The future of that coverage now hangs in the balance, as President-elect
Local health care leaders are hovering between deep unease and cautious optimism as they consider what that would mean for their patients and
"Because of where we live and because of the population that we treat, we have a disproportionately high number of
However, leaders say, legislation moves much more slowly than campaign promises, and it will be hard to completely backtrack on something that millions of Americans benefit from.
"You look at 20 million people across the nation who have never had insurance before and felt that they didn't have access to care because of lack of insurance, who are now insured. ... It would be very difficult, even for this administration, to say 'Your coverage is going to go away,'" said
Plus, many features of the ACA are very popular, regardless of political beliefs, including keeping kids on their parents' insurance until age 26; no denial of coverage based on pre-existing medical conditions; and no lifetime limits on essential benefits.
Trump did soften his stance Friday in an interview with the
But for Republican lawmakers determined to repeal and replace, it will be hard to pick and choose pieces of the law to keep, said Dr.
"It wasn't a dumb design, and if you start -- 'I want to keep the tires, but not the rims' -- you're still not going anywhere with the car," Maples said. "Then talk about replace. ... I've not heard any credible plan for replacement."
About 6,000 of
Community health centers have enjoyed bipartisan support for decades. Federal funding for the Health Center Program has never been voted down in
And Trump has shown support for states' rights.
The biggest risk, he said, would be to local hospital admissions, where uninsured patients mean millions in charity care and bad debt every year.
At Virginia Mason Memorial, formerly
"Patients that used to show up at Memorial's emergency department without any insurance now have
While he agrees there are pieces of the law that need to be fixed, Myers also believes a full repeal is "very hard, and "probably not politically likely" given the number of people who gained coverage.
Regardless, he said, "The whole emphasis in health care is about moving from the concept of being paid for volume to one of being paid for value, and that's not going to change."
From discussions with national hospital leaders, Myers said, it appears unlikely that the
"Bottom line is, we're going to be very watchful," Myers said.
A statement from
"It will take some time to develop a transition of the ACA, and we are committed to working with our elected officials to assure continued access to care," the statement said.
As for hopes of achieving cheaper premiums or better coverage by repealing Obamacare, Olivares thinks people will soon discover they were mistaken.
"We have, unfortunately, incredibly selective filtered memories. ... We forget the things that got us to where we are in the first place," he said. "Nobody remembers the people who were losing their homes, people who couldn't get health care, people who were turned away by insurance companies because of pre-existing conditions, and entire devastation of families happened."
And when people don't have insurance, health leaders say, they don't seek medical care.
"If you don't have coverage and you can't afford the bill, you just don't go," Olivares said. "No matter how much you need it."
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