Friday afternoon, and welcome to the Weekly Scan.  Here are some of the key stories you may have missed in the debate on America’s health care future:

The Partnership for America’s Health Care Future and Navigant Consulting, Inc. released a new study which warns that under the public option, “55 percent of rural hospitals could be at high risk of closing,” The Washington Post reports.  And as Becker’s Hospital Review notes, the study finds that the proposed government run health insurance system could “have a significant effect on rural hospital closures across the country.”  They write:

… [A] public option could put up to 55 percent of U.S. rural hospitals, or 1,037 hospitals in 46 states, at “high risk of closure.”  The finding was based on Navigant’s study of various public option scenarios on the revenue of nearly 1,900 critical access and short-term acute care hospitals in rural areas.  Researchers found that: … A Medicare public option where employers move 25 percent to 50 percent of their covered workers to the option could put 51 percent to 55 percent of rural hospitals at high risk of closure, and 39 percent to 41 percent of rural hospitals at moderate risk.  Navigant estimated that Medicare would have to boost payments to hospitals for a public option 40 percent to 60 percent above current Medicare rates to prevent the financial consequences associated with public option scenarios.

Modern Healthcare added that “rural hospitals could lose between 2.3% and 14% of their revenue” under the public option.  And while profoundly negative health and economic consequences could be felt in rural communities across the country, Becker’s Hospital CFO Report also notes that some states could be hit particularly hard by the proposed government insurance system, as the analysis shows that “states with the most high-risk rural hospitals” include Kansas (63), Iowa (51) and Minnesota (49).

Meanwhile, following last week’s Democratic presidential debates, in which 2020 hopefuls promoted a variety of government insurance systems – namely Medicare for all and the public option – editorial boards cautioned voters on the pitfalls and realities of these plans.

 … [P]roposals should meet a baseline degree of factual plausibility – a bar that, for example, the Medicare-for-all plan that Mr. Sanders and Ms. Warren favor does not clear …[T]he numbers behind the proposal simply do not compute: The senators cannot deliver a system that provides far more benefits than other single-payer systems they claim as their model while preserving the level of care and access that insured Americans currently enjoy.  They … should be honest about the trade-offs.

The Harris plan would move the country to single-payer health care over 10 years … The first step is that anyone in America could buy into Medicare.  At least Ms. Harris is honest that this is away station to single payer … She wants her plan to appear less disruptive than the Sanders bill, yet the obvious conclusion is that it would still blow up traditional employer-sponsored insurance, which 150 million Americans have.  Ms. Harris said Wednesday that she’d “listened to American families” who want “an option that will be under your Medicare system that allows a private plan.”  But could Americans keep the employer plans they have?  No.  This is bad policy and politics … [S]ome 69% of people rate their health-care coverage as excellent or good, according to a Gallup poll from December 2018.  The number who say the health care they receive is good or excellent?  Some 80%.  Ms. Harris also ducks whether her plan would slam the middle class with higher taxes … A 2016 analysis from Kenneth Thorpe at Emory University found that more than 70% of working privately insured households would pay more for health insurance under the Sanders plan … Rationed care and waiting lists are inevitable.
Plans such as [Medicare for all] are not happening any time soon, even if Democrats manage to win the presidency.  They won’t happen for the simple reason that too many Americans have private insurance that they either affirmatively like or would be apprehensive about losing for some uncertain alternative … That’s why preserving the ACA has to be the priority.  Enacting Obamacare was a big (bleeping) deal, as Vice President Joe Biden put it at the time. The law needs champions who will oppose efforts to repeal it.
Emphasizing the point that we should focus on protecting and shoring up the Affordable Care Act (ACA) rather than implement a risky new government insurance system, Scott Serota, president and chief executive officer of the Blue Cross Blue Shield Association, writes for CNN:
Everyone should have access to health care, no matter who you are or where you live.  To achieve this, we need to implement common-sense solutions that protect people with pre-existing conditions, expand access to coverage and care—and lower costs for everyone.  How do we do that?  The Affordable Care Act provides the framework. 
The Associated Press reports that “[g]overnment surveys show that about 90% of the population has coverage, largely preserving gains from President Barack Obama’s years.  Independent experts estimate that more than one-half of the roughly 30 million uninsured people in the country are eligible for health insurance through existing programs.”
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