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WASHINGTON, D.C. – A northwest Ohio hospital CEO today outlined the devastating impact repeal of the Affordable Care Act could have on Ohio hospitals – forcing them to cut care and eliminate jobs.
As talks on the Senate plan to repeal the Affordable Care Act happen behind closed doors, the Senate Democratic Policy & Communications Committee held a public hearing on the impact repealing the law would have on local communities.
Ohioan Philip Ennen, the President and CEO of Community Hospitals and Wellness Centers in Bryan, testified. In his testimony, Ennen outlined the impact of the ACA on the increased services his hospitals have been able to provide, and warn against the consequences of repealing it.
In his prepared testimony, Ennen said, “Passage of the AHCA means we are looking at millions of dollars of revenue losses. The very survival of our independent hospital is in play. How can we work to improve this community we love, if we cannot rely on the government for sustainable funding?”
Other northwest Ohio health officials have also warned of the potential repeal and its impact on local jobs.
“Repeal won’t just mean kicking Ohioans off their insurance, it could cost people their jobs when area hospitals are forced to cut services to patients and lay off workers,” said U.S. Sen. Sherrod Brown. “Mr. Ennen is right. Instead of kicking 900,000 Ohioans off of their insurance, we need to work together to lower costs and make healthcare work better for everyone.”
Ennen’s written testimony as prepared for delivery follows below.
Testimony of Philip L. Ennen as Prepared for Delivery
Community Hospitals and Wellness Centers
Chair Stabenow; Vice Chair Manchin, and members of the Committee, my name is Phil Ennen and I am the President and CEO of the Community Hospitals and Wellness Centers in Bryan, in Northwest Ohio. I greatly appreciate this opportunity to address the Committee and to bring the voice of my community to this paramount national issue.
Bryan is located in rural northwestern Ohio. To help you visualize my home, we are in the very upper left corner of the state. Any farther north, you would be in Michigan. Any farther west, you would be in Indiana.
On July 14th, I will mark thirty years with my hospital. Bryan is the place I grew up. My wife and I met in first grade. After college we returned to Bryan and I started my career at the hospital. In 2008, I became CEO. We went back to Bryan for all the reasons someone who had a wonderful childhood chooses to go home. In my childhood, Bryan was a community filled with classic midwestern folk…working classic midwestern jobs…in farming and light industrial manufacturing. People either “made things” or “grew things”. People had good jobs with good benefits and health care coverage. The kids went to good schools. And many people actively served in local government.
But the northwest Ohio of my childhood is now in twilight. Small companies with local owners were swallowed by ever larger companies with owners who don’t live anywhere near Ohio. The recession wiped out hundreds of good jobs. The jobs that “came back”…are not the same kinds of jobs. They pay less, and are often part-time. Our schools are still good, but they are being overrun with the stress of life. Children are coming to school hungry, sleepy and distracted. Our local government is sound, but the challenge of providing basic community services and public health programming grows every day while the funding shrinks.
Collaboration with Public Health to Assess Community Need
For the past ten years, we have worked hand-in-hand with the Williams County Public Health Department to carry out community health needs assessments. The surveys make clear that people in our community suffer from an inability to gain access to regular health and dental care and have almost no meaningful access to mental health and addiction recovery services. Too many families suffer from food insecurity. Too many children go home for the weekend at risk of not enough access to proper food. We don’t eat well. We are too heavy and we don’t have meaningful exercise. Finally, there are many more of our friends and neighbors than we care to admit who rely upon government assistance programs.
Our national system for providing and paying for health care, prior to the Affordable Care Act (ACA), was a true mess. The ACA improved upon that mess. I’ve never considered the ACA to be the complete and total solution. I have always considered the ACA to be the first step toward creating true equity in access, true understanding of the cost of care, and true assessment of health outcomes. I hoped (I still hope) there would be thousands more steps.
What the ACA has done is given us the stability to start making investments to address community health needs. CHWC launched a series of programs to bring Mindfulness Based Stress Reduction classes directly into our community. CHWC pays all fees and costs for people to attend MBSR. More recently we’ve added new classes in mindful self-compassion and programs targeted specifically for teens.
We provide financial support to the Williams County Drug Court. Through the Court we are witness to the wonder of assisting people to move away from addiction and toward recovery with constant positive support instead of punishment and incarceration.
