ROBERT SIEGEL, HOST:
The American Hospital Association lobbied against this health care bill. It represents more than 5,000 hospitals around the country. And to hear how this legislation could affect them, we're joined now by Rick Pollack, the association's president and CEO. Welcome to the program.
RICK POLLACK: Thank you very much.
SIEGEL: Just after the vote, your group put out a statement saying that passage of this bill would jeopardize health coverage for millions of Americans, and you specifically mention older and sicker patients and those with preexisting conditions. What do you see actually happening to those patients if indeed this becomes law?
POLLACK: Well, states are given the opportunity to seek waivers, waivers that would allow changes in the essential benefit requirements that are existing under current law. It would allow, under those waivers, insurance companies to be able to charge higher amounts to people that have preexisting conditions. Those often are people with issues like cancer and chronic conditions. And that's a real concern to us.
SIEGEL: Well, of course the last-minute addition to the bill was to kick in $8 billion more for patients in just those situations - high-risk pools. Did that did that in any way ease your disappointment with this bill?
POLLACK: Not really. It's been an uneven track record over the years in terms of the utility of high-risk pools. And in relationship to the funding that was provided for it, it doesn't appear as if that will be enough to address the problems of people that are in that situation.
But in addition to that, the underlying bill, aside from the changes that you just referenced, included a lot of provisions that were very disappointing to us, provisions that would scale back the Medicaid expansions that gave coverage to many people and significant cuts in the Medicaid program which serves our most vulnerable patients.
SIEGEL: Well, how does all this then - how do you sum it up? Is it a problem for many hospitals whose bottom lines would be affected and would have to lay off people? Is it a situation where many patients would be turned away from hospitals? Is it one where hospitals would shut down?
POLLACK: You know, we take care of everyone that walks through our doors. That's a commitment that we make, and it's a promise that we make to the public. And we will continue to make it as long as those doors are able to stay open. But the real impact and the real concern is not so much on hospitals per se. It's on the people that we take care of and the communities we serve. And when tens of millions of additional people will be uninsured and lack coverage, that's a real concern to us. When those individuals don't have access to preventative care to prevent them from ending up in the emergency departments, that's a real concern to us. How we deal with...
SIEGEL: You would be concerned now about a return to the emergency room, something that you've seen less of under the Affordable Care Act.
POLLACK: The concern about coming back to the emergency room is that the emergency room shouldn't be the family doctor to individuals. We ought to be able to catch things in advance through having other access points. The emergency room isn't the place for really providing primary care. And that's one of the issues that we are concerned about, and that's why we care so much about people having coverage in the first place.
SIEGEL: Mr. Pollack, if health care costs don't come down, then debates as to whether we should be paying for them either through Medicaid or through private insurance or federal subsidies or high-risk pools are almost academic. Is - do you see any change, or have you seen any change during the period of the Affordable Care Act that say hospital costs would actually be less?
POLLACK: Well, we have seen a reduction in the rate of increase in Medicare spending, a reduction in the rate of increase in Medicaid spending. We've seen a reduction in prices. We have in fact seen efficiencies that have occurred in the delivery system through restructuring that has made it more efficient.
POLLACK: But again, the real issue here is coverage.
SIEGEL: Now that the bill goes to the Senate - the Republican bill - are you at all optimistic that some of your concerns will be heard and worked into legislation there?
POLLACK: We're hoping to see that the Senate restarts and resets this discussion. And I think that most House members would concede that what passed the House today is not going to be the final product. And we look forward to working with the Senate on that.
SIEGEL: But restart and reset means back to square one, if I hear you right.
POLLACK: The Senate is going to want to reconsider this and take a entirely different look. It's a different environment in the Senate.
SIEGEL: Rick Pollack, president and CEO of the American Hospital Association, thanks for talking with us.
POLLACK: Thank you for having me.
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