Thursday, December 29, 2016

Hospitals Brace for Nightmare of Obamacare Repeal

Back before many Trump voters cast their votes in what amounted to a possible act of suicide, I noted that many rural hospitals in Southwest Virginia - and a few urban hospitals too - faced possible bankruptcy and closure should Obamacare (as the new Gilded Age advocates in the GOP call the Affordable Health Care Act) be repealed.  Now, once Trump is sworn in and the GOP controls both houses of Congress, what hospital systems feared may be about to happen.  The irony is not only will many of the GOP voting areas see large numbers of residents losing health care coverage, but their local hospitals - typically among the locale's largest employers - closing down. It's as if these regions decided to not only take a fatal drug overdose, but also put a bullet in their own heads simply to satiate their hated of others with different skin colors, religious faiths and/or sexual orientation.   In my view, these voters deserve whatever horrors may befall them.  A piece in the New York Times looks at the self-inflicted threats to hospitals serving these cretins.  Here are excerpts:
PHILADELPHIA — Jason Colston Sr. went to the emergency room at Temple University Hospital last month with his calf swollen to twice its normal size. A bacterial infection had entered his bloodstream, requiring him to spend nine days at Temple, where patients are overwhelmingly poor.
Mr. Colston, 36, had no insurance through his job at a 7-Eleven, but it turned out he was eligible for Medicaid under the Affordable Care Act. Temple helped him enroll as soon as he was admitted, and Medicaid paid for his stay and continuing treatment.
Before the health law, the hospital had to absorb the cost of caring for many uninsured patients like Mr. Colston. Now, with President-elect Donald J. Trump and the Republican-controlled Congress vowing to dismantle the law, Temple and other hospitals serving the poor are bracing for harsh financial consequences that could have a serious effect on the care they provide.
Since the election, hospitals have been among the loudest voices against wholesale repeal of the health law. In a letter to Mr. Trump and congressional leaders this month, the two biggest hospital trade groups warned of “an unprecedented public health crisis” and said hospitals stood to lose $165 billion through 2026 if more than 20 million people lose the insurance they gained under the law. They predicted widespread layoffs, cuts in outpatient care and services for the mentally ill, and even hospital closings.
The stakes are particularly high for safety-net hospitals like Temple, but even more prosperous hospitals face uncertainty after investing in new ways to deliver care under the law.
Temple executives estimate their system could lose as much as $45 million a year if the law were entirely repealed, which would return it to the losses it posted for years before the health law took effect.
“We are the de facto community hospital in one of the poorest neighborhoods in the country,” said Robert Lux, the senior vice president, treasurer and chief financial officer of Temple University Health System, which includes two general hospitals and a cancer center. “Any kind of change like this would not only push Temple University Hospital into financial extremis, it would do the same thing for our entire system.”
Still, even hospitals serving affluent populations have reason to be nervous about a future without the health law. Main Line has invested substantially in response to the law’s push to base hospital pay on patient outcomes instead of the amount of medical services provided. Repealing the law would create uncertainty about the future of this new paradigm, which has forced hospitals to rethink how they deliver care.
Over all, the health law has improved the financial outlook of Pennsylvania hospitals significantly, even though the state was a year late in expanding Medicaid. The former governor, Tom Corbett, a Republican, initially balked, and the program did not expand here until 2015. Still, hospital operating margins statewide increased to about 5.5 percent on average in 2015, from 4.25 percent in 2014, according to the Hospital and Healthsystem Association of Pennsylvania. The amount of care provided to patients who cannot pay dropped by 8.6 percent on average.
Under the health law, hospitals that served a large number of poor and uninsured patients agreed to a series of funding cuts in exchange for getting far more patients with insurance coverage. Temple has lost about $11 million so far in these federal funds, known as disproportionate share payments, Mr. Lux said.
But like other hospitals in the 31 states that expanded Medicaid under the law, it has made up that revenue in part through the Medicaid expansion. It recorded about 13,000 more visits from patients with Medicaid coverage in 2015, the first year Pennsylvania expanded Medicaid eligibility, and at least as many this year. Still, Temple is barely turning a profit: It had operating income of $3.6 million in the fiscal year that ended June 30, despite revenue of $1.7 billion.  “Our current state of stability could be broken pretty quickly.”
So, too, could Temple’s efforts to connect its newly insured patients with preventive care instead of waiting until they show up in the emergency room with advanced, expensive illnesses. Dr. Robert McNamara, chairman of emergency medicine at the Lewis Katz School of Medicine at Temple University, said he had seen more than a few uninsured people arrive in the emergency room with kidney failure, needing costly dialysis for the rest of their lives because they had lived with high blood pressure for so long.
“We were finally in a situation where for most of our patients there was a coverage option,” said Anita Colon, Temple’s director of patient financial services, already speaking about the health law in the past tense. “Now there’s just a total unknown about what will be left.”

What is most troubling is that human excrement like Paul Ryan and many of the 81% of evangelicals who voted for Trump simply do not care about what happens to others.  They go to church each week and act all pious, yet in reality they are worse than the Pharisees of the Bible.  Their version of Christianity is a foul evil.  

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