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San Jose Police Crack Down On Violence

The San Jose Police Department is cracking down on violent crime after the city's 25th homicide this year.

KQED Launches Affordable Care Act Guide

Are you confused about Obamacare? KQED and The California Report created a guide to help answer your questions about the Affordable Care Act.

Obamacare Repeal Could Leave Millions Uninsured

Trump has vowed he will repeal Obamacare and replace it with something "better." This could affect millions of Californians. Specifics are scarce, but one plan Trump has outlined is to change how the federal government funds Medicaid, health coverage for low-income people.

San Diego Mother Mourns While Mental Health Gaps Persist

Insurance companies create so many obstacles to getting mental health care, some Californians don't get the right care -- or any care at all. State regulators are supposed to police the situation, but some advocates say they're too cozy with the insurance industry.

PBS NewsHour

Skin cancer from tanning beds costs U.S. $343 million per year

A view of a tanning bed at a spa facility at Mistral Hotel in Gniewino, which the Spanish soccer team has chosen as their
         hub for the Euro 2012 soccer championships, is seen in Gniewino November 30, 2011.  Photo taken November 30, 2011. (EURO 2012
         Team Hotel) REUTERS/Peter Andrews (POLAND  - Tags: SPORT SOCCER TRAVEL) - RTR2URYI

A view of a tanning bed at a spa facility at Mistral Hotel in Gniewino on November 30, 2011. Photo by Peter Andrews/Reuters

Tanning beds can ring up a steep bill — a whopping $343 million each year in medical costs in the US alone.

Indoor tanning has long been tied to skin cancer, the most common type of cancer in the US. It’s estimated that 30 million people — nearly 25 percent of whom are teenagers — head to tanning beds at least once a year.

And the health care costs of the habit can add up, health economists report in a new study published Tuesday in the Journal of Cancer Policy.

Tanning beds emit UV-A rays, which can damage DNA, and UV-B rays, which can burn the skin and increase the risk of skin cancer. Research has shown that indoor tanning before age 35 raises the risk of melanoma up to 75 percent.

Health care researchers at the University of North Carolina focused on melanoma and two other types of skin cancer, basal cell carcinoma and squamous cell carcinoma.

READ NEXT: Most cancers due to ‘bad luck’? Not so fast, says study

The researchers looked at all skin cancer cases in 2015, and then applied data on indoor tanning prevalence and relative risk of skin cancer after using a tanning bed to those numbers. They estimated that there were 263,600 cases of skin cancer in 2015 that could be attributed to the use of tanning beds.

The researchers then summed up the average annual cost of treating patients with each type of cancer, which totaled more than $343 million each year.

“Our findings highlight both the negative health and negative financial impacts associated with indoor tanning,” the authors wrote.

The Food and Drug Administration has taken steps in recent years to rein in use of tanning beds. In 2014, the agency announced that manufacturers would be required to put a black-box warning on tanning beds that states they shouldn’t be used by anyone under 18. The FDA also classified tanning beds as moderate-risk products in 2014, giving health officials the authority to review tanning beds for safety before they hit the market.

READ NEXT: Do more moles mean more risk of skin cancer?

The Affordable Care Act aimed to reduce use of tanning beds, too, by implementing a 10 percent excise tax on indoor tanning services.

A couple caveats: The new numbers are just an estimation — it’s impossible to nail down the cause of each individual case of skin cancer. The results also don’t include costs associated with other health problems blamed on tanning beds, such as burns.

But the study’s authors said they are hopeful that putting an estimate on the social costs of indoor tanning will help reduce use of the devices.

This article is reproduced with permission from STAT. It was first published on Feb. 28, 2017. Find the original story here.

The post Skin cancer from tanning beds costs U.S. $343 million per year appeared first on PBS NewsHour.

AP fact check: Trump’s overly downbeat view of health law

President Donald Trump waves as he arrives at the podium to address Congress. Photo by Kevin Lamarque/Reuters

President Donald Trump waves as he arrives at the podium to address Congress. Photo by Kevin Lamarque/Reuters

WASHINGTON — A claim by President Donald Trump from his speech to Congress and how it stacks up with the facts:

TRUMP, in prepared remarks: “Obamacare is collapsing … so I am calling on all Democrats and Republicans in Congress to work with us to save Americans from this imploding Obamacare disaster.”

