The officials who spoke at a Feb. 15 hearing on the possible fallout from the repeal of the Affordable Care Act didn't mince words. Getting rid of the law would hurt major hospitals, healthcare providers and the ability of low-income residents to secure medical treatment.
The hearing was convened by the Chicago City Council's Committee on Workforce Development and the Cook County Board of Commissioner's Committee on Workforce, Housing and Community Development.
During his first week in office, President Donald Trump signed an executive order saying that ACA should be repealed and replaced as soon as possible.
Cook County Commissioner Bridget Gainer (10th), who chairs the workforce committee, said that, although there is no way to know what would actually happen if the law were repealed, she and her counterparts in the City Council wanted to hold the hearing to get a sense of what the worst-case scenario would look like.
City employees, medical professionals and public health advocates in attendance said that repealing the ACA would increase the number of patients who use emergency rooms, straining the budgets of every single hospital.
Repealing the law would be particularly painful for charities at medical institutions such as Mt. Sinai and Loretto hospitals. The end of Medicaid expansion would leave tens of thousands of people without any kind of health coverage, as Cook County wouldn't have enough funds to keep it going.
When the Affordable Care Act was adopted, Illinois received funds to expand Medicaid program to cover low-income individuals who couldn't afford health insurance. Applicants could choose from a variety of plans. In Chicago, that includes CountyCare – a health plan managed by the Cook County Health & Hospitals System (CCHHS).
ACA also prohibited insurance providers from denying coverage based on existing conditions or dropping coverage when a person gets sick. In addition, it required everyone to have some kind of insurance.
Dr. Jay Shannon, the CEO of CCHHS, told the elected officials that ACA has been "integral" to the system's efforts to reduce the number of people using emergency rooms by shifting resources to local healthcare providers. This way, medical issues could be treated before they become dangerous and more expensive to treat.
And, thanks to ACA, the system spends less out of its own pocket to cover patients that do need hospital care.
"In addition, CCHHS has contracts with most other Medicaid managed plans in Cook County," Shannon said. "These are new sources of revenue for our health system that have once been largely dependent on local taxpayers for support."
This, along with other ACA provisions, decreased the number of uninsured patients, Shannon said. Prior to the passage of the ACA, more than half of patients in CCHHS were uninsured. In a follow-up interview, Shannon said that 67 percent of the CCHHS patients now have health insurance.
He said that, if ACA was fully repealed, over 50,000 patients who are currently covered by Medicaid expansion would be left without insurance coverage. In addition, CCHHS's budget would lose about $100 million. Hospitals and smaller community healthcare providers that aren't part of the system would be hurt, too, Shannon argued.
"It would also mean that we will no longer be able to pay other health care providers who currently give care to ACA adults," he said. "Virtually every hospital has seen its revenue improve because they are seeing more patients who used to be uninsured but now have Medicaid card."
Ald. Anthony Beale (7th) said that a number of his constituents were concerned about rising premiums, which Shannon attributed, in part, to the lack of an enforceable individual mandate.
Dr. Julie Morita, the Commissioner of the Chicago Department of Public Health, told the elected officials that ACA helped Chicagoans in a number of ways.
"As the result of ACA, colon cancer screaming among older adults increased by 10 percent," she said. "From 2010-2014 has seen fewer hospitalizations a year due to diabetes. Chicago's teen pregnancy rate has decreased to an all-time low due to [better] access to contraceptives."
Greg Kelley, the Executive Vice President of the Service Employee International Union Healthcare Illinois & Indiana, said that West Side hospitals are particularly vulnerable to the consequences of a possible repeal of the ACA.
"Safety net hospitals like Loretta, Roseland and Mt. Sinai are already operating on shoe string budgets," he said. "[ACA repeal] will dramatically reduce access to healthcare in vulnerable communities and result in suffering and debt."
Angela Waller, Loretto Hospital's community relations manager, said that the majority of Loretto's patients have Medicaid.
"It would hinder access to care in our community and impact health outcomes that are already challenged in Austin," she said.
Some elected officials wondered whether there was a way to keep CountyCare going, but Cook County Commissioner Robert Steele (2nd) said that that simply wouldn't be feasible.
"Realistically, we don't have anything to make up that gap," he said.
On Feb. 18, U.S Rep. Danny Davis (7th) held a press conference to highlight concerns about ACA repeal. He said that he didn't want the Chicago area's healthcare system to regress if ACA is repealed. Davis added that Republican lawmakers in Congress lack empathy.
"They don't necessarily want for the taxpayers what they find desirable for themselves," he said. "They don't need what ACA has provided, because they already got it."
Illinois State Rep. Marry Flowers (31st), who chairs the House's Heath Care Availability Access Committee, said that ACA repeal was unacceptable.
"There are some things that need to be tinkered, but to repeal and replace — replace with what?" she said. "[Before ACA] we had patients who died because they couldn't afford access to healthcare. This is America. We shouldn't [have] that. "
Ald Jason Ervin (28th) said that West and East Garfield parks, which make up most of his ward, have faced issues with access to quality healthcare. ACA helped, he said, but its repeal would be a huge step back.
"It will cause more people to lose coverage, and we'll see more preventable deaths," he said.
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