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Access to Care

ACA Repeal and Replace

The U.S. Senate’s Better Care Reconciliation Act of 2017 includes deep cuts to the Medicaid program, which serves nearly 2.8 million of Pennsylvania’s children, pregnant women, seniors, and individuals with disabilities. Please click here to contact our U.S. Senators and tell them how Medicaid has helped your hospital.

Pennsylvania hospitals have been committed to and engaged in health care reform efforts that have reduced the ranks of the uninsured and advanced the Triple Aim—improving overall health and the safety and quality of health care while reducing per capita U.S. health care spending.

Federal policymakers are in the process of reconsidering the Affordable Care Act (ACA).

HAP has produced an interactive state map to help the public and policymakers understand the Affordable Care Act’s health care coverage impact in the state’s Congressional districts.

View Map

The hospital community has stood firm in its commitment to coverage and transformation. As such, any alternative to the ACA must:

Ensure continuity of coverage and care through access to a robust, competitive delivery system
Ensure stable and sufficient funding for hospitals
Maintain momentum in delivery system transformation and innovation

Leading into the 115^th Congress, the Republican-controlled Congress and the incoming Trump Administration pledged to take swift action to repeal the ACA. Those advocating for repeal have cited key areas of concern with the law including federally imposed mandates, instability and rising prices under the health insurance marketplaces, and a greater role and financial responsibility of the federal government in health insurance coverage.

Congress is grappling with how to approach repealing the law, and what alternative health care reform policies to pursue.

Policy concepts to address coverage and Medicaid reform that have been contemplated by Republican policymakers include:

Market-oriented, consumer-driven mechanisms to expand coverage such as health savings accounts and refundable tax credits
Insurance Market Reforms—retaining some of the consumer protections of the ACA, or attempting to achieve similar means through alternative policies
High-risk pools and default options for the uninsured
Tax Treatment of Employer-Sponsored Coverage—replacing the current Cadillac tax with a cap on the exclusion for employer-sponsored insurance
Medicaid Reform—proposals to block grant or provide a per-capita allocation, and reform through waivers

Pennsylvania hospitals face significant implications if repeal is not coupled with adequate replacement policies:

Coverage: 1.1 million Pennsylvanians have benefit from health care coverage through the health insurance marketplace, Medicaid expansion, and dependent coverage. More than 412,000 Pennsylvanians have gained health insurance coverage through the marketplace, with 78 percent relying on subsidies, and from 2013 to 2016, 685,000 Pennsylvanians have secured coverage through Medicaid or the Children’s Health Insurance Program (CHIP). Millions of Pennsylvanians have also benefited from consumer protections secured as a result of the ACA—coverage for patients with pre-existing conditions, no lifetime limits, a minimum essential benefits package.
Funding to support care: A report, issued by the American Hospital Association (AHA) and Federation of American Hospitals, details the impact ACA repeal would have on hospitals and health systems nationwide. ACA-mandated hospital cuts will amount to $14.9 billion for Pennsylvania hospitals for the period of 2018 to 2026. Hospitals will need that funding to address the additional uncompensated care that will result from growing numbers of uninsured patients.

ACA IMPACT – INFORMATION AND RESOURCES

HAP President and CEO Andy Carter Letter to Pennsylvania Delegation (Download PDF) -3/22/17

SUMMARY: The American Health Care Act (Download PDF) - 3/1/17

PA Health Care Providers Letter to Pennsylvania Congressional Delegation (Download PDF) - 5/2/17

PRESENTATION: The American Health Care Act: Policy and Implications (Download PDF) - 3/28/17

Analysis of the CBO Report and Implications for Pennsylvania (News Article) - 3/13/17

AHA Letter to Members of Congress on AHCA (Download PDF) - 2/16/17

Report Card Health Care Transformation in PA (Download PDF) - 2/14/17

PRESENTATION | Fundamentals of Medicaid (MS PowerPoint) - 3/2/17

INFOGRAPHIC | Repealing the ACA: Coverage Consequences (Download PDF) - 3/17

Regional Economic Impact of Pennsylvania Hospitals and Health Systems (Download PDF | MS PowerPoint) - 2/17

