Las Vegas Sun

March 29, 2024

Obamacare repeal effort endangers progress made at Las Vegas public hospital

University Medical Center ER Dr. David Obert

L.E. Baskow

Dr. David Obert, UMC ER attending physician, helps to establish an airway on a patient with nurse practitioner Francine Clegg on Friday, March 13, 2015.

As Southern Nevada’s only public hospital, University Medical Center was tremendously affected by the Affordable Care Act.

It helped the hospital — a lot.

Now, management at the taxpayer-funded hospital have their eyes turned toward Washington, D.C., as lawmakers discuss the possible repeal or replacement of the health care legislation commonly referred to as Obamacare.

Nevada’s uninsured rate has dropped since the ACA was enacted. From 2013 to 2015, it dropped from 19 percent to 11 percent.

Additionally, Gov. Brian Sandoval became the first Republican governor to opt to expand Medicaid eligibility under the ACA. When that decision went into effect in January 2014, it brought coverage to 221,000 Nevadans. Officials estimate that more than three-quarters of that group lives in Clark County.

According to UMC CEO Mason VanHouweling, taking away that coverage could undo some financial gains the institution had made over the past few years.

In 2014, the financially troubled institution needed a $70 million subsidy from the county and $45 million in emergency loans just to continue operations. It also endured hundreds of layoffs and the closure of four satellite campuses.

By 2016, the operating income was in the black.

“The past two years, we’ve had a positive income related to the ACA,” VanHouweling said. “We’ve reinvested (that money) back into the community.”

Investments include instituting an electronic health records system, improving procedures for the Children’s Hospital of Nevada and developing a strategic partnership with the new UNLV School of Medicine.

The bottom line, according to VanHouweling, is that “outcomes have improved.”

Before the ACA, 29 percent of UMC patients were on Medicaid, and 24 percent were self-paying. Only 14 percent had private insurance.

Post-ACA, 47 percent of UMC patients were on Medicaid, and only 10 percent were self-paying.

That translates to hospital bills that actually get paid. One longtime issue at UMC and other public hospitals is that uninsured people would too often skip preventive visits to doctors and instead only visit when emergency room care was needed. Those high bills would often go unpaid.

UMC reports that the enactment of the ACA and Medicaid expansion reduced uncompensated care from 40 percent to 11 percent.

Clark County commissioners, who act as the board of trustees for the hospital, recently received a report on how the possible repeal of the ACA would affect UMC.

“The ACA was a true blessing,” said Commissioner Lawrence Weekly, who serves as chairman of the UMC board. “There wasn’t a whole lot of love when it came to the hospital. We were there through some tough times. I’m grateful for management stepping up.”

Commissioner Steve Sisolak, who is running for governor, commented that the finances were telling, but they weren’t what’s most important.

“More so than that, it’s the individual lives affected and potentially lost,” he said. “When you see (people) are going to lose their mom or son, you can’t put a dollar value on that. I think we as a commission and decent human beings need to do everything we can to make sure health care coverage is maintained for everyone, especially our most vulnerable population.”

The commissioners directed staff to draft a resolution they could pass and send to the Nevada congressional delegation. They also directed staff to provide them regular updates on the issue, which appears to be evolving and changing every day.

Commissioner Chris Giunchigliani, who has been contemplating a run for governor, suggested hosting town-hall meetings to educate the public on the impact the ACA and Medicaid have made on people’s lives. The topic needs to stay at the forefront of people’s minds, she said.

“It’s not about money,” she added, “It’s about care.”

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