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How to Make Sure Hospitals Are Ready for Obamacare Repeal

The opinions expressed by columnists are their own and do not necessarily represent the views of

You knew it wouldn’t take long, and it hasn’t.

On the first day Congress was in session and still two weeks before Donald Trump is to be sworn in as president, one of his tweets already has made it to the floor of the Senate.


It came from Bernie Sanders, socialist, failed presidential candidate and ranking member of the Senate Budget Committee.

With the quote printed out and pasted to a larger paper on an easel behind him, Sanders was urging the president-elect to veto any legislation that cut Medicaid, Medicare and Social Security.

“Let me quote someone who I suspect I will not often be quoting,” Sanders said. “On May 7, 2016, Donald Trump tweeted, ‘I was the first & only potential GOP candidate to state there will be no cuts to Social Security, Medicare & Medicaid.”

Sanders went on to point out “Trump didn’t just say this in passing. This was a cornerstone of his campaign.”

It’s no less uncommon for those on the right to admit Sanders has a point. But he does in some aspects. Because, although it is most satisfying to talk about removing Obamacare root and branch, some steps will have to be taken to ensure the infrastructure of American health care, particularly for seniors, does not collapse afterward.

That means, when Obamacare is repealed, Congress and the president will have to restore Medicare funding to hospitals. Obamacare will cause 22 million who now are covered by policies purchased from the exchanges or under Medicaid to lose coverage, and many will be forced to seek care for which they can’t pay.


Hospitals always have cared for indigent patients and always will in the United States. But the more than $700 billion in Medicare cuts under Obamacare hit them hard, and they’ll need some assistance to offset a surge in uncompensated care that could total nearly $170 billion.

Since Obamacare passed in 2009, it has become harder and harder to figure out who benefits. It’s not the patients. The rollout was a disaster, premiums have skyrocketed to levels never before seen, thousands and thousands have lost their jobs or seen their hours reduced, and the coverage has become characterized by exceedingly high deductibles, which makes it of little use to the people forced to buy it.

It’s not the doctors. The relationships they worked hard to build with patients and which are indispensable to holding down the cost of care were obliterated. President Obama’s solemn and repeated promise that “if you like your doctor, you can keep him” was named Politi-Fact’s lie of the year in 2013.

And it certainly wasn’t the hospitals. The law authorized $715 billion in reductions to them over 10 years. Many of the bad outcomes of the law were not fully appreciated when it took effect, but Richard Foster, chief actuary of the Centers for Medicare and Medicaid Studies, identified the problems with this provision right away.


In his very first assessment of the law’s impact, on April 22, 2010, Foster said the payment cuts would make 15 percent of hospitals and other Medicare Part A providers unprofitable and thus “jeopardize” seniors’ access to care.

That August, he revised his estimate to claim 25 percent of Medicare providers could have “negative” profit margins by 2030 and 40 percent by 2050. Most, he predicted, would not be able to sustain these losses and would have to close or leave the program. It’s already a dicey financial proposition to operate hospitals in less-populated areas. Without them, millions of Americans would find themselves hundreds of miles away from care.

It’s even worse for the skilled nursing facilities and home health agencies that figure to be the growing sector of care delivery in coming decades. The Centers for Medicare and Medicaid Studies estimates 70 percent of nursing facilities and 90 percent of home health agencies will not be able to afford to serve Medicare patients by 2040.

Obamacare has been an unmitigated disaster for Democrats. They’ve lost 62 seats in the House of Representatives and 11 in the Senate since it passed. Republicans have gone from controlling nothing in Washington from 2008 through 2010 to now controlling both chambers and – come Jan. 20 – the White House. In addition, we now have 36 Republican governors and more than 1,000 more Republicans in state legislatures across the country in large part because voters looked for any opportunity to express their opposition to Obamacare.


Republicans should do all they can to repeal as much of the law as possible as quickly as possible. The voters who have given them these electoral victories are becoming frustrated at their inability to pull the trigger.

But although Americans want to get rid of Obamacare, they will not look kindly on a Congress, administration or political party that leaves seniors vulnerable to government-induced financial turmoil at their local community hospitals.

So proceed with vigor. Celebrate appropriately. But remember, the president-elect has promised to preserve Medicare and restore the Obama-led cuts. All that’s needed for Democrats to get back into the electoral game is for Republicans to mess this up.


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