In 2016, we launched School Based Mental Health Therapy. We provide a specially trained youth counselor who works directly inside three Williams County School Districts to help students build coping skills. Right now we are adding a second counselor, to cover three more school districts. CHWC is funding over 90% of all costs for this program. There is no source of payment for this service or any of the programming I have identified.
The AHCA Doesn’t Build Upon Anything
There is very little in the AHCA that builds upon the ACA. I can’t see how this will help my community. Maybe in some small ways, for a small number of people. But not for our population as a whole. What I do know for a fact is that there are 2,578 Medicaid beneficiaries in the four counties that make up northwest Ohio who will not receive services at all or will have much longer wait to access services. What I do know is that the much needed improved access to behavioral health care will be wiped out.
For the professionals who work in the health insurance industry (our local insurance agents) there is great concern with the AHCA language that either eliminates or caps the employer-tax exclusion. Thousands of people in my community (approximately 400 at my hospital) receive their health insurance through their employer. Eliminating the exclusion would cause tremendous confusion in the commercial insurance industry. It will create complicated tax consequences that will result in fewer employers choosing to offer health care coverage.
We Have Reached Out – We Have Made Our Appeals
We have spoken with leaders in Ohio and in Washington, both in personal and small group sessions. Our message is consistent. The ideas of personal responsibility are worthy, but they are not reality to the members of my community and the patients at CHWC. The idea that every job will have health care with it…that’s just not true anymore. And even if it does, the costs borne by the employees are too often more than they can financially handle. Leaders have been respectful, polite and attentive, but our efforts have not resulted in changed hearts.
CHWC is Dependent Upon Governmental Payments
CHWC is heavily dependent on governmental payments (see table #1). We are now easily over 60% in combined Medicare and Medicaid payments. Passage of the AHCA means we are looking at millions of dollars of revenue losses. The very survival of our independent hospital is in play. How can we work to improve this community we love, if we cannot rely on the government for sustainable funding? Why do we have to be pulled first in one direction and then in the other when power changes hands? Why is healthcare in the United States not an opportunity for common cause? When did it become a cudgel? Something to be used as a measure of competitive success?
Medicaid Expansion has increased our reliance on Medicaid payments, but it has also reduced our Charity burden (see table #2 and #3). There is a clear connection between expansion and reduction in charity and uncompensated care. Prior to the recession, our typical charity write offs were 1.5%. When the recession struck that burden rose to 3.5%. Medicaid expansion has brought the numbers back to 2.25%. Medicaid expansion helps us to give relief to people who cannot pay. Last year, over 2,000 people applied for and received either partial or total financial relief from their bills. How can we continue to serve with millions of dollars being taken away?
Please LISTEN to Rural America
For rural America, too often the pain of the remedy is worse than the illness. Under the tutelage of my daughter, I have spent the last two years reading all the classics that I was supposed to read as a young adult. (Think Wilde, Eliot, Dickens, Austen, Bronte) Right now I’m reading Thomas Hardy’s The Mayor of Casterbridge. There’s a paragraph in Chapter 25 that I want to paraphrase, because I believe it speaks to why I am here with you today.
In rural America, we are too well familiar with our wishes being set aside for what leaders instead believe we should want. We don’t truly experience disappointment as much as we experience substitution. Continually, what we desire is not granted…and what is granted – we do not desire. With AHCA I am left to wonder what unwished-for solutions might now be laid upon all the people I represent.
Every time I visit this city…every time…I make a pilgrimmage to the Lincoln Memorial. I stand before that second inaugural speech; a speech I consider one of the greatest works in all the written languages. We probably all know how he ends. I choose to repeat him now:
With malice toward none, with charity for all, with firmness in the right as God gives us to see the right, let us strive on to finish the work we are in, to bind up the nation's wounds, to care for him who shall have borne the battle and for his widow and his orphan, to do all which may achieve and cherish a just and lasting peace among ourselves and with all nations.
I appeal to the Congress and the Administration. Please stop working FOR us…and start working WITH us!
Again, Senator Stabenow and members of the Committee, I appreciate the opportunity to testify before you today.
Combined Medicare & Medicaid Payments
As a Percentage of ALL CHWC Payments
Percentage of CHWC Revenues Forgone
Under Our CHWC Charity Care Policy
As a Percentage of ALL CHWC Payments