THE FACTS: There are problems with the 2010 health care law, but whether it’s collapsing is hotly disputed.

One of the two major components of the Affordable Care Act has seen a spike in premiums and a drop in participation from insurers. But the other component, equally important, seems to be working fairly well, even if its costs are a concern.

Trump and congressional Republicans want to repeal the whole thing, which risks leaving millions of people uninsured if the replacement plan has shortcomings. Some critics say GOP rhetoric itself is making things worse by creating uncertainty about the future.

The health law offers subsidized private health insurance along with a state option to expand Medicaid for low-income people. Together, the two arms of the program cover more than 20 million people.

Republican governors whose states have expanded Medicaid are trying to find a way to persuade Congress and the administration to keep the expansion, and maybe even build on it, while imposing limits on the long-term costs of Medicaid.

While the Medicaid expansion seems to be working, the markets for subsidized private health insurance are stressed in many states. Also affected are millions of people who buy individual policies outside the government markets, and face the same high premiums with no financial help from the health law.

Larry Levitt of the nonpartisan Kaiser Family Foundation says “implosion” is too strong a term. An AP count found that 12.2 million people signed up for this year, despite the Trump administration’s threats to repeal the law.

Contributed by Associated Press writer Ricardo Alonso-Zaldivar.

READ MORE: Read the full text of Trump’s address to Congress

The post AP fact check: Trump’s overly downbeat view of health law appeared first on PBS NewsHour.

In the war on heroin, Baltimore drug programs face an uncertain future

In 2015, Baltimore wrote a city-wide prescription for a heroin antidote. Two years later, as the city tries to expand access to addiction treatment, will the White House support its mission?

Baltimore public health outreach worker John Harris shows his hands as he talks about his efforts to combat opioid addiction in his hometown. Photo by Frank Carlson/NewsHour

With a black plastic bag in hand, Gerald Young ducked into the needle exchange van parked across the street from Baltimore’s Saint Paul Freewill Baptist Church. A cold January rain drizzled outside.

Young shuffled to a small table and sat down, untying and overturning his half-knotted bag. Three bundles of used needles tumbled into a red medical waste bin.

Across from Young, John Harris opened a new box of clean hypodermic needles and restored Young’s supply. Harris, a Baltimore public health worker, also gave him a new kit of naloxone, an opioid antidote that stops a potentially fatal overdose in moments. Young, a 61-year-old homeless Baltimore native, rose to leave the van and wander around his hometown.

On that same van, outgoing U.S. drug czar Michael Botticelli, whose strategies targeted substance abuse and addiction treatment for the White House Office of National Drug Control Policy, stood off to the corner, asking workers what they’d been seeing. Botticelli had traveled to Baltimore to praise the city’s fight against the opioid epidemic. On the eve of President Donald Trump’s inauguration, he wondered how his work would carry forward.

Over the last five years, the nation’s opioid crisis has gained momentum, despite federal, state and local officials’ attempts to control it. The most recent government data shows more than 33,000 Americans died from opioid overdoses in 2015 alone. Those deaths have quadrupled since 1999, according to the Centers for Disease Control and Prevention. And in Maryland, which ranked 14th in drug overdose death rate nationwide in 2015, that rate rose 20 percent over the previous year. By September 2016, 70 percent of the state’s 918 fatal heroin overdoses happened in and around Baltimore, state records show.

70 percent of Maryland’s 918 fatal heroin overdoses happened in and around Baltimore

Policymakers have targeted opioid deaths with new programs in recent years. All states except Missouri use real-time electronic records to monitor how often doctors prescribe and pharmacists dispense drugs. When Congress approved and President Barack Obama signed the 21st Century Cures Act last year, states secured $1 billion to fund substance abuse treatment targeting heroin and opioid users. And a growing number of cities and states have expanded access to naloxone; Baltimore was one of the nation’s earliest adopters.

Without these strategies, Botticelli told the NewsHour, “I don’t know where we’d be in terms of overdose deaths.”

As the nation sees a historic rise in fatal drug overdoses, and a new president steps into the White House, the future of those programs are unclear. The national drug control policy office, created by President Ronald Reagan nearly three decades ago, has faced political threats before. While advocates have praised the office’s ability to coordinate anti-addiction efforts across federal, state and local offices, critics say billions in spending hasn’t stopped drug use from rising.