POSITION PAPER: Coverage Consequences (Download PDF) - 3/2/17

POSITION PAPER: Eliminating Medicaid Expansion (Download PDF) - 2/17/17

POSITION PAPER: Medicaid Financing Reform (Download PDF) - 2/17/17

POSITION PAPER: Health Care Transformation (Download PDF) - 3/1/17

NEW HAP POSITION: Medicaid DSH Payments (Download PDF) - 9/14/17

NEW POSITION PAPER: Repealing the ACA: Addressing Insurance Rate Increases (Download PDF) - 9/6/17

NEW POSITION PAPER: Repealing the ACA: Stabilizing the Insurance Market (Download PDF) - 9/6/17

NEW RESEARCH BRIEF: Extend Funding for S-CHIP (Download PDF) - 9/8/17

Health Care Transformation

By the Numbers: Health Care Transformation in PA (Download PDF) - 2/17/17

Health Care Transformation in Pennsylvania Before and During the Affordable Care Act (ACA) (Download PDF) - 2/17

Economic Impact

MAP | Projected Regional Economic Impact of Medicaid Expansion in 2016 (Download PDF | MS PowerPoint) - 2/17

The Commonwealth Fund recently released a survey assessing the extent and quality of coverage for U.S. working-age adults, and an interactive map that lays out states' efforts to access adequate health insurance.

Supreme Court Committee Postpones Consideration of Venue Rule Change by Rmoore@haponline.org

Following significant outcry from the hospital community, health care leaders, business leaders, and policymakers, the Pennsylvania Supreme Court Civil Procedural Rules Committee today announced that it will delay making changes to a key medical liability rule until it has reviewed the results of a legislative study.

Newly Introduced Federal Legislation Would Offer Flexibility for Rural Hospitals to Meet the Needs of Rural Communities by Rmoore@haponline.org

Two new legislative proposals introduced in the U.S. House of Representatives would provide flexibility for rural providers to appropriately manage the length of stay of patients served by critical access hospitals and better leverage the clinical workforce to provide care to patients in underserved communities.

House State Budget Hearings Begin with Independent Fiscal Office by Rmoore@haponline.org

Today, the state House Appropriations Committee began its series of Pennsylvania state budget hearings, with testimonies from the Independent Fiscal Office (IFO), Department of Revenue, and Department of Aging.

HAP Convenes Health Care Talent Task Force; Efforts Align with Governor’s Budget Priorities by admin

HAP has convened a Health Care Talent Task Force to guide the development of strategies that will help attract and retain the health care talent pool needed to provide quality, patient-centered care for Pennsylvania communities. The goals of the workforce align with the Governor’s dedication to developing Pennsylvania’s workforce as expressed during his recent budget address.

New AHA and HHS Roadmaps for Sustainable Rural Health Care Align with HAP Initiatives by admin

The American Hospital Association (AHA) this week released a new report, “Challenges Facing Rural Communities and the Roadmap to Ensure Local Access to High-quality Affordable Care,” outlining the challenges that threaten rural hospitals’ ability to maintain access to health care services in their communities. Also this week, in remarks at the National Rural Health Association’s meeting in Washington, D.C., Alex Azar II, U.S. Secretary of Health and Human Services (HHS) unveiled three strategies for making rural health care affordable, accessible, and high quality.

Governor Wolf’s Budget Proposal Protects Hospital Supplementals and Tobacco Funds and Spotlights Workforce Development by Rmoore@haponline.org

HAP Statement: Governor’s Budget Plan Protects Key Hospital Funding Lines, Spotlights Workforce Development by Rmoore@haponline.org

Andy Carter, President and CEO of The Hospital and Healthsystem Association of Pennsylvania (HAP), released the following statement regarding Governor Tom Wolf's state budget address, which was delivered today.

State Senate Passes Senate Judiciary Chair Baker’s Resolution Calling for Study on Venue Rule Change by jkissinger@haponline.org

Senate Judiciary Committee Chair Lisa Baker (R-Luzerne) secured Senate approval for her resolution to study the Supreme Court Civil Procedural Rules Committee’s proposed rule change to venue.

HAP Supports House Republican Leaders’ Efforts to Protect Access to Care, Fight Return of Venue Shopping by jkissinger@haponline.org

HAP joins House Republican leaders, physicians, and business and health care executives to address venue reform and access to care.