The oath every physician takes is to “Do no harm.” I think it’s an important credo for Congress and the Trump Administration to bear in mind as they wrestle with the future of the Affordable Care Act.

There are countless stories of real people, with real healthcare worries, that have been helped by the ACA. They are the most poignant reasons to preserve a law that has helped people access better healthcare and has protected them from financial devastation if they are hit with a major illness or pre-existing condition.

Truth is, the potential for harm extends far beyond the 22 million Americans and 800,000 New Jersey residents who receive health insurance under the ACA. The impact could be felt in reduced coverage protections for all healthcare consumers, in financial hits that jeopardize healthcare providers that care for us all and in deep federal funding cuts that could punch a hole in our state budget – with potential reverberations for all residents.

Those of us in the healthcare community are watching the current debate over whether to “repeal, replace or repair” the ACA with the hope that Washington does no harm to an industry that is responsible for 17 percent of our nation’s gross domestic product.

The ACA has, quite frankly, changed the way our healthcare system operates. The healthcare community has moved aggressively since the law’s passage in 2010 to implement the component parts by enrolling uninsured individuals into Medicaid or an insurance plan; adopting more preventive health measures to keep people out of the hospital; and investing greatly in improved healthcare quality to prevent hospital readmissions and increase the value of the care we deliver.

Insurance coverage is critical to providing care to people in the right healthcare setting – that is, the setting where people can get the appropriate level of medical services at the lowest cost. It makes no sense to wait until you are very ill to come to an emergency department for care when a visit to a primary care doctor a week prior could have prevented that from happening.

I’m heartened to hear President Trump say that no one will lose coverage under a replacement plan. That’s critical to the people who are now covered under the law, and it’s also critical to the healthcare provider community in New Jersey. Why? There are two reasons.

First, the provider community – hospitals, health systems, nursing homes and others – absorbed $1.8 billion in cuts over a eight-year period to help pay for the ACA. Those cuts were offset because providers were caring for many more people with health insurance. If the coverage under the ACA erodes, our healthcare system could be staggered by a one-two punch: billions of dollars in cuts, plus the loss of payments from insurance companies.

Second, New Jersey law requires all of our hospitals to provide care to all people in all settings, regardless of their ability to pay. We’re proud of this commitment to caring for all of our communities here in the Garden State, but it comes with a steep cost. Prior to the ACA, hospitals provided more than $1 billion annually in charity care services to 1.3 million uninsured New Jerseyans. In exchange, hospitals received partial reimbursement from the state. The state kicked in $650 million for those charity care costs prior to the ACA’s coverage mandate, but that funding stream has now been reduced to $302 million as the number of uninsured diminished.

Gov. Christie made the right decision for our state to expand Medicaid to more individuals, and it has had a real impact. But if the ACA is repealed without an adequate replacement, the number of insured will spike. Hospitals will provide the care needed, but it will require a reinvestment of state dollars into the charity care pool to adequately pay hospitals for that care. If the reinvestment doesn’t occur, many New Jersey hospitals will struggle financially. It’s a simple, but alarming, formula: Fewer patients with insurance + less money to pay for charity care = a fiscal crisis for New Jersey’s healthcare community.

Our “ask” to Congress members is this: As you debate how to recast the ACA – whether a “repair” or a “replacement” – recognize the importance of health insurance for those 800,000 New Jersey residents and the healthcare providers that care for them. And then, remember that age-old oath and do no harm.

Elizabeth “Betsy” Ryan, Esq., is president and CEO of the New Jersey Hospital Association, a not-for-profit healthcare trade organization based in Princeton.

Increased pressure for transparency and lower costs has created a wealth of hospital quality “report cards,” intended for consumers to make well-informed healthcare decisions. But as there are more and more of these ratings systems developed, instead of having a clear idea of quality of care, the waters get muddied. Imagine receiving five or more different report cards in school!

