HEALTH COACH - The repeal of the Health Act could threaten the engine of jobs in the United States

HEALTH COACH - 
 The repeal of the Health Act could threaten the engine of jobs in the United States  

 The exceptional economic role of the US health care industry increases the risks posed by Republican efforts in Washington to repeal the Affordable Care Act, enacted in 2010 under President Barack Obama, 39 is a delicate time for the economy in general. 
 
 While the government announced Friday that unemployment was at its lowest point for more than a decade, the health care industry has been a driving force for much of the world. , Hiring, adding jobs to more than three times the rate of the rest of the economy since 2007. 
 
 Growth is also not limited to hospitals. With the vast expansion of Medicaid's workforce that began three years ago, nursing homes, ambulatory centers and medical laboratories have also grown, transforming a fragmented industry into a strong political force. 
 
 Governors on both sides of the alley, As well as many moderate Republicans on Capitol Hill, expressed their concern about whether repeal will harm local economies, especially in Places where health care has softened the breath of distressed industries like retailing now or manufacturing in the past. 
 
 In addition, in a recovery plagued by uneven growth and an increase in income inequality, the sector has been a reliable source of steady gains. Health care now accounts for about one fifth of gross domestic product, up from 13 per cent in 2000, and is ready to surpass retail and recreation and hospitality as Second largest source of employment, after professional and commercial services, counting one In eight private sector jobs. 
 
 The health care boom has not started with the Affordable Care Act. The industry was among the only parts of the economy that emerged relatively unharmed from the Great Recession, and it flourished under the Democratic and Republican presidents. 
 
 "The demographics and expansion of Medicare and Medicaid over the past decades have contributed to the rising share of healthcare economy, and Obamacare has extended this," said Michael Gapen, American economist of the United States at Barclays. Nevertheless, he warned that if the law approved by the House Thursday was to become a law, which is far from certain given the skepticism of the bill in the Senate, this could hinder overall economic growth. 
 
 "This is not trivial, and it is much easier to coerce the activity than to promote it," said Mr. Gapen. "Inversing Obamacare is negative for the 39 , Economy over the next year or two. "
 
 The cost of providing coverage to millions of other Americans has its own economic consequences. 
 
 Many employers, Particularly small businesses, complain that they are faced with the legal requirements and argue that the ACA is choking economic growth by forcing companies to pay heavy taxes and heavy regulatory burdens. The law, which many Republican supporters of the proposed revision, say that businesses and individuals are also forced to pay too generous a cover. 
 
 Whatever the macroeconomic dangers, economists say that the potential effects on individual consumers are just as worrisome. The House version of the repeal law includes significant tax cuts, which usually stimulate economic activity, but with most savings in wealthiest households, this premium is likely To be saved, not spent. 
 
 At the same time, the loss of insurance coverage tends to limit household spending while increasing financial insecurity among families, according to Matt Notowidigdo, an economics professor at Northwestern. 
 
 A 2016 article on which Mr. Notowidigdo worked showed that an uninsured hospital stay doubles the risk of bankruptcy for individuals, while reducing credit ratings and leaving consumers in Average of $ 6,000 in unpaid bills. 
 
 The bill poses more risks for some areas of the country than others, said Mark Duggan, an economics professor in Stanford. 
 
 For example, about 9% of the population in Florida buys coverage through New Trade created under the Affordable Care Act, more than any other state. "If you lower subsidies to cover 1.8 million Floridians, this will reduce what they can spend on other goods and services," he said. 
 
 Mr. Duggan said that states like Kentucky, Arkansas, New Mexico and West Virginia would be hard hit by the expected cuts in Medicaid, estimated at over $ 880 billion Dollars over 10 years. 
 
 Another vulnerable part of the population is workers who are Some years from age 65 when Medicare intervenes. "If there is one group that loses the most it is close to the elders," said Craig Garthwaite, director of the health care program at the Northwestern Kellogg School of Management. "Their health care is so expensive, but the tax credit in the House bill is $ 4,000."  


   

  People who have already made deliveries to factories now do so in hospitals, said Samuel D. DeShazior, Deputy Mayor of Akron. 


 
 
 Mr. Garthwaite, who is a registered Republican and describes himself as a conservative economist, said there were few benefits for local economies in the bill, "And from an individual point of view, it will financially paralyze the poor." Already, he added, "We see hospitals taking a break and adapting to uncertainty by rethinking plans for expansion." 
 
 Hospitals in particular have been able to grow in recent years, with more of their patients now covered either by Medicaid or by insurance purchased in the new scholarships. 
 
