On Monday, Republicans in the U.S. House of Representatives revealed their plan to repeal the Affordable Care Act, aka “Obamacare,” and replace it with a new law that would eliminate many of the ACA’s key elements, including a mandate requiring most Americans to have health insurance as well as the Medicaid expansion that extended coverage to more than 10 million Americans in 31 states.
According to health care leaders on the North Coast, these changes threaten to strip thousands of local residents of their health insurance and increase costs for thousands more.
Late last week, before the Republican plan had been released, Open Door Community Health Centers CEO Dr. Herrmann Spetzler expressed concern about the rhetoric coming out of Washington, D.C.
“There is no less expensive way to provide health care to the uninsured, that I’m aware of, than what the ACA model has right now.” Except, perhaps, a single-payer system, he added. At any rate, he said, “I don’t think you can drop out a mandate that everybody participate and [still] guarantee everybody access to insurance.”
The Republican plan announced Monday would replace the mandate with a system of age-based tax credits for people purchasing insurance on the open market. It would also scrap the requirement for larger employers to offer coverage to full-time employees and strip federal funding from Planned Parenthood clinics. This despite the fact that federal dollars are already prevented from paying for abortions except in cases of rape or incest, or when the life of the mother is endangered. (Congressman Jared Huffman addressed some of the misconceptions about the organization in his latest podcast episode.)
Addendum: It should be noted that while the Republican bill would not penalize people who don’t purchase insurance, it would levy fines on those who allow their coverage to lapse. “Insurers could increase their premiums by 30 percent,” the New York Times notes, “and in that sense, Republicans would replace a penalty for not having insurance with a new penalty for allowing insurance to lapse.”
Since the ACA took full effect in California in 2014, nearly 19,000 Humboldt County residents have obtained coverage through Medi-Cal, the state’s Medicaid program, and another 5,570 residents have received subsidized coverage through Covered California, the state’s ACA insurance exchange.
In Humboldt and Mendocino counties, 13.9 percent of the adult population receives health care coverage thanks to the Medicaid expansion, a higher rate than in any other county in the state, where the average is 9.4 percent. Under the Republican proposal put forth this week, many of these locals stand to see reduced federal payments through Medi-Cal, or to lose their insurance altogether.
The ACA has had a dramatic impact on the nonprofit Open Door organization, which has expanded to include 14 access points, from Crescent City to Petrolia. Last year Open Door had roughly 250,000 patient visits from about 55,000 unique individuals, Spetzler said, and Obamacare provided coverage for a huge portion of those visits.
“We used to have 40 percent of our patients had no health care insurance access,” Spetzler said. “Now we have six percent.” All told, 54 percent of Open Door’s patients receive coverage through the ACA.
St. Joseph Hospital President Dr. David O’Brien said the ACA has helped Humboldt County move toward a “population health” model, offering more preventative care — and higher-quality care — as opposed to emergency room visits from people who avoided doctors until their conditions became an emergency.
“The ACA has done some good things for our country and for our patients by expanding the access for a lot of people who had no access to health care,” O’Brien said. “I think everybody has benefited from it, because patients are getting care now when they weren’t getting care before.”
Between 2013 and 2015 the number of uninsured adults in Humboldt County was cut by more than half, from 23,000 to 11,000, according to a report by the U.C. Berkeley Center for Labor Research and Education and the UCLA Center for Health Policy Research.
The Republican bill does retain some popular Obamacare provisions, including, as the New York Times reports, “the prohibition on denying coverage to people with pre-existing conditions, the ban on lifetime coverage caps and the rule allowing young people to remain on their parents’ health plans until age 26.”
But Republicans hope to repeal the income-based tax credits that have helped nearly 6,000 Humboldt County residents get insurance through Covered California. They also want to undo the law’s taxes on those with high incomes and the penalty for not having insurance.
O’Brien said repealing the insurance mandate could cause problems. “If insurance companies are only insuring people with medical problems … then the insurance model falls apart,” he said. “You need to have a broad base of patients to spread that risk out.”
Spetzler agreed, noting that Open Door offers care people “absolutely need,” people throughout Humboldt and Del Norte counties and beyond, into Brookings and parts of Mendocino, Trinity and even Siskiyou counties.
“Preventing that access for those populations is not good health care delivery, and it’s also not good economics,” Spetzler said. “Because if you have some kind of a condition that we can take care of for you but we’re not available then it will happen in the emergency room at many times the expense.”
The Republican bill will next be considered by two House committees in hopes of sending it to the Senate before the April 7 spring break. Its outcome there remains uncertain, according to numerous news sources, with Democrats and some Republicans expressing concerns. President Donald Trump has expressed support for the bill.
Our local state Assembly representative, Jim Wood, is in Washington, D.C., today and posted the following message on Facebook: