CHARLESTON, W.Va. — The potential repeal of the Affordable Care Act without a specific replacement has hospital officials in the Mountain State and their patients concerned at the start of 2017, according to the president and CEO of the West Virginia Hospital Association.

“We have a fragile hospital component around this state. We have very sick patients. We have rural hospitals. It’s not a one size fits all ‘Obamacare is good, Obamacare’s not good.’ It’s the uncertainty that’s hanging out there,” said Joe Letnaunchyn.

Leaving ACA, also known as Obamacare, the way it is, he said, does not make sense because of the problems he sees with it.

“But saying we’re going to repeal and not knowing what the replace is, that’s a tough way to go into a boardroom for our CEOs and their boards and say, ‘This is our strategic plan for how we’re moving forward to provide care to the patients of West Virginia.'”

Letnaunchyn was a guest on Thursday’s MetroNews “Talkline.”

He’ll be in Washington, D.C. next week to meet with his health provider counterparts from other states and to talk with staffers for members of West Virginia’s Congressional delegation as the ACA repeal debate ramps up on Capitol Hill ahead of the inauguration of President-elect Donald Trump, a vocal critic of the law.

“We have a lot of questions and a lot of concerns about how it would impact the hospitals, the patients we serve and how we’re paid for providing those services,” Letnaunchyn said.

One of his stops will likely be the office of 2nd District Congressman Alex Mooney (R-W.Va.).

2nd District Congressman Alex Mooney (R-W.Va.)

“There’s no one magic fix,” Mooney admitted during a separate “Talkline” appearance Thursday.

He’s calling for the law to be repealed followed by a transition period to allow for a replacement to be developed, one that could include any number of GOP-backed proposals like the return of high-risk pools; the creation of tax credits for people who don’t have employer-based health insurance coverage; a greater reliance on health savings accounts and an end to mandated benefit requirements.

Under ACA currently, all individual health insurance plans must meet federal minimum standards for, what are called, 10 essential health benefits:

1. Ambulatory patient services
2. Prescription drugs
3. Emergency care
4. Mental health services
5. Hospitalization
6. Rehabilitative and Habilitative Services
7. Preventative and wellness services
8. Laboratory services
9. Pediatric care
10. Maternity and newborn care

Many states go beyond those requirements with additional consumer protections which is one of the reasons why there have been criticisms of another Republican proposal, one Trump has touted as well, to allow for the sale of health insurance across state lines.

Trump has said lifting the boundaries could lower costs and add to competition, but those opposed to the idea fear it would lead to bare minimum insurance coverage plans and send the healthiest people out of states like West Virginia en masse for cheaper options.

The ACA already allows states to create health care “compacts” with other states, but that provision in the lengthy law has not been fully implemented because compact regulations were not finalized at the federal level.

“I’m not saying that opening the state lines, in and of itself, is going to solve all the problems. It’s just one option that we think we should consider to potentially help the situation,” Mooney argued.

At the same time, Mooney is an advocate for returning more control of health care to individual states.

“The states should be the prime actors in a lot of these plans that are being made available, not necessarily the federal government,” Mooney said.

He used the Medicaid expansion as one example. Under ACA, Medicaid coverage was expanded to include those whose annual earnings are up to 135 percent of the poverty level which has brought more than 170,000 state residents into the program.

Republicans have proposed rolling back the expansion and, instead, allocating Medicaid funding to individual states via block grants to potentially allow for more flexibility.

“If the state of West Virginia can afford that and they think it makes sense, you can keep it,” Mooney said.

It would be up to states to answer other questions like, “At what point do people pay for part of their own health care? I know that’s a sticking point for a lot of folks who obviously can’t afford it. But understand Medicaid is for poor folks, at the poverty level or below.”

Letnaunchyn had many questions about that possibility including how the amount allocated to West Virginia would be determined. Also, he asked, “What kind of strings will be attached with the money?”

West Virginia’s hospitals employ 45,000 people, according to Letnaunchyn, who noted the hospitals are important economic drivers.

“Those hospitals are on the bubble not knowing where things are going to go, just like we are,” he said.

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