As the federal government edges closer to potentially replacing the Affordable Care Act (ACA), which is sometimes referred to as "Obamacare," hospital leaders and staff have been watching the proceedings closely. Among them is Newton Medical Center (NMC) President and CEO Vallerie L. Gleason.

Gleason said Newton Medical Center serves a geographic area encompassing Harvey County and portions of contiguous counties. The hospital's primary service area is a population of over 65,000 people.

Gleason said hospitals and other healthcare providers have spent six years adapting to fully conform with ACA requirements. It has been an expensive and disruptive journey to date, so for legislation to completely reverse this work concerns her, especially in the absence of a clear future pathway.

"The Congressional Budget Office indicates a wholesale repeal may leave 14 to 24 million people without access to healthcare coverage," Gleason said. "This includes those who are already in fragile circumstances – such as frail elders, as well as a number of disabled persons, children and those with mental health issues. So far we have not seen alternative policies to provide coverage for these vulnerable populations."

Gleason said staff is concerned – not only for NMC, but for its community healthcare partners, such as physicians and community living or long-term care facilities that depend upon financing from Centers for Medicare/Medicaid Services (CMS) to carry out their missions to care for the sick and frail within the community.

For example, Gleason said, the growing drug epidemic and those with behavioral (or mental health) issues impact nearly every community in the United States. Progress in these areas depends upon individuals having coverage and access to healthcare locally, and NMC considers this just one area of high-priority need in the communities it serves.

"When persons have no payment source for medical care (insurance of some kind), they frequently avoid routine, maintenance healthcare visits," Gleason said. "This results in our having to see patients who have foregone care in our Emergency Department or in our clinics – who have advanced or complicated conditions."

Gleason said the care of medically neglected individuals is complex and expensive. NMC would rather avoid those situations – and so would patients.

Newton Medical Center has also supported and will continue to support Medicaid expansion in Kansas. Gleason said the expansion program, which is known as “The Bridge to a Healthy Kansas,” would save Kansas taxpayers money while providing needed care to 150,000 hard-working Kansans. It would also expand jobs in Kansas.

Additionally, Gleason said the expansion program would return federal funding to our state that has been previously swept out by the ACA with its promise to return it through Medicaid expansion – which has never happened.

According to the Kansas Hospital Association (KHA), Kansas has currently forfeited nearly $1.8 billion in federal funds because of its failure to expand Medicaid.

National and State healthcare policy decisions have had an overall negative impact on virtually every healthcare provider across the United States, Gleason explained, including providers in Kansas and Newton.

"We have had to be resourceful and creative with our staff talent and our financial resources in order to be successful and sound," Gleason said. "Our hospital staff and medical staff are completely dedicated to our mission and our goal is to protect and defend our community’s health at all times. We work together with our community partners such as Health Ministries, our local physicians and other hospitals throughout the area to ensure healthcare vitality of our communities. We will continue to work with our federal and state legislators to ensure that the community has access to high-quality healthcare locally."

Hospitals and health care systems are also a powerful economic force in Kansas.

An early 2017 press release from the KHA sites findings from the January 2017 report, "The Importance of the Health Care Sector to the Kansas Economy," which details estimates of the “gross” impact of the health care sector on economic activity in Kansas.

In that report, K-State researchers identify three primary ways health care influences local economic development: health care attracts and retains business, attracts and retains retirees and creates local jobs.

According to that study, the state’s health care sector generated $14.6 billion in income and $24.7 billion in sales last year, ranking it fifth among all economic sectors in the state. Hospitals alone have a total impact on Kansas income of nearly $9 billion, and they employ more than 84,000 people across the state.

Jobs are an essential part of the economic impact; however, funds also flow to businesses and throughout the economy when hospitals purchase goods and services. Hospitals generate more than $3 billion in local retail sales in Kansas each year. The hospital sector generates nearly $200 million in state sales tax.

“Hospitals and health services truly are an economic anchor in our state,” said Tom Bell, president and CEO of the KHA. “This report documents the importance of the health care sector to the Kansas economy. While the estimates of economic impact are substantial, they are only a partial accounting of the benefits that health care in general, and community hospitals in particular, provide to the state. Kansas community hospitals help stabilize the population base, invigorate their communities and contribute significantly to quality of life.”

The positive effects of health care services in the state could grow even more if Kansas developed a solution to expand the KanCare program.

The ability to cover more than 150,000 low-income Kansans has the potential to inject $2.4 billion in federal dollars into the Kansas economy between 2016 and 2018, according to study commissioned by the Kansas Department of Health and Environment.

Additionally, a study conducted by researchers at Regional Economic Models, Inc. and George Washington University shows that, without expanding KanCare, fewer jobs will be created across all industries. This negative result grows each year, reaching 3,830 fewer jobs in 2020.

“While these reports indicate the importance of community hospitals and health services to the Kansas economy, they also make it clear that the budgetary challenges faced by our state cannot be shouldered solely by the health care sector,” said Bell. “These challenges require a community-wide response involving government, business and civic leaders. Expanding KanCare will add needed dollars that will grow the economy, creating jobs and supporting the state’s budget through increased revenues and cost savings.”

According to the 2017 economic report, Kansas hospitals employ 4.3 percent of all job holders in the state. The report calculated economic multipliers, or “ripple effects,” and estimated that hospitals account for 74,014 additional jobs throughout all other businesses and industries in the state.

For each new job in the hospital sector, another 0.88 jobs were created in other businesses and industries in Kansas. Hospital sector employment had a total impact on state employment of more than 158,400 jobs.

In addition, the study suggests the entire health sector in Kansas employs nearly 226,175 people, or 11.6 percent of all job-holders in the state. This puts Kansas ahead of the national average, which is 10 percent of job holders in the United States working in health care services.

The total employment impact of the health services sector in Kansas is approximately 374,173 jobs, making it the fourth largest aggregate employer in the state.

According to the KHA's press release, hospitals generate more than $5.7 billion in direct labor income to the Kansas economy each year. For every dollar of income generated in the hospital sector, another $0.56 was generated in other business and industry.

A full statewide report, as well as links to county reports can be found on the Kansas Hospital Association website (http://www.kha-net.org/).