In October, Trump pointed to then-running mate Gov. Mike Pence’s work in Indiana, where he “increased the mandatory minimum sentences for the most serious drug offenders, while expanding access to treatment and prevention options for those struggling with addiction,” Trump said. “We must make similar efforts a priority for the nation,”he added.

The Obama administration praised Baltimore's efforts to combat the opioid epidemic. Under the Trump administration, it
         is unclear how the nation will face this public health crisis. Photo by Frank Carlson/NewsHour

The Obama administration praised Baltimore’s efforts to combat the opioid epidemic. Under the Trump administration, it is unclear how the nation will face this public health crisis. Photo by Frank Carlson/NewsHour

But a month after Botticelli’s visit, the New York Times reported the Trump administration planned to ax the national drug control policy office. Trump has yet to nominate someone to take Botticelli’s place. His team also hasn’t spoken publicly about dissolving the office. Last week, advocacy groups submitted a letter to the White House, making the case for why the office needs to stay. A day earlier, the Fraternal Order of Police sent its own letter urging the Trump administration “to reject any notion or proposal to eliminate” the office, saying it “plays a vital role in coordinating a national strategy to fight drug trafficking and reduce illegal drug use.”

When reached Thursday, a White House spokesperson told NewsHour in a written statement that it’s “premature to comment,” adding: “The President and his cabinet are working collaboratively to create a leaner, more efficient government that does more with less of taxpayers’ hard-earned dollars.”

The Obama administration held up Baltimore as an example of how a cash-strapped city can forge partnerships at all levels of government and develop new ways to prevent drug overdose deaths, expand treatment access and nurture greater recovery, but the opioid problem is not yet solved. In Charm City, people are dying for answers.

***

The Saturday night after Trump’s inauguration was bitterly cold in Baltimore. People huddled around the city’s needle exchange van at Harford Road and 25th Street; a few people asked Harris if they could come inside to warm up. He obliged.

At least 15 people asked Harris: “Y’all have that medicine that brings people back?”

He did. That night, Harris trained people to use naloxone. He told them if they saw someone with no signs of life — at church or a bus stop, in a restaurant bathroom or their own home — they should release the nasal spray antidote and call 9-1-1. Within moments, naloxone stops the overdose and sends the person into withdrawal, a preferred side effect if the only other option is death.

“Y’all have that medicine that brings people back?”

But what Harris has seen disturbs him. People shoot up or snort forms of synthetic heroin called fentanyl and carfentanil, which is 10,000 times stronger than morphine and used as an elephant tranquilizer — aiming for a more potent high at the risk of losing it all. And with the price of heroin as low as $3, Harris said it’s more accessible than ever. By his count, 43 people overdosed in Baltimore that January weekend.

“The trauma [of being] there, to see someone drop and die in your presence, can leave a scar forever,” he said. “It’s in your neighborhood. It’s everywhere. I’m just glad to be a part of the solution as opposed to the problem.”

Harris lives in the same Coppin Heights home where he was born. But the neighborhood where his father and his mother raised 13 children changed long before the opioid crisis captured national attention. Down the red-brick street, a drug market openly thrives. The sounds of children laughing and playing no longer bounce off the brick rowhouses with white trim. It’s not safe anymore, said his niece, Rhonda Harris. Instead, ambulance sirens start wailing after lunchtime and go all night long, occasionally punctuated by gunshots, John Harris said.

Harris, 59, knows the ghosts of addiction who haunt his street all too well. He was once one of them.

Part of the solution — Baltimore public health outreach worker John Harris stands on the porch of his Coppin Heights home, the same house where he was born and where his parents raised 13 children. In long-term recovery from his own addiction to heroin, Harris trains the public to use an overdose antidote called naloxone, writes treatment referrals for people ready to confront their addiction and attends weekly Narcotics Anonymous meetings. Photos by Frank Carlson/NewsHour

Harris was captain of his high school wrestling team; he also played basketball and ran track. But he was shy to talk to girls or speak up in class. To take the edge off, he smoked marijuana and sipped cough syrup. When he first snorted heroin, Harris said it made him feel “real smooth.” He remembered competing in wrestling meets while high on heroin and thought he hid it well.

