Monday, January 9, 2017

Last Call For That Death Spiral Thing

Republicans are busy putting out press releases that they and they alone can save the "failing" health care sector by repealing Obamacare, but the reality in hospitals and doctor's offices and urgent care clinics across the country is that the GOP plan to repeal the law without an alternative will cause tens of billions in economic damage and hurt millions of Americans, and health care providers and insurance companies are now in a state of near-panic.

Hospital and health plan leaders talk in almost apocalyptic terms about what might lie ahead if Republicans abolish Obamacare without a blueprint for its replacement. 
Their doomsday scenario: Millions of people could lose their health care coverage, hospitals could hemorrhage cash and shocks to the $3 trillion-a-year health system could send ripples through the entire economy.

“That transition period is going to be like that slow-moving tsunami that we know is coming, and we can watch it and try to prepare for it — but in the aftermath of the tsunami, there’s devastating loss that we never could have planned for,” said Heidi Gartland, vice president for community affairs and government relations at Cleveland-based University Hospitals Health System. 
Hospitals estimate that repealing Obamacare could cost them $165 billion by the middle of the next decade and trigger “an unprecedented public health crisis" if sick people are unable to get care. Even before that happens, though, uncertainty about what might replace the law and how it could affect the bottom lines of hospitals, in particular, has spurred CEOs to cut spending. 
“Everybody is going to continue to belt tighten and take action fearing the worst is going to happen,” said William Conway, CEO of Detroit’s 1,300-physician Henry Ford Medical Group. 
That anxiety has already claimed casualties: The Advisory Board Company, which provides services to health care firms, announced last week that it is laying off 220 people because hospitals hit the brakes on spending following the GOP sweep. Providers warn the situation will worsen the longer Congress goes without passing a replacement as fears of mounting losses prompt decisions to close programs, trim staffs and curtail care.

The healthcare sector is already starting to weaken as a result.  Without knowing what's coming, the industry can't plan, won't hire, and is resorting to hunkering down until the storm is over.

Unfortunately, this storm is going to cost lives too, lives ruined by Republicans. It won't be mere statistics, either.

But this is what the GOP promised to do.  Following through on that promise is a lot harder than they realized of course. Vox's Sarah Kliff notes that repeal is starting to look very shaky in the Senate.

Republicans are struggling to maintain party unity on leadership’s preferred “repeal and delay” strategy. There are at least seven Republican senators who have expressed reservations about the idea of repealing Obamacare and setting a deadline a few years in the future to come up with a replacement. Three defections from the 52-member Republican Senate caucus would be enough to sink a repeal-and-delay bill, which would need 50 votes to pass. I expect this list of seven to grow, as there are still dozens of senators who haven’t voiced an opinion either way on the matter. 
Republican governors are trying to slow down Obamacare repeal. Governors who expanded Medicaid are starting to voice concern about the effect of repeal in their states. This includes Republican Govs. John Kasich of Ohio and Rick Snyder of Michigan. “Our hospitals needed Medicaid expansion,” Kasich told reporters last week. “It has worked very well in this state.” 
The Republican Party is fracturing around Obamacare in ways we haven’t seen before. This is happening for a simple reason: It’s really, really hard to end health insurance benefits for 20 million Americans, especially when you don’t have a plan for what comes next. I still think repeal is the most likely outcome of this debate — it just doesn’t seen nearly as certain possibility as it did a month ago.

If Americans figure out the first thing the GOP does for them is take away their health insurance and access to health care, they are going to revolt as they did in 2006 and 2008.

But even if the GOP doesn't go through with repeal, the uncertainly may kill Obamacare anyway.

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