LETTER: What ACA repeals could do in state
With a new administration, a new Congress in Washington, DC, a new Governor, and the North Dakota Legislature beginning its deliberations, several issues loom that could have a significant impact on North Dakota health care facilities and their patients.
In Washington, D.C., there are discussions about repealing the Affordable Care Act (ACA). While there are definite improvements that could be made to the ACA, there are also several provisions that provide real benefits to North Dakota citizens and health care providers.
The ACA contains a component dubbed the “Frontier States Amendment” which is critical to correct unfair Medicare reimbursement in rural states such as North Dakota. If this provision is repealed, it is estimated to reduce payments to health care providers by $68 million in North Dakota alone.
A second provision is Medicaid Expansion, which provides insurance coverage for about 20,000 North Dakotans. The Legislature must make a decision during this legislative session whether to reauthorize this needed program. However, with the uncertainty about Medicaid Expansion in Washington, D.C., local legislators will need to decide how to proceed. Pulling health insurance coverage from 20,000 residents would be devastating for not only those residents, but also for the medical facilities providing their health care. Hospitals and other community-based providers saw a significant reduction in their “bad debt” and uncompensated care with the implementation of Medicaid Expansion. We have estimated that the financial annual impact in North Dakota would be $202 million.
In addition, if the ACA is repealed, many who gained coverage through health insurance subsidies would become uninsured. This reversal of coverage would mean that hospitals and other providers have to absorb the increasing cost of uncompensated care for these additional uninsured patients.
There is discussion in Washington, D.C., about repealing the ACA immediately with replacement to occur at a later date. That strategy is very concerning to us. It leaves a lot of uncertainty in the health care world for patients and presents serious challenges to hospitals that are mandated to comply with ever increasing regulatory requirements. How can anyone plan without knowing what is to be replaced after the repeal?
If Congress repeals the Frontier States Amendment, health insurance subsidies, and Medicaid Expansion or if the North Dakota Legislature fails to reauthorize Medicaid Expansion, jobs will be lost in our state and some rural hospitals, working on little to no margin, may be forced to either close or significantly reduce services for patients. We hope that Senators Hoeven and Heitkamp, Congressman Cramer, and North Dakota legislators will be mindful of these facts when deciding these very important issues for North Dakota health care facilities and the patients they serve. The loss of over $270 million annually in the medical system within our state would have a profound impact on North Dakotans. We urge our state legislators to reauthorize Medicaid Expansion. And we urge the North Dakota Congressional delegation to ensure there is a thoughtful, deliberate replacement plan in place before repeal of the ACA goes into effect.
Jerry Jurena, President; Courtney Koebele, Executive Director North Dakota Medical Association; Shelly Ten Napel, CEO, Community Healthcare Association of the Dakotas