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What Hospitals Think Of The GOP Health Care Plans


For the third day in a row, lawmakers will take to the Senate floor and cast votes for a plan to fix the country's health care system. The Senate has already rejected some of the proposals on the table. But Republican leaders now appear to be focusing on what they're calling a, quote, "skinny repeal." This is something that would roll back parts of the Affordable Care Act that are the most unpopular. We're going to get one perspective from the health care industry itself. Tom Nickels is the executive vice president of the American Hospital Association. He joins us now. Thanks so much for being with us, Mr. Nickels.

TOM NICKELS: Glad to be here.

MARTIN: I imagine this perpetual ambiguity over health care is making your life rather stressful these days?

NICKELS: These are busy times for sure. And things keep changing by the day. Things changed last night. And I'm sure they'll be different tomorrow than they are today.

MARTIN: You represent thousands of hospitals. What's on the line for those facilities that you represent?

NICKELS: Well, I think the most important thing for us and for my members is coverage, coverage of individuals under Medicare, coverage of individuals who purchase insurance on the markets. And that's what we've been completely focused on. And we'll keep being focused on it until this is over.

MARTIN: Is there anything about this, quote, "skinny repeal" idea that you like?

NICKELS: Well, looking at it on the merits, there are parts that we like. For example, they get rid of the Medicaid cuts, you know, in excess of $700 billion in cuts to the Medicaid program. And they don't roll back the expansion of the program. That's a positive move. On subsidies, they don't reduce the subsidies, practically $400 billion in the underlying bill. They don't do that either. So that's a plus and a recognition, I think, that those are not policies that can pass the Senate.

However, there are also some downsides to it, which is the elimination of the individual mandate. And what will that do to the marketplace? Will it destabilize? And how many more people will lose their coverage? The other concern, of course, is we can look at the bill on the merits. That's one thing. But also, what is this in terms of a political move? This is potentially - and I think Senator Corker talked about this pretty publicly yesterday. This is potentially just an effort to get something passed to get to a conference with the House. And we have real, serious problems with the House bill.

MARTIN: So talk about those. What is the most egregious part of the House bill, as you see it?

NICKELS: Well, I think the most egregious part is Medicaid. And in two parts, one is, again, it rolls back the expansion of the Medicaid program, beginning on January 1st of 2020. And secondly, it completely restructures the Medicaid program into a per capita cap arrangement. And it's not so much that arrangement but the dollars that come out of the program in excess of $800 billion under the House bill. And to us, that is just untenable. And it will do significant harm to people who really need that coverage.

MARTIN: We have seen an effort for a wholesale repeal of the Affordable Care Act. That didn't work. But if the substance of the Affordable Care Act or at least a significant part of it, the individual mandate goes away through something like a skinny repeal vote, what would be the consequences? I mean, that lowers the number of people who are paying into the system.

NICKELS: Right. So I think you could look at two consequences right out of the box. The first is - and the Congressional Budget Office has said this - that potentially as many as 15 million people could drop coverage. Now, again, we'll need to see the CBO - a new number from them to know that for sure. This is a two-year-old piece of data. But that's the first problem. The second thing is what does it do to the market?


NICKELS: Because the whole notion is to have people, healthy people, sick people in between, all need to be in. And this could potentially really disrupt the market.

MARTIN: Tom Nickels, he's executive vice president of the American Hospital Association. Thanks so much for your time this morning.

NICKELS: Thank you.