Healthcare providers across the nation are unsure of whether they will be able to survive an abrupt repeal of Obamacare without a comprehensive replacement.

Millions of patients now insured through the state or the federal Marketplaces under the Affordable Care Act and many receive some form of cost assistance for health insurance. Additionally, millions more are insured through Medicaid expansion in 31 states and DC, who weren’t before the ACA (encouraging and funding the expansion of coverage to non-disabled low-income adults).

How many people will no longer be able to afford health insurance if the ACA is repealed? How many of those will no longer utilize primary and preventative care before medical conditions require emergency medicine or long-term care? What effect will this have on healthcare providers? Or the healthcare industry as a whole including device makers, drug makers, and insurers?

One of the primary improvements under the Affordable Care Act for healthcare providers was an increased demand for services brought on by fewer people being inhibited by cost for primary and preventative health care. While high deductibles pose obstacles for many patients even with the new expanded coverage options, that increased demand for preventive care (covered before deductibles) pushed an increase in facilities and primary care providers for those services. A full loss of coverage for those individuals means demand could plummet if the ACA is repealed and not immediately and adequately replaced.

Expanded coverage under the Affordable Care Act is predicted to increase by 2019 the number of annual primary care visits between 15.07 million and 24.26 million. Assuming stable levels of physicians’ productivity, between 4,307 and 6,940 additional primary care physicians would be needed to accommodate this increase.

What happens if millions of Americans go back to being uninsured? Certainly, new jobs aren’t added, and current jobs could be on the line too, along with the well-being of those who would lose coverage.

FACT: Congressional Republicans are leaning toward a plan that would repeal the law early next year, but may delay enacting a new system for up to three years. This poses real issues to providers who accepted new rules and public health program cuts in exchange for increased business with the ACA. See: Hospitals Issue Dire Warnings About Repealing Obamacare Without A Backup Plan.

How Could Could a Replacement Plan Address The Providers Concerns?

There are options for designing a comprehensive, possibly simpler, replacement plan for the ACA, and many discussions and debates have been had here on ObamacareFacts.com about various replacement plans that have been proposed.

When we consider addressing cost and access for providers, one smart solution may be including a unified national public health network in a replacement plan. It should be possible to accomplish without needing additional taxes for public health, as it could use existing tax revenue for Medicaid, Medicare, CHIP, L&I, Native Health, and Federal Employee Health Benefits (all or any combination). Not only can a public network address some of the issues associated with repeal, but it can also be combined with other proposals such as a public option, GOP-favored expanded HSAs, tax deductions for premiums, and sliding scale fees for the services by those network providers when patients are uninsured.

While a Nationwide Public Healthcare Network isn’t all that would be required in a comprehensive replacement plan for the Patient Protection and Affordable Care Act, I believe it is a critical element to include. It ensures a strong primary and critical care structure regardless of the future of healthcare reform.

The bottom line is simple, without healthcare providers to administer care, then insured rates, assistance levels, drug makers, device makers, insurers, and even government healthcare spending levels are nearly useless.

What do you think?

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