Rural hospitals await Obamacare decision

LACONIA — The U.S. Supreme Court is not expected to take up a challenge to the Affordable Care Act for months, but concerns over Obamacare’s future are not far from the minds of hospital officials.

A study by the North Carolina Rural Health Research Program found that 162 rural hospitals have closed since 2005, with most of the closures attributable to financial problems.

At Lakes Region General Hospital, major changes to the 10-year-old Affordable Care Act or to expanded Medicaid could exacerbate existing money problems. The hospital is looking to merge with a large health care organization to improve its finances.

“Yes, I worry about repeal of the ACA and Medicaid expansion,” said LRGH President and CEO Kevin Donovan. “Medicaid expansion has been good for NH Hospitals (including ours) and while Medicaid is not a great payer (40 cents on the dollar of cost), it is much better compared to no insurance.

“And, without insurance, patients forego care, ultimately costing them from a health perspective and all of us from a financial perspective (via the cost shift).”

He noted that the American Hospital Association’s advocacy efforts seek to preserve gains in health coverage made over the past decade and further expand coverage.

The association has pledged to actively defend the constitutionality of the ACA in the courts and promote its benefits in Congress and in the public arena.

On Jan. 21, the Supreme Court denied a legal motion from the House of Representatives and Democratic-led states for expedited consideration of a challenge to the Affordable Care Act. That means the future of Obamacare will likely not be known until after the election.

The act originally included fines for those who did not follow the “individual mandate” requiring people to buy insurance. In 2017, a Republican-led Congress zeroed out these fines. Opponents of Obamacare then argued in court that, without the fines, the entire law is unconstitutional. The Trump Administration supports the effort to overturn the law.

If the Supreme Court were to throw out the law, there likely would be upheaval in the markets and the potential for many people to lose their insurance. Also, doctors and hospitals would expect to see an increase in uncompensated care costs.

The Affordable Care Act has helped to reduce these costs, according to Protect Our Care, an organization that seeks to strengthen health services. 

According to that group:

• 12 percent of New Hampshire adults living in rural areas are uninsured compared to 8 percent in non-rural areas.

• Since the act passed, the uninsured rate has fallen by 4 percent in rural parts of New Hampshire.

• Between 2013 and 2015, New Hampshire hospitals’ uncompensated care costs decreased by $111 million, or roughly 52 percent.

On the other hand, Rep. Mike Sylvia, the Republic chairman of the Belknap County legislative delegation, said he would like to see an end to Obamacare.

"I don't think these big government programs are beneficial in the end," he said. "They cut into private industry, doctor choice or insurance choice."

He said he would favor a free enterprise system where people knew what they were paying for health care and could make informed consumer-driven choices.