The passage of the Republican plan to replace the Affordable Care Act would be nothing short of "catastrophic" for NYC Health + Hospitals and the low-income patients it serves, Stanley Brezenoff, the health system's interim president and chief executive, told Crain's Tuesday. "If I were like a certain tweeter," Brezenoff said, laughing, "I would probably ascribe it to a personal attack on me and Health + Hospitals."

Brezenoff said he's holding out hope that Republican lawmakers will voice their opposition loudly enough to stop the legislation in its tracks. Edited excerpts of his conversation with Crain's Caroline Lewis follow.

How do you think the Republican proposal to replace the Affordable Care Act will impact Health + Hospitals?

If this proposal is enacted, and that's a big if, it would eviscerate Medicaid. That's horrible for poor people across America and horrible for New York state and New York City and horrible for Health + Hospitals, starting with the impact on our patients.

How would the proposal to cap Medicaid payments to states affect H+H?

It's hard to speculate in a specific way, but it bodes terribly for Health + Hospitals and safety net health care organizations, because even with the best intentions in the world, New York state is going to find itself billions of dollars short.

One wonders about people losing their insurance, whether through changes in Medicaid or simply because the tax credits are not enough to help people with limited wages. If there are fewer people with insurance, they will not get the continuity of care, the preventive care, the wellness care. Instead, their conditions will get worse over time until they must present themselves in an emergency room uninsured and in worse condition than they should be.

The ACA cut supplementary payments to hospitals that serve disproportionate numbers of Medicaid and uninsured patients, and the Republican plan proposes to reinstate those payments for Medicaid expansion states in 2020. Do you think that measure would be sufficient to offset the potential negative impact of the Republican plan on your health system?

On the great "come and get it" day in 2020, does anyone believe these characters are actually going to make money available? And in the meantime, hundreds of millions of dollars will be denied in a punitive way. What else is it besides punitive if they seek to take disproportionate share hospital payments from the states that expanded Medicaid? Many of those states have Republican governors. I hope they have Republican senators, too, who will rise to the challenge and not let their states get punished.

Some legislators have put forth universal, or single-payer, health care in New York as a way to safeguard the system here. What do you think of single-payer?

On an individual basis in my entire career, I've always been for single-payer for a lot of reasons. My viewpoint hasn't changed on that. But in and of itself, it doesn't deal with the challenge here. The challenge is the taking of hundreds of millions of dollars on the part of the federal government from New York state and similarly situated states. No amount of restructuring is going to deal with the theft of these dollars, and that's the problem the state and H+H and other health care providers would have to deal with if this bill becomes law.

Do you think if this plan goes through, it will result in hospital closures?

It's really hard to speculate. Health + Hospitals is not going away. Our mission isn't going away, our commitment to the mission isn't going away and we'll do what we have to do. But make no mistake about it, this is a brutal attack on safety net health care in America, and Health + Hospitals is a principal instrument of safety net health care.