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Jan Bergen, President & CEO

Since the presidential election last fall, few questions have occupied the public—and healthcare administrators—more than how a Republican president and Congress would implement one of their most consistently stated campaign promises: the repeal and replacement of the Affordable Care Act (ACA).

Now we know, sort of. As House Speaker Paul Ryan said after the implosion of his effort to get a repeal-and-replace bill through the House, “We are going to be living with Obamacare for the foreseeable future.”  In hindsight, the failure of the American Health Care Act was perhaps inevitable: Conservative Republicans in Congress felt it did not go far enough; moderate Republicans felt it went too far, and Democrats vowed not to support any attack on the ACA. Professional groups such as the American Medical Association and the American Hospital Association were vocal in their opposition to the new bill. Add to that the growing public concern about how the bill might have affected costs, coverage and access, and it’s not hard to see why this first attempt to uproot Obamacare went nowhere.

The ACA was not perfect when it became law in 2009. As different elements of the law have taken effect, hospitals, physicians and other stakeholders have identified areas where it could be improved or where it has not produced the intended consequences. This should not be a surprise. Virtually every law ever passed by Congress has required continual refinement. But in “repealing and replacing” the Affordable Care Act, Congress forgot one of the oldest tenets of healthcare: First, do no harm.

Whatever its faults, the Affordable Care Act has made progress toward important goals.  More Americans are now enrolled in health insurance plans than at any time in our history. New payment systems in the law have encouraged the development of Accountable Care Organizations, which take a more holistic, and more economical, approach to providing care. And many of the Act’s insurance-related provisions—such as requiring coverage for pre-existing conditions—are broadly popular with Americans. On the other hand, insurance premium costs have not dropped as anticipated, and many people object to the mandate to purchase insurance. Any reform effort should maintain and enhance the ACA’s positive effects, while addressing areas where it has not worked as well.

What happens next is anyone’s guess. President Trump and the Republican Congress have considerable leeway in how ACA regulations and provisions are enacted and enforced. On the other hand, Democrats and other stakeholders in the ACA have been emboldened by their victory and will likely be diligent in resisting changes they feel diminish the ACA. President Trump is learning that, indeed, healthcare reform is complex, and the consequences will have serious and real-world implications for every American, every physician, every hospital.

I am not able to predict the outcome of this issue in Congress—no one is. But I do want to stress an important point to the community served by Lancaster General Health. Whether the Affordable Care Act is retained or replaced, LG Health will remain fully committed to serving our patients. We have been an integral part of Lancaster County for more than a century, and over that time we have maintained our mission through economic upheaval and political uncertainty. We aren’t going anywhere, and members of the community can continue to rely on us for every aspect of maintaining and protecting their health.

Our goal in any debate over healthcare policy is simply to remind our lawmakers that reform should meet certain fundamental standards. It should improve access to care. It should encourage greater quality and safety. It should support preventive and primary care. It should drive innovation, accountability and lower overall cost in both health insurance and healthcare delivery. I believe everyone can agree on these goals, even as we might disagree on how best to get there.

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