‘Repeal and Replace’ Legislation in Congress: An Update from URMC CEO Mark Taubman

 Uncertainty surrounding proposals in Congress to “repeal and replace” the Affordable Care Act (ACA) is generating concern for faculty and staff members of the University of Rochester Medical Center, along with many of the patients we serve.

On May 4, the U.S. House of Representatives approved the American Health Care Act (AHCA), a bill which would dramatically reduce federal funding for Medicaid and repeal most of the Affordable Care Act’s provisions for individuals purchasing private health-insurance plans. Last Thursday, the members the U.S. Senate released details of the Better Care Reconciliation Act (BCRA), a separate bill that proposes similar cuts to Medicaid but maintains some elements of the ACA’s support for private health insurance. This online comparison published by The Kaiser Family Foundation provides a concise overview of the different bills.

Late last week, Governor Andrew M. Cuomo’s office requested that URMC host a panel discussion for the Governor’s representatives with area experts to discuss how the Senate bill could impact New York State and this region in particular. The panel begins this morning at 10 a.m. in the School of Nursing’s Evarts Lounge and limited seating may still be available; please RSVP to Kaleigh.Benedict@exec.ny.gov or Conor.McMahon@exec.ny.gov if you are interested in attending.

U.S. Senate Majority Leader Mitch McConnell has announced his intent to have a vote on the BCRA this week, though news reports suggest a delay is possible and the bill could undergo changes before the Senate votes.We are monitoring the situation closely through our own legislative contacts and professional groups—including the American Hospital Association, the Association of American Medical Colleges, the Hospital Association of New York State (HANYS), and the Children’s Hospital Association. Through these associations and our own efforts, we are lobbying to maintain coverage for Americans who have benefited from the Affordable Care Act, and to ensure that our most vulnerable patients are not left behind.

The Congressional Budget Office (CBO) estimated late Monday that the Senate bill would cut Medicaid by $772 billion and result in 22 million additional uninsured individuals by 2026, nearly identical to the 23 million uninsured estimate for the House bill -- which would also cut more than $834 billion in Medicaid funding over the next 10 years, and substantially weaken important consumer protections. HANYS estimates that under the House bill, nearly 104,000 people served by UR Medicine in Monroe, Livingston, Ontario, Allegany and Wayne counties would be at risk of losing health coverage. Statewide cuts to Medicaid would cost our hospitals and affiliated practices an estimated $350 million over the next ten years. We will of course continue to serve all patients who need medical care, regardless of coverage. However, these newly uninsured patients are likely to be sicker before seeking treatment, and the costs to our institution will be far higher than if they maintained regular access to care.

Our hospital leaders made these points in a June 15 letter to our U.S. Senators, who have pledged to work for legislation that maintains or improves access to care instead of cutting it. The University Office of Government and Community Relations has a website with copies of these and other statements, letters, and lobbying efforts under the “Affordable Care Act” tab.  

Many faculty and staff members have asked me what actions they can take to register their opinions about this important legislation. The American Hospital Association is part of the Coalition to Protect America’s Health Care, a broad-based group of hospitals, businesses, and national and state associations dedicated to educating the public about issues impacting hospitals and their patients, which has created a website with information and tips for getting involved. For the time being, we ask that any letters or comments regarding this legislation be made as individual citizens in accordance with the University’s Lobbying Activities Policy—on your own time, without using work resources or referencing your University title except for purposes of identification. As the legislative process moves forward, we may invite staff members to send letters or participate in other advocacy efforts as part of a coordinated lobbying effort with our national associations.  

Although these bills are of great concern, I also want to emphasize that we will take steps to ensure that they do not create a crisis for our institution. Our integrated financial model and the new forecasting tools we are developing will help to maintain stability as the economics of health care changes. Business improvement plans are being implemented across the organization to increase the efficiency of our work.  If and when any new legislation becomes law, we will develop a plan using these and other tools to minimize, as best we can, the negative impact on staff members, patients, and the communities we serve.