Cleveland Clinic CEO on ACA replacement: 'We're really concerned'

During an interview with Bloomberg's David Gura, Toby Cosgrove, MD, president and CEO of Cleveland Clinic, said the likely decline in coverage rates across the U.S. under the proposed American Health Care Act is a primary concern.

"We're concerned, frankly, that it's going to adversely affect the number of people who are getting covered, and also the extent to which they will [be] covered," said Dr. Cosgrove.

In particular, the fate of those who obtained health insurance through Medicaid expansion or using the ACA's premium tax credits are subject to the highest risk of losing coverage under the AHCA, which House Republicans unveiled Monday. The potential consequences of this are worrisome to hospitals, many of which were able to decrease bad debt and charity care under the ACA because of those two major provisions, according to Dr. Cosgrove.

"About 52 percent of hospitals in 2016 essentially didn't make any money," he said. "They're hanging on a very tenuous financial situation and if you begin to take away a lot of the coverage for the care that they provide then they're going to be in even deeper financial trouble."

The pace at which congressional Republicans are trying to enact change is another source of worry for Dr. Cosgrove, who pointed out healthcare is the biggest U.S. industry and affects all Americans. "I think it's going to take a lot of thought and input because there's a tremendous number of sectors involved."

Ultimately, Dr. Cosgrove thinks the next chapter of American healthcare reform will look more like an amended version of the ACA than a completely new set of policies. "I doubt we are going to have total repeal," he said. "I think what we're talking about more is repair," noting the most popular aspects of the ACA — such as guaranteed coverage for people with preexisting conditions and ability for people to stay on their parents' health plans until age 26 — would stay in place under the AHCA.

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