Repealing the Affordable Care Act without replacement could cost Pennsylvania hospitals a good chunk of change — more than $17.1 billion to be exact, according to one Pennsylvania hospital association.

Republicans have attempted to repeal the health care law dozens of times since it became law in 2010. With president-elect Donald Trump in the White House, a chance to accomplish that goal might come in 2017. However, while repealing the ACA is likely, the path to that repeal isn’t set in stone. Some are asking for caution to prevent financial ruin.

In a report released this week by the American Hospital Association and the Federation of American Hospitals, hospitals nationwide are estimated to take a $165.8 billion hit. AHA and FAH used the most recent version of a bill to repeal Obamacare, approved by Congress in 2015 and vetoed by the president in January, in looking at the financial impact on hospitals nationwide from 2018 to 2026.

The Hospital and Healthsystem Association of Pennsylvania estimates its members could already face a $17.1 billion payment reduction between 2016 and 2025, even without big cuts resulting from a repeal of the ACA. Repealing and not replacing it could lead to even larger shortfalls.

“The report … supports AHA’s position that any reconsideration of the ACA should be accompanied at the same time by provisions that guarantee similar coverage for those who would lose it,” reads an HAP statement posted to the website following the national announcement.

If Congress moves forward to reconsider the ACA without enacting a replacement, the statement warns, the legislation should prospectively restore Medicare and Medicaid reimbursement reductions included in the ACA to offset the cost of providing coverage.

“What the AHA and we are calling for is to proceed with caution as you look at repealing and replacing the ACA,” HAP Chief Strategy Officer Paula Bussard said.

Bussard said in the six years since the ACA has been law, hospitals and health care systems have overhauled the ways by which they give care and are reimbursed for that care. From agreeing to take reduced Medicaid and Medicare reimbursements in hopes that there would be a reduction in uncompensated care, to being rewarded for value over fee for service, health care has changed drastically.

A repeal without a replacement or extension of some provisions of the ACA would affect not just the 20 million people who federal officials say would lose their health insurance but also the hospitals that have overhauled the way they operate.

The association has not analyzed the data further, but Bussard said uncompensated care — people who never pay for the care they receive —has gone down in the last year since the late expansion of Medicaid in Pennsylvania. Additionally, hospitals and other providers have received incentives to change the way they provide care.

“There’s a lot of concern in the health care community that if that’s just taken away and not replaced by something else that helps foster that information — especially for things like telehealth that consumers are asking for — that could go by the wayside,” HAP spokeswoman Katie Brynes said.

A spokesman for WellSpan Health said the health care system hadn’t examined the financial impact of a repeal as of last week.

“Given the uncertainty that still exists, we remain committed to improving access to health care for the uninsured and under-insured,” spokesman Dan Carrigan said.

Calls and emails to Memorial Health and Hanover Hospital were not returned.

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