Major health care groups in Buffalo are warning that the health plan emerging in Congress will lead to millions of people losing health insurance and many others being hurt by major cutbacks in Medicaid.
They also see the potential for unintended and unwanted consequences, voicing concern that the changes will raise costs for doctor-training and worsen crowding in emergency rooms.
And it could hit Western New York hard, they say, because of the region's large populations of older and poorer residents.
“We feel the legislation could be devastating," said Candace Johnson, president and chief executive of Roswell Park Cancer Institute, who expressed particular concern for the effects on cancer patients.
Every major health care provider in Buffalo has voiced similar views about legislation to repeal the Affordable Care Act that is about to emerge from the Senate. They say proposed cutbacks in Medicaid and changes to insurance regulations in the Republican health care plan, which has been discussed behind the scenes so far with no public hearings by the Senate, will do "irreparable" harm.
The leaders of Kaleida Health, Erie County Medical Center and the University at Buffalo issued a joint statement this week warning that the bill, known as the American Health Care Act, "will ultimately make health care more expensive for patients, doctors and hospitals."
They expressed concern that the changes would strip people of their health insurance, "either through prohibitively high premiums for people with pre-existing conditions, elimination of the Medicaid safety net or forcing patients into severely underfunded high-risk pools."
Jody L. Lomeo, president and chief executive of Kaleida Health; Thomas J. Quatroche Jr., president and chief executive of ECMC; and Satish K. Tripathi, president of UB, warned that changes under discussion will ripple across the health care system to cause secondary problems, such as increasing the cost of training doctors and filling emergency rooms with patients seeking basic care. UB includes the Jacobs School of Medicine and Biomedical Sciences, which works closely with key hospitals here.
They also noted that medical education and biomedical research represent central components of the region’s economic recovery and that potential cutbacks that stem from the legislation will pose a challenge.
The head of the Catholic Health system offered a similar bleak take on the current politics of health care.
"In its present form, the American Health Care Act would leave tens of millions of Americans without health coverage; eliminate essential protections for older and sicker patients, including those with pre-existing conditions such as cancer; and cut billions from Medicaid, which helps our most vulnerable patients – children, the disabled, the poor and the elderly," Joe McDonald, president and chief executive officer, wrote in an email response.
Similarly, cancer center officials and cancer-related groups have expressed serious reservations or opposition to the Senate's draft of the American Health Care Act, which previously passed the House. The Senate is expected to vote on its version of the bill next week.
Johnson, Roswell's CEO, said that while she doesn't view the Affordable Care Act, also known as Obamacare, as perfect, the foundation of the bill was good and worth revising rather than dismantling.
"This legislation does not advantage cancer patients," said Johnson, who is troubled by what she sees as potential rollbacks in support for clinical trials, prevention programs and such insurance protections as requirements to cover pre-existing conditions and essential health benefits.
Details of the Senate bill remain unclear but, like the House legislation, it is expected to cap payments to states for Medicaid and, starting in 2025, slow the growth of the payments below increases in the overall Consumer Price Index. That's important because medical prices have grown faster than the index.
The Senate bill also looks likely to stop the expansion of Medicaid eligibility under the Affordable Care Act, a provision that was optional for states. Thirty-two states, including New York and the District of Columbia, provide the expanded coverage.
In addition, the bill that passed in the House allows states to opt out of major insurance requirements in the Affordable Care Act, including those that define what benefits must be covered and that ban charging people with pre-existing conditions higher premiums if their coverage lapses.
Supporters say the bill will eliminate the taxes and regulations in Obamacare, and increase competition in health insurance. But there have been conflicting descriptions about the evolving details. President Trump, after passage in the House of the American Health Care Act in May, called the legislation "incredibly well-crafted" and said premiums and insurance deductibles will come down. More recently, he described it as “mean” and urged the Senate to write a “more generous” bill, according to news reports.
For hospitals, nursing homes and other health care providers here and elsewhere, the repeal effort follows steady growth in health care jobs and a decline in the rate of the uninsured since the Affordable Care Act was signed into law in 2010. The potential changes to Medicaid pose significant risks to the finances of institutions, which have come to rely on the funding, and the availability of care to people in a program that touches lives in many different ways.
Of the approximately 80 million Medicaid enrollees, 43 percent are children, 14 percent are disabled or blind and 9 percent are elderly. Medicaid pays for more than 60 percent of nursing home residents and nearly half the births in the United States, according to the Kaiser Family Foundation. There are more than 325,000 Medicaid enrollees in Erie and Niagara counties.
Officials from UB, ECMC and Kaleida Health described the American Health Care Act as failing to "fix what is currently broken" and "doing more harm than good" at a time of significant development downtown related to the Buffalo Niagara Medical Campus.
"Western New York and the patients that we serve are even more sensitive to the dynamic impact health care legislation has on a community," they said. "Not only is Western New York home to an older, poorer population needing more intensive health care interventions than other regions, but also medical education and biomedical research are central components to our region’s economic recovery."