The Senate voted 51 to 48 early Thursday to approve a budget resolution instructing House and Senate committees to begin work on legislation to repeal major portions of the Affordable Care Act. The House is expected to take up the legislation Friday.

Senate action came eight days after Senate Budget Committee Chairman Mike Enzi (R-WY) introduced the budget resolution for the remainder of fiscal year 2017 to begin the process to repeal and replace parts of the ACA. 

Concerned about the impact of repealing the law, the AHA issued a Dec. 14 Action Alert that asked hospital and health system leaders to contact their legislators and urge them to preserve coverage.

The Alert followed a study released last week by the AHA and Federation of American Hospitals (FAH) and completed by Dobson DaVanzo that shows repealing the ACA without simultaneous replacement could cause hospitals to lose billions of dollars if Congress doesn’t also restore cuts to hospital payments that were part of the 2010 law.

The groups on Dec. 6 sent joint letters to President-elect Donald Trump and congressional leaders highlighting the findings of the report that said hospitals would experience coverage losses of $165.8 billion between 2018-2026, if the ACA is repealed without a replacement.

Those losses include losses in revenue from those recently covered by the ACA – both on the insurance exchanges and through Medicaid.

The study also found that hospitals would suffer a loss of $289.5 billion in Medicare inflation updates if the payment reductions in the ACA are not restored. And it said failure to restore the ACA’s Medicare and Medicaid disproportionate share hospital (DSH) payment reductions would amount to $102.9 billion.

“Losses of this magnitude cannot be sustained and will adversely impact patients’ access to care, decimate hospitals’ and health systems’ ability to provide services, weaken local economies that hospitals help sustain and grow, and result in massive job losses,” wrote AHA President and CEO Rick Pollack and FAH President and CEO Chip Kahn. “As you know, hospitals are often the largest employer in many communities, and more than half of a hospital’s budget is devoted to supporting the salaries and benefits of caregivers who provide 24/7 coverage, which cannot be replaced.”

The hospital leaders urged the president-elect and Congress to preserve health coverage gains as part of any effort to repeal the ACA. If such protection does not occur, they urged them to restore reductions to payments for hospital services that were included in the ACA, and create a reserve fund so dollars are available for a replacement effort.

“We seek your support for the restoration of the Medicare hospital inflation update, as well as Medicare and Medicaid Disproportionate Share Hospital payments that support those facilities that take care of high volumes of uninsured, poor and disabled Americans,” the letter stated. “Restoring these cuts for the future is absolutely essential to enable hospitals and health systems to provide the care that the patients and communities we serve both expect and deserve.”

The study used as its starting point a bill that is the only ACA-repeal legislation that Congress has approved. It was vetoed in past January by President Obama.

That legislation would have eliminated crucial parts of the health law – among them, federal subsidies to purchase coverage through insurance marketplaces created by the law, penalties for violating its insurance requirements, and the expansion of Medicaid.

Borrowing from Congressional Budget Office estimates, the study says a similar repeal would cause an additional 22 million people to be uninsured by 2026.

At a Dec. 6 press briefing to highlight the report’s findings, Joann Anderson, president of Southeastern Health, a financially fragile rural hospital in Lumberton, N.C., said the prospect of repealing the ACA without a replacement to keep people insured is “gut-wrenching. We cannot take additional cuts.”

She said it would likely lead to a loss of behavioral services at her system, which is a primary provider of such care in what is one of the state’s most economically depressed areas. About 72% of Southeastern Health's patients are on Medicare and Medicaid.

“For this community and surrounding areas, that would be catastrophic,” Anderson said.

See the infographic for more information.