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Lourdes CEO Shares Concern for Patients, Families and Future of Healthcare

There is nothing more powerful, more poignant, than the words of a grateful parent.

Even the hardest of hearts was moved by late-night host Jimmy Kimmel’s description of the fearful hours following  his infant son’s  diagnosis with a life-threatening heart condition. In an instant, the comedian and his wife shifted from joy to dread over their child’s prognosis. Blessedly, thanks to nurses, doctors and access to advanced  services, the baby is doing well.

But just as instantly, the Kimmels’ veered head on into the world of pre-existing conditions. They already know their son Billy will likely require additional surgery to treat his condition, Tetralogy of Fallot. They also know that they are extremely lucky to have the resources to pay for the future care he needs. As Jimmy Kimmel recognized in his monologue, this should not be the case. “No parent should have to decide if they can afford to save their child’s life.”

Under the Affordable Care Act (ACA), a parent of a sick newborn would not have to worry about lifetime limits and pre-existing condition clauses that would deny future insurance coverage. The ACA prevented people from being denied or priced out of coverage because of a pre-existing condition. However, with the American Health Care Act (AHCA), these issues are back on the table. In the current version of the plan, states would be allowed waivers to opt out of essential health benefits and other mechanisms for protecting those at risk. The result would leave states to make decisions that could exponentially increase the cost of coverage for people with pre-existing conditions and price them out of the market.

Now that the non-partisan Congressional Budget Office (CBO) has determined 23 million Americans will lose coverage under the AHCA, those of us in healthcare are fearful for the future. Released the same day as the CBO analysis, the president’s budget only adds to our concern. Proposed cuts to Medicaid and the Children’s Health Insurance Program (CHIP) are unfathomable.

Prior to the ACA, the number of individuals covered by Medicaid varied widely, based on how the states chose to administer it. Since the implementation of the ACA, some states have inexplicably refused to expand coverage to those in need. New Jersey thankfully expanded Medicaid from the start. In just one of our hospitals, 23.6% of our patients are now covered by Medicaid, when the rate was only 10% in 2013. Further, we saw charity care drop from 17% to 4%. Altogether, this means a lot more people have access to care and less worry than before. It also means that now these folks are back to worrying that a shift in the political wind could mean they would lose it all. And for Lourdes Medical Center of Burlington County, we would face the premise that nearly one-quarter of our patients would be without coverage, threatening our financial future and healthcare access for our community.

Some may say it is way too premature to worry about these things. We are told to sit back and not to worry about it and that the Senate will “fix” all of this. We are told that it is best to leave decisions with the states. These are not encouraging words.

Why is it a bad thing to allow states to specify how insurance is governed? Let’s look back at how well this worked before. Left to their own devices, states often avoided the problem. According to the Commonwealth Fund, in 2012, Texas had an uninsured rate of 38%, and the national average was 29%. States like New Mexico, Mississippi and Nevada had rates similarly high, with more than one-third of their populations uninsured. In New Jersey, the rate was around 27%. Now under the ACA, the rate for New Jersey is 7%.

These are complex concepts involving lots of numbers. But each of these statistics represents real people, many without resources, whose fortunes could change quickly and irrevocably with the onset of illness.

In the House version of the AHCA, $8 billion was included to address pre-existing conditions. This seems like a lot of money. It is not. Six years ago, in 2011, Cardiovascular Business reported that the costs associated with congenital heart disease alone topped $6 billion a year. These are conditions that people are born with, like Tetralogy of Fallot, the condition little Billy Kimmel has, and valvular disease, like the thousands of patients we’ve treated here at Lourdes.

We all know that health care is expensive. The ACA incorporated provisions that are addressing that. Those of us in health care are believers in the “triple aim,” and are driven every day to achieve better access, better outcomes and more cost-effective care. These are goals that are incentivized under the ACA, but that will be torn asunder with the AHCA.

We can do better. We are better. No one should have to decide if they can afford to get the care they need. We urge the Senate to consider the true cost of an ACA repeal and to more carefully and humanely address its faults.

Alexander J. Hatala
President & CEO
Lourdes Health System
President
St. Francis Medical Center

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