Mark Woodring, CRMC:

"I had the opportunity to rigorously study the 2010 Patient Protection and Affordable Care Act (aka "ACA" or "Obamacare") at UNC with Dr. Jon Oberlander for the doctoral program in health policy and management back in 2012-2014," said Woodring. "There were many known concerns about the bill then, which was modeled from Mitt Romney's state-based plan for Massachusetts a few years prior to that.

Notably, the comment 'if you like your coverage today you can keep it' was perhaps politically popular with some, but not with health economists. The policy was successful, as projected, in helping reduce uncompensated care in the communities and states that chose to reform their Medicaid programs. That means more dollars to reinvest into our communities, physicians, patient programs, staff, all which are good for the local economy.

Kansas as you know has yet to do this and has forgone over a billion dollars into the Kansas economy." Woodring said there are still many unknowns about the current healthcare reform bill that is under development in the US Senate. "We appreciate Senator Moran holding off on his commitment as we need more time to study its impact, but the known concerns to date with the bill is it would be even worse for CRMC and many rural hospitals nationwide, including an annual cut of approximately $750,000 due to discontinuing the Medicare low census volume payment program," he stated.

"We are still working to overcome the $1.1 million cut to pay for the ACA, which was supposed to return $2.5 million to CRMC had Gov. Brownback not vetoed legislation favored by most Kansans to participate in the program."  Woodring feels the best plan for the southeast Kansas area, in the short run, is to support local healthcare providers. "Establish your medical home in southeast Kansas," he stated.  "Don't travel outside of our service area if your needs can be met here."

His final thought was, "We as a society need to decide what kind of healthcare do we want in our communities, how much it will cost to subsidize it, who will pay for it, and how. Having health insurance isn't necessarily the same as having access to healthcare, but it certainly can impact the way services are utilized. We are all working to help reshape rural healthcare in southeast Kansas, and making some joyful noise!"

Brian Williams, Labette Health:

"Here is my take, following World War II employer sponsored health insurance became a popular employee benefit and as our population has aged the government has become the largest purchaser of healthcare through Medicare, making the American Healthcare System one of the most complex public policy issues that we face," Williams stated. 

"Having said that healthcare is deeply individual and personal making it difficult for the laws of supply and demand to set the equilibrium price because we are talking about life and death decisions and not products like cars and refrigerators. Like it or not the Affordable Care Act was not a perfect solution to our healthcare challenges, but neither is the Better Reconciliation Act because its primary intent is to repeal the Affordable Care Act and not seriously begin to address the many issues that we face in healthcare as a unified nation with a bi-partisan approach. I do not believe that this complex issue can be solved through polarizing political ideologies."

Lucky Lamons, chief advocacy officer, St. John Health System:

Lamons stated, "Throughout this debate, Ascension/St. John has sought to be a voice for our patients by calling on Congress to pass legislation that meets three simple principles, preserve the safety net for those who are poor and vulnerable and continue the progress to assure access to affordable healthcare for all; strengthen and stabilize the individual market because a vibrant and sustainable individual and small group market is essential to a successful, equitable healthcare system; and provide sufficient resources to continue proactively to transform the financing for the delivery of care to one that is value-based rather than volume-based because that is the key to lowering healthcare costs over the long run." 

He said unfortunately, the discussion draft of the Better Care Reconciliation Act of 2017 (BCRA) released by the Senate falls short of achieving these goals.  "That said, I want to commend the Senate for some things it did well in this discussion draft," Lamons explained. "The Senate tried to make sure that individuals with pre-existing conditions are not charged significantly more for healthcare coverage.

The Senate also moves toward a fairer tax credit than the House for older Americans who must buy insurance on the individual market. Americans closer to retirement will still have to pay significantly more than they do now because of the change in age rating bands, but the Senate will be more generous than the House in the amount of the tax credits provided to older Americans. The Senate also proposed waiving an outdated Medicaid exclusion for inpatient treatment of those with addiction, which is sorely needed." 

Lamons said unfortunately, BCRA fails to meet their reform goals for legislation because it would result in even deeper cuts to Medicaid than the House version and put the care for millions of poor and vulnerable children, parents, adults, Americans with disabilities and the elderly at risk. "The bill would cap and cut Medicaid at a rate far below the actual cost growth, especially in the years after 2026," he said.

"In fact, it is the biggest restructuring of the Medicaid program in 40 years, which would impact the very people who need care the most." As the Senate bill is a work in progress, Lamons said he uurges the Senate to go back to the drawing board to keep working to find viable solutions that focus on the three principles above; immediately pass a short term bill to shore up the individual market and halt the spiraling costs and loss of coverage being experienced there; and sit down with colleagues on each side of the aisle to solve the short term and long term problems.

Dennis Shelby, CEO, Wilson Medical Center:

"The Senate version of the bill to replace the Affordable Care Act will hit rural America hard," said Shelby. "It is considered 'anti-rural' in its current form, according to the CEO of the National Rural Health Association. There are deep cuts in Medicaid spending and will end the possibility of Medicaid expansion."

He said 45 percent of rural children use Medicaid compared to 38 percent of urban children and the bill would also reduce funding for the treatment of opioid addiction. According to the NRHA, opioid overdose deaths are 45 percent higher in rural counties.   "I have been contacting our senators [Pat] Roberts and [Jerry] Moran and everyone else should do the same," Shelby stated. "I have heard back from Senator Moran who is not in favor of the bill and said that it was not good for Kansans. We all need to keep writing our legislators."