The Centers for Medicare and Medicaid Services (CMS) just released its attempt at a report card – a star rating system for hospitals – for the first time July 28. The system compresses all 64 quality measurements that make up the Hospital Compare database into a one-star through five-star ranking of hospitals around the country. The government’s hope was to provide a clear picture of hospital performance, but we think consumers will walk away from the new system more confused than before.

The New Jersey Hospital Association, its members and members of the New Jersey Congressional delegation were among many voices asking CMS to delay the release of the star ratings system until several issues were clear. We had concerns that the rankings were not adjusted for sociodemographic factors – a major driver of health outcomes – which punishes hospitals in ethnically diverse states like New Jersey. In New Jersey, there are more than 150 different languages spoken by our patients. This report card actually punishes hospitals that treat a large number of low income patients.

We were also concerned that, while the ratings were intended to increase transparency, hospitals were unable to get the data used by CMS to create the rankings. Not being able to replicate the process and double check the numbers used means hospitals have little recourse to dispute a potentially incorrect score. Other issues raised by hospitals and Congressional leaders included lower ratings for hospitals that see a disproportionate share of low-income patients and that train medical students.

Our members are not opposed to transparency. We tried to work with CMS to refine the process and create a useful tool for patients and their families across the state. An informed consumer is good for all parties involved. Unfortunately, the star system was published without many of the stakeholders’ concerns being addressed.

We will continue to work with CMS and other rating organizations to ensure that the high quality of healthcare offered in this state is recognized fairly and accurately.

In one year since the Morristown Memorial tax court decision was announced on June, 25, 2015, 30 lawsuits representing more than half of the state’s 58 non-profit hospitals have arisen across the state pitting municipalities against their not-for-profit hospitals. While not particularly surprising, this is an unfortunate response. Over the years, hospitals and municipalities have had a strong history of working together as good partners and it is a shame that these mounting lawsuits are eating away and placing stress on these otherwise successful and cooperative working relationships.

The initial response by members of the New Jersey Legislature following the court decision was to introduce a bill to provide consistency and certainty for both hospitals and municipalities. The bill was pocket-vetoed by the Governor, who instead called for a two-year freeze on any property tax liability and a commission to study the 70-year statute that was the basis for the original dispute and offer a solution. Since January, there have been a few bills introduced but no formal action has been taken on any of them.

Instead of endless litigation, what is needed is a thoughtful legislative approach that would create a sound statewide policy allowing hospital contributions to flow to their towns much faster than disjointed, drawn-out legal battles. We urge the Legislature to pass a bill that quells the legal uncertainty for not-for-profit hospitals and ensures a balanced statewide solution.

Make no mistake, hospitals are more than willing to contribute to their towns for the municipal services they use. The hospital community supported the bill in the lame-duck session of the Legislature that would have provided $25 million in hospital financial support to their communities.

Today, hospitals support bill A-3635/S-2329 sponsored by Assemblyman Herb Conaway and Senator Nilsa Cruz-Perez. This bill provides an opportunity for thoughtful discussion while placing a moratorium on the lawsuits that could cost towns and hospitals millions to litigate and years to resolve. Specifically, it would create a “Non-Profit Hospital Property Tax Exemption Study Commission” that would meet over a two-year period to develop and recommend a sound statewide policy approach. We’ve even offered compromise language that would have hospitals contribute a reasonable amount to their municipality while the study commission does its work.

A second bill S-2212/A-3888, introduced by Sen. Bob Singer (R-Ocean), would protect the legality of PILOT agreements – or Payments in Lieu of Taxes – between hospitals and their host municipalities. The hospital community also supports that measure.

The Morristown case that initially spurred this issue was seven years in the making. It’s wise to take some time as presented in bill A-3635/S-2329 to get this right and arrive at a sound solution that will help municipalities and tax payers without threatening the viability of hospitals and the healthcare services they provide to our communities.

