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Local health care experts weigh in on Affordable Care Act debate

By Mike Tony mtony@heraldstandard.Com 4 min read
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Insurance experts say changes to the health care law will have local consequences.

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Blair

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Zolbrod

The future and scope of the Affordable Care Act lies in the balance as U.S. Senate Republicans continue aiming to agree upon some measure of repeal of the health law, and area health insurance experts said that any outcome on Capitol Hill will have local consequences.

After the Senate on Wednesday rejected a measure that would have repealed major provisions of the health law but would not have provided a replacement, Senate Republicans are trying to unite behind a so-called “skinny repeal” that would only undo select provisions, according to the Associated Press.

But the “skinny repeal” is still likely to eliminate the mandate requiring individuals to carry health insurance, something that area experts warned would further destabilize the health insurance market locally and nationally.

Jim Blair, a Speers-based insurance broker, said that failing to enforce the mandate would cause a “death spiral,” encouraging younger, healthier people to “bail” on signing up for health insurance.

“Because if there’s no mandate, they won’t get insurance until they get sick,” agreed Aaron Zolbrod, owner of the Health Insurance Store in Connellsville.

Zolbrod noted that the Affordable Care Act (ACA), colloquially known as Obamacare, has already resulted in a marketplace flooded with older and sicker people as younger, healthy people choose to pay a fine instead of obtaining insurance, resulting in higher premiums for some of his clients.

Days before Donald Trump assumed the presidency in January, Zolbrod said 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.

But Republican efforts to repeal and replace the ACA under Trump have been designed to pick “winners and losers” as well, Zolbrod added.

“And the winners were going to be the middle-class and the healthy,” Zolbrod said. “And the losers were probably going to be the poorer people who weren’t going to get as much subsidy, and the older people who were getting subsidies.”

Zolbrod also noted that the ACA enabled many local residents made health insurance attainable for those who could never previously afford it, either because they had preexisting conditions, which the ACA eliminated as a reason for insurers to turn consumers away, or because their incomes were simply too low.

“I know how many of our people it’s helped,” Zolbrod said.

But health insurers have hemorrhaged money as a result of older and sicker people flooding the market, and Zolbrod noted that Highmark’s pulling out of the ACA marketplace last year left UPMC Health Plan as the only government marketplace provider in many counties, including Fayette.

“This area’s done for if UPMC pulls out of the market,” Zolbrod said.

In a statement, U.S. Rep. Tim Murphy, R-Upper St. Clair, whose district includes parts of Greene, Washington and Westmoreland counties, favored coordinated-care models as “the future of providing better health care in America.”

“To provide better care at a lower cost, we must invest in an integrated, coordinated health care delivery system that cares for both the physical and behavioral health of the patient,” Murphy said. “An individual with diabetes, a chronic illness, doubles the likelihood of depression, which will double the cost of care.”

Zolbrod touted a single-payer system as a solution to the shortcomings of the current health care status quo, stressing that it was not socialized medicine but instead a framework in which the government pays premiums, gives vouchers and allows insurance companies to compete for consumers to cast vouchers with them for “hopefully zero dollars, or next to zero dollars.”

“My experience has been if you really want to screw something up, put the government in charge of it,” Blair countered, saying that he is “not all that enamored” with the possibility of a single-payer health care system, even as it gains popularity amid the legislative back-and-forth regarding health care on Capitol Hill.

Blair suggested that all consumers should have catastrophic coverage with a high deductible that the government could back, with insurance companies insuring the difference.

But whether or not key provisions of the ACA survive the “vote-a-rama” on health care amendments that, according to the Associated Press, are expected to last into the wee hours of Friday morning, local residents will feel the results, or lack thereof.

“It’s all scary, it really is,” Zolbrod said. “I’m scared for my clients.”

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