 At the same time, an aging and costly population Treatments like medicines to treat hepatitis C and life-threatening forms of cancer have increased consumer demand among many health care providers, S they have tense budgets. Health care now accounts for about one-fifth of overall consumer spending. 

 The potential loss of billions of dollars in federal money to states like New York, where major health systems like Northwell and Mount Sinai Health are among the largest private employers, have helped state officials As the Andrew M. Cuomo government to be vehement Critics of the abrogation efforts. The state estimated that the repeal could affect more than $ 2.4 billion in costs each year to taxpayers and hospitals. 
 
 Economists on the left and right say the Affordable Care Act requires substantial changes to ensure its long-term sustainability. However, they anticipated that the current legislation of the House is so broad and that its changes are so sudden that it has its own economic risks, particularly given the size of the health sector and the slow growth of l & # 39; economy. 
 
 Health care workers also monitored developments in Washington with caution. 
 
 Oscar Onteveros, 37, began working as a nursing assistant at the Los Angeles County Medical Center-University of Southern California three years ago, after working for years in factories and jobs temporary. 
 
 "I thought it would be more stable than working in the job and I could go up," he said. "I worry about what happens next because nothing seems certain." 
 
 When assessing the impact of the Republican House bill in a previous form, the Bureau of Congress Budget estimated that 24 million people would lose insurance during the next Decade as a result of cuts to the Medicaid program and the decline in people able to pay for individual coverage. 
 
 Potential changes to Medicaid "will impose unbelievable pressure on the states, resulting in incredible pressure" on what hospitals are receiving in payments, said Daniel Steingart, who is following the industry for Moody's Investors Service. The way in which States could respond could vary considerably, he said, with some doing more to compensate for the federal government's shortfall. 
 
 Security hospitals and university medical centers that cater to low-income populations are likely to be the hardest hit by the cuts, Steingart said. 
 
 The industry in general has benefited from the strong economy and coverage extensions under Medicaid, he said. "People have jobs and they have insurance," he said. Approximately 20 million people have received coverage under the federal Health Care Act. Hospitals have experienced significant demand, and they "hired like crazy," said Steingart. 
 
 Hospital leaders said they were facing a huge uncertainty. Many, such as Dr. Akram Boutros, CEO of the MetroHealth System in Cleveland, spoke with lawmakers to make the case against the abrupt cuts to the bill in Medicaid, A relief to the Senate. The expansion of Medicaid in Ohio has been "incredibly important for the health of the community," he said. 
 
 Like other leaders, Dr. Boutros argues that health system groups need to find ways to reduce the overall cost of care. 
 
 "The system as it stands today is underperforming and failing the American public," he said. Hospitals could offer better care for less money, he said, highlighting a MetroHealth program that improved the health of people with high blood pressure and diabetes while saving $ 1,500 per patient per year. 
 
. Steingart agrees, arguing that with Washington, the problem of coverage, the difficult debate on how to control costs has yet to take place. "What has been missing is what makes health care too expensive in this country," he said. "We have not tackled this issue, and it is a big one". 
 
 The House Health Bill faces a difficult battle in the Senate, which seemed to ease some of the major cuts outlined in the House's version that have been put in place to make the legislation more palatable to the Senate. Conservative Republicans. 
 
The prospect of cuts of any size challenged hospitals to try to provide less expensive care while preparing to absorb the loss of paying patients. 
 
 Many health systems say their expenses are rising much faster than payments from government programs like Medicare and Medicaid. This month, Advocate Health Care, one of the largest employers in the Chicago area, announced plans to cut spending by $ 200 million. Advocate Health charged the cost of providing care for which it was not reimbursed. "Our spending needs to be adjusted to meet current and anticipated rates of Medicare, Medicaid and Commercial Insurance," said Jim Skogsbergh, General Manager, in a memo to employees. 
 
 The Atlantic healthcare system in Morristown, NJ, which has benefited from the expansion of Medicaid and the decline in the number of people without insurance, risks losing $ 65 million per year in income. 
 
 The chief executive of the system, Brian Gragnolati, spoke to his staff on Thursday of the possible impact of the House bill. "What I care about in our organization is how we are going to look at the changes we have to make while we have that uncertainty that is there," he said. 
 
 But Mr Gragnolati is also concerned about the health bill Potential effects on patients, some of whom have accessed care for the first time. 
 
 "What will happen here is when people do not have access now to care, they will go back to emergency departments for their primary care, pending and Pending "to get a condition dealt with, said Mr. Gragnolati. "I feel that we will get back to where we were ten years ago. It 's an absolute shame." 
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