With time ticking away, it is inevitable that more municipal lawsuits will be added to the already substantial list. This patchwork of litigation offers no guarantee of consistency or equality for individual municipalities or the hospitals, and perpetuates an ongoing cycle of lawsuits that will take years to resolve and cost millions to litigate.

While supporting new legislation and agreeing to pay their fair share, it is important to note that New Jersey’s non-profit hospitals already contribute significantly to municipalities and the state, as reported by EY (formerly Ernst & Young LLP). These hospitals deliver care 24/7, provide $2.4 billion in community benefit and serve as prime drivers of economic activity within their communities – employing nearly 144,000 people whose wages and tax contributions ripple throughout the economy. Charity care services to the poor and uninsured alone total about $1 billion annually.

This group of not-for-profit hospitals that have been exempt from property taxes in New Jersey since laws were enacted in 1913 have already volunteered in a unified manner many months ago to contribute additional funds to their municipalities to support essential functions and provide local property tax relief. In return, the only thing requested by the hospitals was to preserve their current property tax exemptions and provide them relief from litigation.

So, I return to my call for legislation versus litigation. We support bill A-3635/S-2329 that addresses the needs of municipalities, while providing certainty to our hospitals. We urge action on this legislation and re-affirm that our members are committed to doing their share to support their municipalities, while continuing to serve as good neighbors and answering the needs of their patients.

I’ve worked in healthcare for most of my career, but recently I viewed my local hospital from a new perspective – as a patient during a 13-day hospital stay.

It was scary and sometimes confusing. But it was also profound. I don’t think I’ve ever been more grateful for a group of compassionate caregivers, a team of skilled physicians and all of the employees, from food service workers to the housekeeping team who always had a kind word. I also was amazed by my firsthand view of modern medical technology – and very, very appreciative that it’s here for us in New Jersey hospitals.

As we celebrate National Hospital Week this week (May 8-14), I hope you’ll join me in saying thank you to our hospital professionals who are there to care for us 24-hours a day, every day of the year. New Jersey is fortunate to have 111 acute care and specialty hospitals that employ 141,000 dedicated individuals.

I know our healthcare system isn’t perfect. But it sure is reassuring to me, and families across our state, to know that our community hospitals are always there for us.

There is some exciting and innovative work being done in South Jersey by the region’s five healthcare systems – Cooper University Healthcare, Inspira Health Network, Kennedy Health, Lourdes Health System and Virtua.

These healthcare leaders – otherwise fierce competitors – have come together to address a need for better care for those confronting mental health or substance use issues.

Called the South Jersey Behavioral Health Innovation Collaborative, this unique partnership also includes NJHA and the Camden Coalition of Healthcare Providers.

This collaborative was born from information in the community health needs assessments that hospitals regularly perform to examine the most pressing healthcare needs facing their local area. The gaps identified in those assessments focused hospital leadership on systemic problems that made it difficult for residents to access the behavioral health and substance abuse services they needed. The results included poor outcomes for these individuals, lots of return visits to the hospital emergency room and high healthcare costs. I applaud the five CEOs who put competitive issues aside and came together to address these regional findings.

The project started one year ago, and recently we gathered to share the findings from our first year of data collection, mined by the Camden Coalition through an extensive process. We found that ED visits for behavioral health or substance abuse needs increased 30 percent between 2010 and 2014. We also found 800 individuals who had visited all five health systems, and an overwhelming majority had at least one mental health or substance use disorder. Together, those patients logged more than 31,000 hospital visits with more than $260 million in charges. That shows the power of data in identifying problems and designing solutions.

There’s been a great deal of progress in a short period of time. The collaborative’s partners and their dedicated teams are working together to share protocols and data for the greater good of the patient. They are conferencing together on patient cases for individuals that commonly visit multiple hospitals. They’re integrating psychiatric specialists in their EDs. And moving forward, they are offering supportive needs like stable housing and exploring a regional site for psychiatric emergency services.

This project shows the power of collaboration in today’s complex healthcare system, and it highlights the commitment of our members in doing what is best for their patients and their communities.