are a fallacy in a byzantine system where it’s impossible to get a price quote for an M.R.I., he said. 
 
Medical costs are a prime cause of bankruptcies in New Jersey — and the high prices buy “very mediocre” medical results, said Margaret Koller of the Center for State Health Policy at Rutgers. “It’s absurd,” she said.
 
Alida Karas of Morris Township told the forum that her late husband’s extended illness wiped out her family’s savings. While grieving her husband’s death, she said, she had to fight with a hospital over a $6 million bill.
 
“This is not the way our society should be treating ourselves,” said Howe, who called Trumpcare a formula for family bankruptcies.
 
‘OBAMACARE IS HELPING A LOT OF PEOPLE’
 

Obamacare has flaws, Gragnolati acknowledged. But the pluses outweigh the minuses.

“I get frustrated when I hear people say Obamacare is a system that’s not working. The reality is, it’s helping a lot of people. That’s why it’s important to look back eight years ago, and see how much better it is today,” he said.
 
“The ACA needs to be improved. But the concept of completely repealing it doesn’t need to happen. It doesn’t make sense,” he said, asserting that universal access to healthcare is essential.
 
He would like to see better integration of hospitals and community resources, and more experiments with Accountable Care Organizations, to rein in prices.
 
“What we ought to be focused on now is how to build on improvements of what’s working today, address issues that need to be addressed, to get functioning insurance markets, and see how do we keep the notion of Medicaid expansion going forward,” Gragnolati said.
 
Mayor Tim Dougherty and Atlantic Health CEO Brian Gragnolati, at Morristown Jazz & Blues Fest announcement, March 30, 2017. Photo by Kevin Coughlin
Morristown Mayor Tim Dougherty and Atlantic Health CEO Brian Gragnolati in March 2017.  In 2015, Atlantic and its subsidiary, Morristown Medical Center, agreed to a landmark tax settlement with the town. Photo by Kevin Coughlin

“Things we really need to work on? We’ve got to work hard to see how to expand Medicaid in the remaining states. The second thing: How do we get these insurance markets for individuals to work better, by getting a balanced pool of sick and well patients into these products, in a way that allows insurance companies to predict their medical costs.”

 
The House bill removes penalties for people who don’t buy insurance. With fewer healthy people buying in, critics say, insurance companies will be saddled with costs for the sick.
 

Republicans have proposed a 10-year, $138 billion fund that states could tap for “high-risk” pools to cover people with pre-existing conditions. 

But high risk pools have not worked well in the past, according to the Kaiser Family Foundation, and even some conservastive analysts suggest the proposed federal subsidies are too small.

Frelinghuysen and other House Republicans say their bill protects people with pre-existing medical conditions, a popular feature of Obamacare. But critics, and the CBO report, cite state waiver scenarios that could make it impossible for such people to afford coverage.
 

Before Obamacare,  if you were a 55-year-old woman with breast cancer, or a freelance writer with hypertension, and you lacked an employer health plan, it was nearly impossible to buy affordable individual insurance, Gragnolati said.

The ACA created market exchanges for them. And for the poor, it expanded Medicaid for states that wished to participate. “All but 19 chose to do so. We did in New Jersey, and it helped dramatically,” Gragnolati said.

“Hospitals across the country saw a reduction in charity care, and in bad debt,” Gragnolati said. 
 
The House bill may be D.O.A. in the Senate. Republicans there appear well aware of the rough reception that people like New Jersey Rep. Tom MacArthur (R-3rd Dist.) have gotten from constituents.
 
Sen. Lamar Alexander (R-TN), chairman of the Health Education and Labor Committee, said the Senate “is writing its own bill, which will receive its own score from the Congressional Budget Office before the Senate votes.”
 
 

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1 COMMENT

  1. Forget the budget! Why aren’t you working to solve the problem regarding how to educate the poor and train them so they can be gainfully employed?
    Stop thinking of giving, giving, giving and start thinking how to solve the problem.
    Maybe highly paid executives can contribute at least 10% of their gross income to fund job training by local businesses.
    Giving to everyone that is unemployed is not an incentive for them to contribute to society.
    I know this is a huge problem because it is difficult to separate those who are in dire need from those who are scamming the system.
    I ask all who oppose the budget to tackle the problem.
    God be with you.

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