Guest Columnists

ACA repeal must reinstate hospital reimbursements

A nurse holds a syringe filled with the flu vaccine. (Mark Boster/Los Angeles Times/MCT)
A nurse holds a syringe filled with the flu vaccine. (Mark Boster/Los Angeles Times/MCT)

As President Donald Trump and the Republican-controlled 115th Congress get to work, I’m glad to see that one of their main priorities is the repeal and replacement of the Affordable Care Act. But while I’m wholly in support of dismantling this misguided and destructive law, as a rural Iowan who understands the key health and economic role hospitals play for our communities, I also urge caution in how they move forward.

Repealing the ACA will be for naught if patients and health care providers continue to pay the price for poorly structured public policies.

Most urgent is the issue of Medicare hospital reimbursement payments. Under the ACA, hospitals, clinics, and other providers took a major financial hit. By taking away significant Medicare hospital reimbursement funding from medical facilities and doctors, the ACA forced many facilities to shrink their services or even close down due to the crippling amount of uncompensated care they had to absorb. If Congress passes an ACA repeal bill without reinstating these payments, hospitals will be in an even worse position.

If this occurs, U.S. hospitals face a nationwide uncompensated care tally of more than $1 trillion over a decade. In Iowa, the number is just as scary — about $2.7 billion. There is simply no way our hospitals can handle such a massive burden of uncompensated care. If they are forced to, it will not only be these facilities themselves that pay the price, but rural residents and seniors as well.

Most seniors in our state rely on Medicare, and rural residents more often have access to the kind of community hospitals that get a significant portion of their patients from Medicare. If these facilities close, limit services, or shut down, seniors and rural people will face major hurdles in accessing care.

At the same time, our economy will suffer. The health care sector is an important component of a healthy, growing economy in our state. Nearly 70,000 Iowans work full time or part time in hospitals, more than 7 percent of our workforce.

Repealing the ACA without restoring Medicare hospital reimbursement payments would result in the loss of roughly 26,000 Iowa jobs in health care, construction, real estate, retail, insurance, finance, and the public sector.


It is essential that we repeal the ACA. But it is also essential we do it right. Congress must include restoration of Medicare hospital payments as part of their repeal efforts.

• Marlys Popma, Rock Creek Lake, is former president of Iowa Right to Life Committee, former executive director of the Republican Party of Iowa and former board member on the National Cancer Advisory Board, the oversight board of the National Cancer Institute. She is a 17-year survivor of breast cancer and is the campaign director at Campaign Headquarters in Brooklyn, Iowa.



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