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Uncertainty Over Affordable Care Act Subsidies May Mean Higher Rates


Companies that want to sell health insurance through the federal Affordable Care Act marketplace in 2018 have to finalize their premium rates by next week. At the moment, it's unclear if they're going to get the federal subsidies that would keep prices lower. Intermountain Healthcare is a nonprofit that provides medical services and health plans in Utah and Idaho. It also runs nearly 200 clinics and hospitals. Marc Harrison is the company's CEO. He joins us on the line from Salt Lake City. Dr. Harrison, thanks for being with us.

MARC HARRISON: It's great to be here. Thank you.

MARTIN: What happens if you don't get these subsidies?

HARRISON: Well, two things happen. The patients and their communities, we view them as ours regardless. So we're sticking. We're not going to - you know, we're swearing to continue to take care of the people. The other is that from a premium standpoint, you know, we think that the premium increases could really be shocking and leave people functionally or absolutely uninsured.

MARTIN: So your company, as we mentioned, also owns clinics and hospitals. So you're seeing this from both sides of the equation. If you raise your rates as someone who sells insurance and then people can't afford health insurance, what does that then mean for your health care facilities?

HARRISON: Well, unfortunately what it'll probably mean is people will start showing up in our emergency departments again. And we'll be as creative as possible to take those uninsured folks and give them the least restrictive and most effective way of staying healthy that they can afford. But we would really be quite disturbed by the fact that, you know, the significant rates - decreases in rates of uninsured that we've seen that have happened over the last couple of years will probably be erased. And people will go back to emergency care and really episodic or not take care of their chronic conditions.

MARTIN: Before the ACA, though, you were already caring for a lot of people who didn't have insurance or were underinsured. And you weren't being reimbursed at all by the federal government. So why do these subsidy payments matter so much?

HARRISON: So we run about 50 clinics or are subsidized about 50 clinics that take care of many, many poor people right now. So we give away about 500,000 visits a year. In the absence of these subsidies, we think that that could easily double or triple. And, you know, we're committed to our communities. And we're committed to people regardless of their economic ability. But what we won't be able to do is this sort of longitudinal, thoughtful preventive care that we know people need in order to keep them well.

MARTIN: Just briefly, what's the first thing that Democrats and Republicans need to fix about the Affordable Care Act?

HARRISON: What they really need to do before they make any decisions is go to some clinics and see what it's like to be a poor person who's receiving care. I think they'll find these people are people, and they'll have a lot more empathy for them.

MARTIN: Marc Harrison is the CEO of Intermountain Healthcare. Thank you so much for your time this morning, Dr. Harrison. We appreciate it.

HARRISON: It's my pleasure, thanks. Have a good day.

MARTIN: You, too. Transcript provided by NPR, Copyright NPR.

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