For more than a decade, addiction tightened its grip on him. He spent less money on haircuts, new clothes and movie tickets. Instead, it went to heroin. He injected heroin, puncturing his arms with dirty needles. He lost his job, his friends, his family, his home, his health. He picked up and dropped off drugs, taking a cut for himself when he couldn’t afford to buy them outright. He overdosed. He broke his parents’ hearts. Finally, in 1989, when Harris found out his girlfriend was pregnant, he panicked and said he couldn’t get high with a baby on the way.

A short time later, a high school friend who worked at a drug treatment facility found Harris sitting on the street in a gutter. He told Harris to come to treatment.“‘If you don’t like what you see in 28 days,” the friend said, “you can go back and do what you was doing because it’s waiting for you.’”

That made sense to Harris. For more than a month, he completed in-patient substance abuse treatment at Wyman Park and the Tuerk House in Baltimore. Harris emerged from treatment clean, in time to see his son born.

But he was scared to come home.

Harris tried to apologize to his father, his lifelong hero, who for more than 30 years worked two jobs as a postal worker and union leader to provide for his family. His father told him: “‘Don’t come telling me what you’re gonna do. You show me.’”

xx

Baltimore public health outreach worker John Harris, right, stands at a Penn-North neighborhood bus stop in Baltimore and trains a man to use Narcan, also called naloxone, an antidote that can reverse an opioid overdose within minutes. Photo by Matt Ehrichs/NewsHour

His father’s command lit a fire inside of him that still burns. He took classes at Baltimore City Community College to learn how to counsel others battling addiction. He attends Narcotics Anonymous group sessions at least twice a week and says those conversations keep him in line. And he began working on the needle exchange vans that roll six days a week to meet the challenge of substance abuse in Baltimore.

He is encouraged that people talk more openly about substance abuse and addiction as families, communities and the country are confronted with a mounting opioid epidemic. He works to remove addiction’s stigma, seeing people come to him “from all walks of life.”

“They’re not bad people,” Harris said. “They’re human beings who have made some unhealthy decisions, who have put their lives in a dangerous place, and they need help.”

***
Since she was appointed in January 2015, Baltimore Public Health Commissioner Leana Wen has tried to figure out how the city would navigate the opioid crisis. In October 2015, Wen, an emergency room physician, wrote the city’s 620,000 residents a standing prescription for naloxone, also called Narcan, after she used the antidote on hundreds of patients herself.

“I’ve seen that, [if there’s] someone who’s overdosing who has minutes to live, I can literally save their life by nasal injection or by injecting something that’s similar to an epipen into them,” Wen told the NewsHour.

Since then, more than 17,000 people have received naloxone training in jails, at bus stops, at churches around Baltimore. After Wen became commissioner, naloxone has saved more than 800 lives in Baltimore. But as with EpiPen, the antidote’s price for some people is on the rise. So is the demand, at a time when nearly 25,000 city residents are estimated to have an opioid disorder.

kaléo, a Richmond, Virginia-based pharmaceutical company, makes auto-injectors that allow anyone to administer naloxone. A twin-pack of EVZIO auto-injectors that cost $575 in 2014 now costs more than $4,000, Kaiser Health News reported. The company argues that for 200 million people with commercial insurance and a prescription, the auto-injectors are now available free of charge.

In a written statement to the NewsHour, Spencer Williamson, chief executive at kaléo, said the company has donated nearly 200,000 auto-injectors since October 2014 to “public health departments, first responders and non-profits serving patients in need, free of charge.” Those free injectors make up about 40 percent of all auto-injectors shipped as of December, he said. The company plans to donate 100,000 more auto-injectors this year.

“We’ve received reports of more than 3,000 lives saved by EVZIO,” Williamson said. “That’s an average of more than 25 a week since the start of the program.”

The antidote is important, but if that’s the public’s only defense against opioid addiction, then “we’re just on this treadmill,” Wen told the NewsHour. Out of an estimated 20 million people who abuse substances nationwide, 11 percent seek treatment. That’s why she secured $3.6 million to build a stabilization center that offers round-the-clock behavioral health treatment. And as of Feb. 6, the city’s police officers can send minor drug offenders to treatment, rather than jail, in a move championed by law enforcement and Wen’s office.

