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Judy Rich: Simply repealing Obamacare would harm Arizona hospitals, residents

Judy Rich: Simply repealing Obamacare would harm Arizona hospitals, residents

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On the last day of enrollment in early 2016, the TMC enrollment team received a frantic call from a woman looking for insurance. There were only a few more hours left, but the TMC team told her to come right over so they could help her get enrolled through the federal marketplace. She left that day, secure that she had a means to protect her health. Not long after, she was diagnosed with cancer. She was able to get the vital treatments she needed to fight the cancer and continue as a productive member of our community able to support herself and her family. Today, her future is bright.

Multiply that story by 20 million and you can get a better picture of the impact of the Affordable Care Act and the expansion of Medicaid in Arizona. In Pima County, the uninsured rate has dropped from 17 percent to 10 percent in the span of a few years. And from the hospital perspective, statewide uncompensated care costs as a percent of net revenue have more than halved: from 8 percent at the height in 2013, to 3.4 percent in 2015.

At TMC, we absorbed $25.6 million in such costs in 2013, which dropped to $8 million by 2015.

Of course, like any piece of substantial legislation, the Affordable Care Act is not perfect. We have always recognized improvements could be made — and stand ready to work with Congress on a replacement program.

We are at an important crossroads today. Some advocate repealing the act in whole without a replacement plan to ensure coverage for millions and provide appropriate funding to the health-care system we all rely on. The American Hospital Association has estimated that a straight repeal would cost hospitals more than $165 billion between 2018 and 2026 — and that number would be exponentially higher factoring the loss of other parts of the act. In all, these cuts would cripple one of the strongest employment sectors of most communities and would threaten the very place we go when we are most vulnerable.

If these safety nets are removed — if tens of millions of people lose vital insurance coverage — hospitals will again bear the cost of providing the cost of charity care. And many, particularly those in rural areas and those serving the most complex and poorest patients, will face a dire future. More communities will face the reality Douglas, Arizona, faced several years ago when their hospital closed and the local government and other area providers had to step in to fill the gap.

At TMC, we are showing we can bend the health-care cost curve. In collaboration with our accountable-care organizations, we have demonstrated that the cost of care can be reduced by focusing on improving quality, expanding access to care and controlling costs. A straight repeal of the Affordable Care Act threatens to halt this progress.

We encourage three things:

1. Preserve coverage for the 21 million who have gained insurance under the ACA and promote the availability of affordable and accessible health insurance.

2. Understand that a flat repeal without a clear plan for replacement would be disruptive and harmful to the county’s health-care system.

3. Ensure that the health-care safety net is secured, if not strengthened.

While the debate is political, health care is not. It’s about people. It’s about you, me, our families, our neighbors. And frankly, it’s an investment in economic development and economic health of our communities.

At TMC, we have a mission to care for all who come to us regardless of their ability to pay. It’s our mission, it’s why we exist. We’re not afraid of change, but we are concerned when politics puts the lives of the people we care for at risk. Please make your voice heard: That health care is about people, not partisanship.

Judy Rich is president and CEO of TMC HealthCare, a member of the American Hospital Association Board of Directors and former chair of the Arizona Hospital and Healthcare Association. Contact her at

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