GOP plan could make life harder for hospitals

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There’s plenty for the healthcare industry to like in the latest Republican proposal to repeal the Affordable Care Act, which would lower taxes and eliminate rules. There’s also plenty not to like because the plan would funnel less money into helping people pay for insurance and hospital visits.

The GOP bill, which still has a long way before it may become law, would replace Obamacare with a more limited program of insurance subsidies. That would probably result in less comprehensive insurance, increasing the risk that people will be unable to pay hospitals and doctors when they show up for care. At the same time, the proposal would eliminate billions of dollars of taxes on the industry.

The Republican proposal is “mostly positive” for insurers covering people in Medicare and the working population and “modestly worse” for hospitals and insurers that specialize in Medicaid, said Ana Gupte, an health analyst with Leerink Partners, in a note to clients on Tuesday.

“We see on balance fewer lives covered under this proposal, given tax credits replace more generous subsidies under Obamacare,” Gupte said.

There’s no guarantee the legislation will pass or even advance. Conservatives oppose many elements, Democrats have promised not to help, and Republicans have only a small margin in the Senate. It’s likely to change significantly before it gets to the president’s desk.

“We view this legislation as a starting point,” Mike Newshel, an analyst at Evercore ISI, wrote in a note to clients.

Here’s how various parts of the health sector would be affected.

Hospital companies

The hospital industry has been hurt by falling reimbursements and stagnant admissions, and there have been signs that some people still aren’t able to pay portions of their hospital bills because of insurance plans with high out-of-pocket costs. The ACA eliminated payments meant to help compensate for people who don’t or can’t pay for care, and the GOP proposal would restore that money, according to a summary.

On the negative side, 31 states expanded Medicaid to people above the poverty level under the ACA, and the Republican plan would roll that back, although how has become a major point of argument inside the party.

“The GOP is far from united in this, and TrumpCare is being attacked from both the right and the left as the GOP pulls itself apart,” Sheryl Skolnick, an analyst with Mizuho Securities, wrote in a note to clients. “This is more positive for hospitals, particularly those with significant Medicaid exposure.”

The Bloomberg Intelligence North America Hospitals Valuation Peer Group index fell as much as 2.9 percent on Tuesday.

Health insurers

Big for-profit insurers have scaled back from the ACA, which limits their exposure to changes proposed in the House plan. The companies with the most at risk are those that specialize in Medicaid and other insurance for low-income individuals, including Centene, Molina Healthcare and WellCare Health Plans, said Tom Carroll, an analyst at Stifel Nicolaus. Carroll estimates that about 39 percent of Molina’s estimated 2018 profit is tied to Medicaid and the ACA’s exchanges, and about 14 percent for Centene.

Bob Laszewski, a consultant who runs the firm Health Policy and Strategy Associates, was more blunt in his assessment. The Republican plan won’t create a viable individual insurance market because too few people will buy insurance coverage, he said. “It won’t work,” he wrote.

Pharma, biotech and medical device makers

While drug, biotechnology and medical device makers are largely ignored in the GOP proposal, it does eliminate taxes on the sector worth billions of dollars.

“The bill on its own is probably a positive for the industry because there is discussion of rolling back the industry tax,” Steve Chesney, an Atlantic Equities analyst, said. Yet there may be pain in the future, he said. “The view of the industry right now and the sense that I get from talking to management teams is they don’t expect to get away cost-free amid all the changes.”

Device makers, for example, had to pay a 2.3 percent excise tax that was used to fund health insurance subsidies under Obamacare. The industry has fought the provision since it began in 2013, and succeeded in getting a two-year pause on the tax in 2015. The House GOP proposal eliminates it, and would do so for similar taxes on health insurers and pharmaceutical companies.

Here’s a summary of what those taxes were worth when the Affordable Care Act was passed in 2010, according to the Joint Committee on Taxation.

Tax or fees eliminated (estimates based on tax provisions)

“Cadillac” tax on high-cost health plans (delayed in 2015; GOP plan would delay until 2025), $32 billion

Fee on health insurers, $60.1 billion

Tax on medical device makers (suspended in 2015), $20 billion

“Annual fee” on drug makers $27 billion 10 percent tax on indoor tanning, $2.7 billion

Limit on business expense deduction for high-wage employees at health insurers, $600 million

Medicare and investment income taxes on people making more than $200,000 ($250,000 for joint filers), $210.2 billion.

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