After Trump won the presidential election, Wen, along with 10 other public health commissioners of major U.S. cities, wrote a letter to his transition team, asking that they “prioritize combating opioid addiction and overdose in the first 100 days,” and appoint a drug czar “with experience in public health and addiction treatment to ensure that addiction is addressed as the disease that it is.”

Mike Gimbel, of the Maryland Addiction Recovery Center, agrees with Wen’s belief that when communities treat addiction like a disease rather than a moral failing (“treat people rather than put them in prison”), they will produce better outcomes. But he said the city emphasizes naloxone too much and should do more to steer people battling addiction into treatment.

Gimbel, a recovering heroin addict, says he has been clean for 44 years. He scoffs at the way people talk about addiction in the United States today, compared to the searing rhetoric of the drug war of the past. Now that heroin is a middle-class issue, governments want to treat addiction “like it’s every other disease,” he says.

“The inner cities have been dealing with heroin addiction for over 50 years,” he said. “Suburbs have just begun to come to terms with the fact that there’s a heroin problem in white middle class America.”

In October 2015, Baltimore City Public Health Commissioner Leana Wen wrote a standing order for naloxone, an opioid overdose
         antidote, for all 620,000 residents. Photo by Frank Carlson/NewsHour

In October 2015, Baltimore City Public Health Commissioner Leana Wen wrote a standing order for naloxone, an opioid overdose antidote, for all 620,000 residents. Photo by Frank Carlson/NewsHour

But he thinks a standing citywide order for naloxone makes it too easy for people with substance addiction to escape hospital care and treatment. Instead, he says public health officials should invest more resources in long-term treatment facilities and design policies that route people into those facilities. That was the only thing that broke heroin’s hold on him, Gimbel said.

“It takes over your body. It takes over your mind. It takes over your soul. Heroin is literally the devil,” he said. “Middle-class America has never had to confront this.”

Pharmacist Dwayne Weaver began filling prescriptions at his Penn North neighborhood shop two decades ago. Nowadays, clients step up to his pharmacy’s bulletproof glass window once or twice a week, asking for more naloxone under Wen’s citywide prescription. The antidote’s potential is huge, Weaver said. As more people become addicted to opiates, like oxycontin, “the marketplace has turned to heroin for a cheaper high.”

But Weaver holds the medical community partially responsible for its role in the epidemic.

Public health officials “seem to be finally educating doctors on more prudent prescribing of opiates,” Weaver said.

And it’s not just doctor’s prescriptions. A few blocks from Weaver’s store, drug dealers stand shoulder-to-shoulder next to a red brick wall in an open market. A police helicopter circled overhead, and officers patrolled around the corner, but business never slowed down on a chilly Wednesday afternoon.

***
Back on the van, on Michael Botticelli’s final day as the drug czar, he asked public health workers like John Harris what they thought the nation needed to more fully combat the opioid epidemic.

“Heroin is literally the devil. … Middle-class America has never had to confront this.”

Mental health problems and addiction are often tightly intertwined, Harris told Botticelli, and people feel isolated in poverty and violence. Cities like Baltimore need more treatment centers that integrate psychological disorders and substance abuse, he said. Otherwise, said Thomas Clemons, another city health educator who works alongside Harris on the van, “you’re gonna come right back to the same problem.”

Several outreach workers who spoke to Botticelli that day had served on the frontlines of Baltimore’s opioid crisis for roughly a decade. They told him a sense of mission and compassion kept them coming back.

Nationwide, “that’s what we need in the middle of this epidemic,” Botticelli said.

Despite the concern that echoes around him, Harris said he remains optimistic the new president will support his city’s efforts to fight a public health crisis. Officials in Baltimore and other cities across the country are waiting to see how the new administration chooses to tackle this epidemic. Until then, he’ll hand out clean needles, write up treatment referrals and train people to trick death while working to loosen addiction’s hold on his hometown.

The post In the war on heroin, Baltimore drug programs face an uncertain future appeared first on PBS NewsHour.

Hospitals worry an ACA repeal could harm their financial health

obamacare1

Watch Video | Listen to the Audio

JUDY WOODRUFF: Now what hospitals fear about the possible costs of repealing and replacing the health care law.

