Affordable Care Act

Effects of ACA Repeal on Hospital Payment and Coverage
Congress is considering legislative strategies and proposals to repeal some or all of the Affordable Care Act and create new health programs to replace or “repair” it. Armed with a set of advocacy principles endorsed by the MHA Board of Trustees, MHA staff has been conveying hospital concerns and advocacy messages to the Missouri Congressional Delegation.ACA Repeal

MHA has created a Realities of Repeal document that graphically depicts the amount of payment reductions that will be imposed on Missouri hospitals by Title III of the ACA during the next 10 years. Title III includes Medicare marketbasket adjustments, Medicare and Medicaid disproportionate share hospital payments, and Medicare pay-for-performance initiatives. Statewide, the payment reductions exceed $9 billion, with further analysis showing their distribution by rural and urban hospitals, and each of Missouri’s congressional districts. The document also shows the loss of Missouri health insurance coverage associated with a repeal of the federal subsidies offered through CMS’ health insurance marketplace. Such a repeal is projected to increase the number of uninsured by more than a quarter-million Missourians.

Although legislative attention is being focused on repeal of the individual and employer mandates to have or offer health insurance and of the various direct taxes ― the “Cadillac” tax, tax penalties, insurer tax, etc. ― legislators must recognize and account for the billions of dollars of savings generated by ACA payment reductions for hospitals. If the ACA’s expanded coverage disappears and is not replicated, those payment cuts must be repealed. They cannot become part of the federal fiscal woodwork.

MHA Advocacy Principles for Replacement of the ACA

Implications of the American Health Care Act (March 2017)

Contact Your Federal Lawmaker
Reach out and make contact with your U.S. senators and representatives. Click here to find out who you should contact.


As you make your advocacy contacts, please relay legislators’ responses to Daniel Landon.


Sample Message for ACA Advocacy
Throughout the next decade, Missouri’s hospitals could experience more than $9 billion in cuts to payments through the Affordable Care Act. These cuts were designed to be offset by new health insurance coverage through Medicaid and the health insurance marketplace. As you know, Missouri did not expand Medicaid and now the marketplace is in jeopardy.

As my voice in Washington, I want to share my concern that the “repeal and replace” discussion could lead to these cuts being permanent. This would harm our health care system and imperil its ability to provide care for all Missourians.

If the ACA is repealed, the cuts to Medicaid and other programs should be repealed as well. It’s only fair.

My hope is that Congress and the administration can work to build a system that supports better care and access for all Americans. If there is no replacement, hospitals and other providers will need the support that Medicare and federal funding has traditionally provided to care for the uninsured.

Please protect hospitals and the Missourians they support in the coming debate.