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AHCA Would Shred Healthcare Infrastructure

By John Commins  
   March 15, 2017

It is estimated that the Republican plan to repeal and replace the Affordable Care Act would reduce federal Medicaid spending by $880 billion over the next 10 years. That would have a devastating effect, particularly in rural America.

As many as 24 million Americans could lose their health insurance over the next decade if the American Health Care Act is enacted. That's according to the nonpartisan Congressional Budget Office's staggering assessment of the Republican plan to repeal and replace the Affordable Care Act.

As a result of this draconian contraction in coverage, the AHCA is also expected to generate about $337 billion in net savings for the federal government between 2017-2026.

The CBO says most of that savings would come from reductions in federal Medicaid spending, which would amount to $880 billion over the 10-year span, in part because of a shift to a per-capita, capped entitlement. That estimate does not include the billions of dollars in state Medicaid matching funds cuts that are likely when the federal dollars disappear.

Let that sink in.

Rural America is disproportionately dependent upon Medicaid as a primary health insurance source for a generally older, sicker, poorer population.

It has been widely reported that the AHCA's ill-effects would be felt mostly by older, rural Americans (ironically, a key demographic for President Donald Trump.) We can well imagine what will happen to the quality of life for millions of Americans who may find themselves without healthcare coverage if the ACA's Medicaid expansion is repealed and alternative coverage becomes unaffordable.

Beyond that debacle, imagine how a $880 billion funding loss in the public healthcare safety net is going to be absorbed by thousands of hospitals across the United States, many of which are already under financial duress.

The demand for healthcare services doesn't evaporate when the funding dries up. These tens of millions of newly uninsured people will access care through the emergency department, just as they did before Obamacare.

Unintended Consequences
As bad debt and uncompensated care soar, how many of these hospitals will shutter, and what will the impact of those closures mean, not just on care access, but on the economic vitality of the communities these hospitals serve?

John Commins is a senior editor at HealthLeaders.

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