ROBERT SIEGEL, HOST:
Michael Abrams is president of the Ohio Hospital Association. He's in Washington to talk to lawmakers about health care. And first, briefly, from what you've heard of the House Republican bill, is it an improvement over the Affordable Care Act?
MICHAEL ABRAMS: It's not. We have some pretty serious concerns with the shape that their bill has taken. We've said from the very beginning of this discussion that our paramount priority was coverage. And so our industry throughout Ohio and really throughout the country is quite concerned that the bill does not do what we need to see done with coverage. There are a million Ohioans who have coverage due to the ACA, and we're very concerned with the future of that under this proposal.
SIEGEL: I want to ask you about those who have coverage because of the Medicaid expansion. States had the option of doing that. Ohio Governor John Kasich did it.
SIEGEL: How would your member hospitals be affected by the changes to Medicaid that the Republican bill proposes?
ABRAMS: That's a good question. One in 4 Ohio hospitals is in what I would consider very precarious economic circumstances. Thirty-six of our hospitals are operating in negative margins. An additional 14 have margins under 2 percent. So we looked at the impact of Medicaid expansion as being about a 3 percent positive for Ohio hospitals. So with those kinds of numbers, we are quite concerned that fully 25 percent of our hospitals in Ohio would be at risk of closure under a proposal like this.
SIEGEL: You mean - you're assuming that people who now have Medicaid, if even those who are added to the Medicaid program under the ACA, if they could no longer be covered, the loss of those paying patients via the Medicaid program would sink those hospitals, is what you saying?
ABRAMS: It would certainly have that kind of an impact, absolutely. Seven hundred and fifty thousand people from our state are on the Medicaid expansion population. But another quarter million have coverage due to the ACA's exchange provisions.
So, you know, when you look at those million people who right now have some semblance of coverage being knocked back into the ranks of the uninsured, that can take a precariously situated hospital and put them into a situation where they could no longer provide services to the community.
SIEGEL: As for those who gained insurance through the exchanges under the ACA, you know the argument, which is that if Congress were to do nothing, critics of Obamacare say there'll be a death spiral, and the system will break down of its own flaws. Is that accurate in Ohio?
ABRAMS: You know, I don't think the critics are wrong about that. I really don't. I've looked at that, and I agree that we need to be about the business of perfecting an imperfect law, and that includes looking at the exchanges. That includes looking at why the co-ops did not perform well and trying to figure out how we can make changes to improve that. But I think that this bill does put all of those people who were newly covered in jeopardy of not being covered at all.
SIEGEL: And, Mr. Abrams, just to be clear, are you at risk here of drawing the worst conceivable case by comparing who's covered today with nobody being covered? That is, some people who gained coverage through the Affordable Care Act presumably would manage to get insurance through the new system, wouldn't they?
ABRAMS: Well, I mean, that's possible certainly. But I think my concern is that they would not be. I think that the provisions that are included in the bill that seek to guarantee coverage fall far short of being a guarantee. It's possible that a percentage of the people who gained coverage under the ACA would be able to navigate the complexities of the tax code and retain coverage. But I worry that that percentage would be very small.
SIEGEL: Mr. Abrams, thank you very much for talking with us today.
ABRAMS: My pleasure.
SIEGEL: Michael Abrams, who's president and CEO of the Ohio Hospital Association.
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