Efforts by President Trump and congressional Republicans to unravel the Affordable Care Act are unnerving many hospital executives. They say they’re worried about big changes to their bottom line, particularly after they overhauled how care is delivered in response to the health law’s rewards and penalties.

While Republicans try to figure out their game plan, special correspondent Sarah Varney reports on how hospitals are bracing for the unknown.

This story was produced in collaboration with our partner Kaiser Health News.

SARAH VARNEY: Driving to work amid the barren winter fields in Northern Illinois, Cathie Chapman is worried about the future. She lost her job after a nearby rural hospital closed.

CATHIE CHAPMAN, Perry Memorial Hospital: I was really lucky. I found another great hospital to work in with a wonderful group of people who deliver high-quality care. But not everyone was as lucky.

SARAH VARNEY: And as Republicans work to dismantle the Affordable Care Act, she wonders if it might happen again. Now she runs the pharmacy at Perry Memorial in Princeton, Illinois. And she’s watching the Republicans’ repeal efforts warily.

CATHIE CHAPMAN: I think everybody who works in health care now feels a little uneasy. Even if you’re a large, profitable hospital, we don’t know what’s coming around the corner, and how it will affect us.

SARAH VARNEY: Rural hospitals have long struggled to stay open: They have far fewer patients and thin margins. Dozens have closed across the country in recent years, mostly in states that didn’t expand Medicaid.

But, in Illinois, which did extend Medicaid to nearly all poor adults, patients at Perry Memorial have gained coverage under the Affordable Care Act and many hospitals have found firmer footing.

But Annette Schnabel, the hospital’s CEO, says if large numbers of people lose their insurance under the Republicans’ replacement, the hospital’s finances and its patients would be at risk, especially after the hospital has invested so much money and time in complying with the health law.

ANNETTE SCHNABEL, CEO, Perry Memorial Hospital: We have spent the last six years gearing up towards everything that we were responsible for doing in the ACA. And the idea of we might have to totally go a different direction or how will we do that, it’s going to take a lot of work. There’s a lot of effort that is going into this.

SARAH VARNEY: And for some hospitals to survive or break even, it will require Congress to restore billions of dollars in funding that kept hospitals afloat before the law took effect.

Hospitals made a high-stakes trade when they signed on to the Affordable Care Act. They agreed to massive cuts in federal aid that defrayed the cost of caring for the uninsured. In exchange, they would gain tens of millions of newly insured customers. Now that deal is in jeopardy, and hospital executives are anxiously waiting to see what comes next.

Stroger Hospital of Cook County, in Chicago, is one of the busiest hospitals in the nation. Its emergency and trauma teams have inspired shows like “E.R.” and “Chicago Med” and handle most of the city’s gunshot victims.

The vast majority of patients here used to be uninsured, and the county-run hospital struggled to take care of all of their medical and mental health needs. Those patients now have Medicaid coverage because of the Affordable Care Act, and the Cook County hospital system has gained $200 million in new revenue to cover their services, breaking even for the first time ever.

DR. JAY SHANNON, CEO, Cook County Health and Hospitals System: We have no interest in slipping back in what we have been able to do.

SARAH VARNEY: Dr. Jay Shannon is CEO of the Cook County Health and Hospitals System.

DR. JAY SHANNON: We’re not able to do the kind of work that we do today with good will alone. Our staff are not a volunteer staff. We can’t get I.V. fluids and medical equipment on credit and a wink and a nod.

SARAH VARNEY: Two hospital trade groups, the American Hospital Association and the Federation of American Hospitals, have warned of — quote — “an unprecedented public health crisis” if the law is hastily scuttled.

They say if Congress repeals the law entirely and 20 million people are kicked off their insurance, hospitals will lose $166 billion in Medicaid payments alone in the next decade and face much steeper losses if certain Medicare cuts that were part of the law aren’t restored.

In Chicago, limo driver Jerold Exson is one of those patients who could lose coverage and have his hospital bills once again go unpaid. As of now, the hospital helps enroll low-income adults like Exson into Medicaid. In 2014, he was shot nearly a dozen times in a case of mistaken identity.

His medical care is covered now, and the hospital can provide follow-up surgeries, physical therapy and mental health treatment that were often off-limits to the uninsured.

