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Affordable Care Act repeal could have big impact on economy


Emergency rooms must care for anyone who shows up, regardless of insurance or ability to pay. Amy Pollard, CEO of University of Rochester Medical Center’s Noyes Hospital, in Dansville, knows that federal law well.

“If you had no health insurance, but you felt ill and you presented to an emergency department here we have to take care of you. And we have to take care of you knowing we may not get paid anything for that care,” Pollard said.

But with the Affordable Care Act, a lot more people -- an estimated 20 million -- got health insurance. That means hospitals haven’t been eating costs as much.

“The more people that are out there without coverage, the greater financial burden that is for the hospital providing the care because we’re not going to get paid for that care,” Pollard said.

While people across the country wonder what’s going to happen to their health insurance, some experts are pointing out that the Affordable Care Act is not just about insurance. The Affordable Care Act set off major changes to the funding that hospitals, states and counties receive from the federal government, for example.

Now, some stakeholders say an ACA repeal, without significant replacement, will threaten financial stability -- not just for hospitals -- but for local economies as well, including jobs.

During the development of the Affordable Care Act, medical associations agreed to less Medicare funding -- $165 billion over time -- from the federal government, with the understanding that more people would be insured under the ACA.

Picture a seesaw with the uninsured on one side and federal Medicare payments on the other. If both are lifted off, the seesaw should hypothetically even out.

“That’s basically the equation that launched the Affordable Care Act,” said Dr. William Streck, chief medical and health systems innovation officer at the Health Care Association of New York State.

But it wouldn’t just be hospitals that would deal with ramifications of a larger uninsured population, Streck added, because of the complexities of the Medicaid program.

Funding for the Medicaid program is like a stack of funnels: The money sifts down from the federal government to states and then counties. In New York, Gov. Andrew Cuomo’s report estimates that the state would be looking for $3.7 billion if the ACA is repealed without replacement.

“It has consequences -- it ripples through the economy. I think that is one thing people have to realize,” Streck said.