Saturday, December 17, 2016

Obamacare Repeal Would Hurt West Virginia

The Republican majority in Congress and the Trump Administration are both itching to repeal the Affordable Care Act (Obamacare). maybe as soon as January 2017.

The Affordable Care Act is not perfect and many things need to be improved, but to repeal without a replacement will be a catastrophe. It will hurt just about everybody – people, health care providers and the insurers.

According to a study by the Urban Institute based on legislation to repeal the Affordable Care Act in January 2016 and vetoed by President Obama, we can expect some very harsh and unpleasant surprises.

184,000 West Virginia residents would lose coverage in 2019 under ACA repeal. We now have less than 100,000 uninsured residents. After repeal, the number of uninsured would jump up to 272,000. Without insurance, West Virginians will put off seeking care until their condition is serious or even life threatening, and more expensive to treat. Medical bill bankruptcies will destroy working West Virginia families.

Under repeal, West Virginia would lose $14 billion in federal funding and our state and hospitals will have to try to make up the difference.

In 2019, repeal would mean the loss of $164 million in federal funds to help people buy insurance and a $1 billion cut to the Medicaid state budget.

If we are ever to get a handle on the state’s opioid epidemic, we need all the federal help we can get. Massive cuts in federal funding would threaten our entire health care infrastructure and destroy jobs across the state.

The individual insurance market (for people who do not get coverage through their jobs) would begin to disappear almost immediately. Ending premium and cost-sharing subsidies that make insurance affordable would cause young and healthy people to leave the market and make insurance unaffordable for most families and the people who need it the most. Young and healthy lower-income people couldn’t pay full price; sicker or older people couldn’t come close to affording coverage if available to them at all.

Our Republican friends in Congress will assure you that after repeal, there will be a transition period of perhaps one, two or even three years before a better system can be put in place. I don’t think they have considered the anxiety of people and the disruption and chaos in the health care system as Congress debates a variety of currently undefined alternatives to the Affordable Care Act.

What are some of the broad ideas that the Republicans talk about? One alternative is to create a high risk pool where sick people can be guaranteed coverage. We have already tried high risk pools. They were unsustainable. Costs were high, too high for low-income people, and as a friend who had been in a high-risk pool told me, “they never paid for anything.”

Health savings accounts are another idea. They are good for high-income people to squirrel away before-tax money to use for medically related purposes. They are not too helpful for people living from paycheck to paycheck.

Republicans propose to return to a wild west of unregulated insurance markets. They propose to eliminate insurance company accountability to consumers about how they spend our premium dollars and how much they raise premiums every year. At the same time, the Affordable Care Act is helping hospitals, doctors, and other health care providers explore new ways to lower health care prices without jeopardizing quality and availability (for example, by better coordinating care, and eliminating duplication and the use of unnecessary tests and drugs). We do not want to reverse these efforts.

The Republican majority is embarking on a very dangerous path. I hope that our Congressional delegation will act responsibly and refuse to vote to repeal with no replacement plan. Hundreds of thousands of lives -- pregnant women, children, working parents, seniors, people in nursing homes and who need long-term care – every family in West Virginia has a real stake in this debate. We must be able to evaluate what any replacement plan will mean for our state. We cannot jump off the repeal cliff without knowing what may lie at the bottom.

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