NATALIA RUIZ: How are you feeling today? I see you. You’re kind of down.

JEROLD EXSON, Chicago: I’m not as edgy when I’m, like, driving or out in public, around a lot of people.

SARAH VARNEY: Exson sees clinical psychologist Natalia Ruiz to manage the after-effects of gun violence.

JEROLD EXSON: I had that episode where I was driving that time, and the little rock hit the window, and it kind of sent me into a tailspin.

SARAH VARNEY: The health law also shifted the business model for U.S. hospitals. It offered them financial incentives to move away from expensive E.R. visits to primary care and managing chronic conditions.

Earl Williams Sr. has finally brought his diabetes under control. He’s diligent about exercising, taking his medication, and seeing his doctor.

EARL WILLIAMS SR., Chicago: My sugars was in the 200s. They’re now from 80 to 120, where they’re supposed to be. Then they took some of the medication away because I have maintained due to the teachings of my doctors and the staff here at Woodlawn Hospital.

SARAH VARNEY: Before the Affordable Care Act, hospitals had little incentive to reduce E.R. visits, especially from Medicare patients who generate a lot of revenue.

At the University of Chicago Medicine, an academic medical center, Dr. Kenneth Polonsky says that if those incentives are rescinded and patients forgo preventive care, they will clog up already strained emergency rooms.

DR. KENNETH POLONSKY, University of Chicago Medicine: We will go back to a very frustrating time, where people had limited options for health care because of inability to get health insurance.

SARAH VARNEY: The uncertainty is also roiling county governments, which often fund medical care for the poor. The burden on local taxpayers to fund the Cook County Health System has dropped by $300 million since the health law went into effect.

President of the Cook County Board of Commissioners Toni Preckwinkle says repealing the law could force local governments to raise taxes.

TONI PRECKWINKLE, President, Cook County Board of Commissioners: For us, it’s a $300 million hole in our budget. So, there aren’t a lot of options, other than raising more revenue. It’s a nightmare for us.

SARAH VARNEY: She says the county and the country have been making progress, and repeal is a step backward.

In Waukegan, Illinois, near the Wisconsin border…

BARBARA MARTIN, CEO, Vista Health System: What we’re entering here is our new open heart surgery suite.

SARAH VARNEY: Vista Health System CEO Barbara Martin says with more insured patients and additional reimbursement from the health law, she’s invested in new equipment and hired hundreds of new employees across Vista’s two for-profit hospitals.

She says, if the 900,000 Illinois residents who gained insurance under the law lose coverage and hospital revenue drops suddenly, hospital executives estimate 95,000 jobs could be lost.

BARBARA MARTIN: That could just be catastrophic to the state and catastrophic, not to only Vista, to all hospitals across the country.

SARAH VARNEY: But Edmund Haislmaier, a senior fellow at the Heritage Foundation, a conservative think tank, says U.S. taxpayers already spend too much on health care.

Haislmaier, who was a member of President Trump’s transition team on health policy, says communities and states and local governments shouldn’t rely on hospitals to create new jobs and fill their budget holes.

EDMUND HAISLMAIER, Heritage Foundation: Hospitals in particular have become economic development projects. If you’re paying tax dollars for a public program like Medicare or Medicaid and you’re paying private insurance premiums, this is all what makes health care unaffordable.

SARAH VARNEY: More than a dozen top Republican lawmakers declined to be interviewed for this story. But a spokesperson for Senator Lamar Alexander, chairman of the Senate Committee on Health, Education, Labor and Pensions, said in a statement that he is listening to hospitals, doctors, patients, governors and others as they draft the replacement plan.

Back in Chicago, that all adds up to more questions for patients like Earl Williams.

EARL WILLIAMS SR.: Am I going to have insurance in a month or two?

SARAH VARNEY: Questions doctors are struggling to answer.

MAN: I’m going to give it to you straight. And that is, it’s likely that it’s going to change. It’s not going to be the same.

SARAH VARNEY: With President Trump and congressional Republicans now saying a final replacement plan may not be ready until later this year, the uncertainty is likely to linger.

For the PBS NewsHour and Kaiser Health News, I’m Sarah Varney in Chicago.

The post Hospitals worry an ACA repeal could harm their financial health appeared first on PBS NewsHour.