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Professor Robert Field Provides Insights on Threats to ACA, Demise of Hahnemann Hospital on Knowledge @ Wharton

Professor Robert Field

July 17, 2019

Professor Robert Field predicted that the U.S. Supreme Court will once again decide the fate of the Affordable Care Act during an interview on Knowledge @ Wharton that aired on July 11.

Questions raised by federal appellate judges during arguments on July 9 revealed an apparent but unexpected agreement with a federal district court ruling that found the ACA unconstitutional, Field said.

“Legal scholars were surprised when the district court upheld the claim of the plaintiffs. It’s based on very shaky logic,” Field said, adding that they were also surprised when the appeals court seemed to support the lower court’s decision.

While the Court of Appeals had been widely expected to overturn the district court ruling, Field said, the matter now seems likely to go back before the nation’s high court, where Chief Justice John Roberts will once again find himself in “the hot seat.”

Field said widely reported estimates that 20 million people would be adversely affected if the ACA is deemed unconstitutional are too low.

“I think that 20 million number is an underestimate,” Field said, noting that many patients taking generic versions of biotechnology drugs would be hurt, since that market has been facilitated by the ACA, as would those within in accountable care programs that hospitals are running, medical students who are getting loans and those on Medicare who currently do not have to pay the donut hole for drug coverage. “The impact would be much broader.”

Field compared the district court ruling to “Alice in Wonderland,” since it asserts that the insurance mandate is unconstitutional since it’s been zeroed out of the federal budget.

“It’s become unconstitutional because it essentially doesn’t exist,” Field said. “That defies logic.”

In a second interview on Knowledge @ Wharton, Field discussed the planned closing of Hahnemann University Hospital, which is scheduled to occur in September.

The 496-bed facility serves some of Philadelphia’s sickest and poorest patients and relies heavily on Medicaid funding, which provides a low rate of reimbursement.

Field said that the situation at Hahnemann reflects a broader trend.

“What we’re seeing as a general trend is consolidation, and we’re seeing the rich get richer and the poor get poorer,” Field said. “Major hospital systems here in Philadelphia, the University of Pennsylvania in particular, are growing like crazy. We’re seeing that in cities around the country. They’re adding high-tech procedures and equipment. They’re now onto gene therapy and these futuristic kinds of treatments. But the lower-tier hospitals, which is what Hahnemann has been, or even the mid-tier hospitals have not been able to survive on their own.”

More broadly, Field added, is that at a national level, “we still can’t decide what health care is. Is it a commodity where you can have a for-profit company come in and make money for investors? Or is this an essential public service where it’s a government responsibility, and the government should come in and take care of it?”