Area experts discuss ACA’s legacy, what effects repeal could have locally
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The non-elderly adult uninsured population decreased 8 percent in Fayette and Greene counties and 6 percent in Washington and Westmoreland counties from 2013 to 2015, according to Enroll America, with Fayette County’s 2016 uninsured rate higher than the other three counties.
This photo shows the HealthCare.gov website, where people can buy health insurance, on a desktop screen. (Photo by Roberto M. Esquivel, Herald-Standard)
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The McKinsey Center for U.S. Health System Reform identified Fayette, Greene, Washington and Westmoreland counties’ lowest-price premiums increasing over the past year, but it also stated that the area’s monthly premiums for a 40-year-old nonsmoker are still lower than most of the country.
Zolbrod
Blair
Aaron Zolbrod used to sometimes determine just by looking at a person whether they’d be able to be insured when they walked into the Health Insurance Store he owns in Connellsville. If they had a limp or were obese, Zolbrod knew right then and there they wouldn’t be.
That changed with the implementation of the Affordable Care Act (ACA), which was signed into law by President Barack Obama in 2010. The act ensured that insurance companies could no longer deny patients treatment or coverage based on health status.
Zolbrod recalls that provision resulted in “great stories” of people having access to previously unavailable coverage, specifically noting a man who was finally able to afford rotator cuff surgery.
“(The) pre-existing conditions clause, that can never go away,” Zolbrod said.
But the future framework of health care both locally and nationally is unclear as Republican-led Congress looks to repeal the ACA, colloquially known as Obamacare.
The GOP-run Senate approved a budget early Thursday that eases the way for action on subsequent repeal legislation as early as next month, according to the Associated Press.
President-elect Donald Trump has said he would uphold the ban on denying coverage for pre-existing conditions.
Trump told reporters Wednesday that the repeal of the ACA would be repealed and replaced “essentially simultaneously,” but congressional Republicans are not close to agreement among themselves on what a potential replacement would look like, per the Associated Press.
A repeal of the ACA without a replacement would have a “negative impact” on Monongahela Valley Hospital, according to hospital media specialist Andrew Bilinsky.
“What the hospital was receiving to offset costs would then go back on the patient,” Bilinsky said. “Other hospital reimbursements were also eliminated because more people would have insurance. If they do not have a replacement, they need to reverse those cuts.”
The American Hospital Association and the Federation of American Hospitals this week sent letters to Trump and congressional leaders last month warning that hospitals could lose $165.8 billion between 2018 and 2026 if the ACA is partially repealed and not replaced.
Uniontown Hospital declined comment on how the ACA’s impact on the hospital and how its potential repeal might affect the hospital.
Bilinsky said the ACA is resulting in patients paying more out-of-pocket expenses as a result of choosing their least costly health plan.
Zolbrod observed that the majority of his customers are seeing “really good” premiums and also lower deductibles.
“They are a little nervous about what’s going to happen (with the potential repeal),” Zolbrod said.
But Zolbrod added that 10 to 15 percent of his clients are not getting Obamacare subsidies and are angry that their premiums have nearly doubled and their deductibles have nearly tripled from their pre-Obamacare amounts. Zolbrod said that insurance expenses have gone up for those without an Obamacare subsidy since people with health issues flooded the market as a direct result of ACA, while not enough young and healthy people signed up to balance the market.
“It’s very difficult to tell somebody $1,375 is what they need to pay for health insurance each month,” Zolbrod said, adding that that amount is just the premium and doesn’t cover the $6,500 family deductible.
Fayette and Greene counties saw a more than 20 percent increase in lowest-price silver net premiums for both subsidy-eligible and all quality health plan-eligible consumers from 2016 to 2017, according to the McKinsey Center for U.S. Health System Reform. Washington and Westmoreland counties saw a 10 to 20 percent increase in the same span. The McKinsey Center, though, also identified those four counties as having lower monthly premiums for a 40-year-old nonsmoker than most of the country.
Speers-based insurance broker Jim Blair expects that the Medicaid expansion in 32 states (including Pennsylvania) made possible by the ACA will remain. Zolbrod indicated a rollback of that expansion would hurt local residents.
The ACA provided enhanced federal funding for states to implement an expansion of Medicaid, a health care program for Americans with limited income. Under a repeal, states could potentially lose access to the enhanced federal funding made available for the Medicaid expansion, according to the nonpartisan Kaiser Family Foundation (KFF).
“(U)nder a repeal of the Medicaid expansion, many low-income parents and other adults would be at risk for potentially losing eligibility for Medicaid, which might contribute to increases in the number of uninsured,” a KFF report from last month concluded.
Under the block grant system advocated by Trump’s Secretary of Health and Human Services nominee, Rep. Tom Price R-Ga., the federal government would give each state a fixed sum of money, and states would gain increased flexibility in determining coverage requirements and what the money could be spent on.
“There’s no way Trump is going to repeal this and leave people … to do nothing and have no insurance,” Zolbrod said.
Fayette County’s non-elderly adult uninsured population dropped from 18 to 10 percent between 2013 and 2015, according to Enroll America, a nonpartisan health care enrollment coalition. Greene County’s same population decreased from 16 to 8 percent in the same span, while that population decreased from 12 to 6 percent in both Washington and Westmoreland counties.
Zolbrod said he hopes Congress can identify a solution that smooths out the low and high-price extremes he’s seen the ACA result in for his customers. And he hopes certain features of the ACA will be preserved, recalling 200 people who were ineligible for both Medicaid and an Obamacare subsidy prior to Pennsylvania’s implementation of the ACA’s Medicaid expansion.
“People were calling and screaming at us,” Zolbrod said. “We can’t have that again either.”