Mayors around the country are holding what they’re calling a “day of action” Wednesday to warn of the risks to their cities if Congress repeals the Affordable Care Act without an effective replacement. More than 50 mayors are hosting town halls and other events pressing lawmakers to preserve key parts of the law, which has helped reduce the country’s uninsured rate to a record low.
As a conservative Republican, Mesa, Arizona, Mayor John Giles would like to see the ACA reformed, but outright repeal would leave tens of thousands of his constituents without insurance, he said, and drive up uncompensated health care costs at his city’s hospitals and clinics.
“This is particularly important to mayors, because when the federal government fumbles, it is state and local government that really suffers the consequences,” Giles said.
Some of the financial consequences are direct, said Jill Horwitz, a professor at UCLA School of Law.
“The loss of health insurance for people who live in cities is going to put pressure on alternatives to private health care providers,” she said. “Free clinics, hospital emergency rooms, systems that are run by cities are going to be overburdened.”
“If we’re going to go back to the days where uninsured people call 911 and use a city firefighter paramedic and an emergency room as an approach to health care, that’s going to get very expensive very quickly,” said Los Angeles Mayor Eric Garcetti, a Democrat.
There’s also a larger economic impact. Reduced spending on health care could cost L.A. County an estimated 63,000 jobs, Garcetti said, and $5.8 billion in gross domestic product.
Especially vulnerable to losses are what are known as “safety net” hospitals, which serve mostly low-income patients and saw their uncompensated care costs drop significantly under the ACA. According to the trade group America’s Essential Hospitals, those providers could lose more than $40 billion over the next decade if the law is repealed.