A bill passed by the US House of Representatives earlier this month to “repeal and replace” the Affordable Care Act would cut tens of thousands of Kentuckians from the health insurance rolls by slashing Medicaid, reducing premium subsidies, and dropping requirements that large companies provide health insurance for their employees, health care advocates say.
It would shift costs to older Americans, who tend to be sicker, place a cap on the amount of money a state could spend for Medicaid, and prevent people who lose Medicaid expansion coverage for more than one month from ever signing up for it again.
The bill would also lift the ACA requirement that states provide women with maternity care insurance, according to an analysis by the Kentucky Economic Policy Institute, a Berea-based think tank that opposes the proposal.
The bill was passed by the House of Representatives without an analysis by the Government Accounting Office, and there is some suggestion that the law might have to be returned to the House for a second vote after the GAO analysis is released. That release was scheduled for today (May 24), but a copy of the budget from the Trump administration that arrived in Congress Monday shows many of the cuts already expected, including more than $800 million cut from the Medicaid Program.
Fifth District U.S. Rep. Hal Rogers told the New York Times that the budget will “face a tough sled here.” When the Times asked about the impact on his constituents from reductions in such programs as food stamps, Rogers said, “These cuts that are being proposed are draconian. They’re not mere shavings, they’re deep, deep cuts.”
Rogers voted for the AHCA, however. Rogers said in a prepared statement that he voted for the bill “with confidence.”
“Since the original American Health Care Act was introduced in March, I’ve heard from dozens of people from southern and eastern Kentucky about their fears and concerns for the future of health care in America. After additional amendments were made to the bill addressing some of those issues, including additional protections for people with pre-existing conditions, I cast my vote of support for the AHCA with confidence,” Rogers said.
“The bill isn’t perfect, but it isn’t finished,” he said. “The U.S. Senate now has an opportunity to help rescue our people from ObamaCare’s unaffordable taxes, mandates and broken promises. And it’s urgent. I have received countless calls from people in our region who have been forced out of their health care plan and now pay the annual penalty because they can’t afford the limited and expensive health insurance options under ObamaCare. In fact, half of Kentuckians are left with only one provider to chose from and some families in our region tell me they now pay more for health insurance than their mortgages. The people of Kentucky’s Appalachian region deserve better and the AHCA is simply the first major step required in this rescue mission.”
Despite Rogers’ statement casting the bill as a “rescue mission” that protects people with pre-existing commissions, analysts say it will place people with pre-existing conditions into “high risk pools,” with much higher rates than regular insurance.
While the Affordable Care Act (ObamaCare) provides for subsidies to help pay premiums based on income, the American Health Care Act (TrumpCare) would base the subsidies on age. Younger people would see large reductions in the size of their premiums, while older people would see even larger increases. Those with higher incomes would pay much less as a percentage of their income than poorer people, though the bill passed by the House slightly weakens support for higher-income families in 2020.
The Kaiser Family Foundation issued nationwide estimates in March, before amendments to the plan, but analysts say the amendments did little or nothing to improve the new bill, and may actually increase the number of people who will lose health insurance coverage.
InsureKY, a coalition of health care advocates opposed to repeal and replacement of the ACA, said the new law could shift $16 billion of Medicaid costs to Kentucky, and 470,000 Kentuckians who got Medicaid as a result of the expansion to those who earn 130 percent of the poverty level would lose coverage through attrition, since the expansion will be phased out as people become ineligible, and no new policy holders will be accepted. The Kentucky Center for Economic Policy, one of the InsureKY partners, said the changes will “squeeze” an additional 930,000 additional Kentuckians who receive traditional Medicaid, especially pregnant women.
Premiums would skyrocket for many under the plan put forward by Congressional Republicans in March, according to the Kaiser Family Foundation. That group calculates that a low-income 60-year-old in Letcher County paying 55 percent of his or her annual income for health insurance.
According to the same calculator, a 60-year-old person living in Letcher County and earning $30,000 a year would pay 36 percent of his or her income annually for health insurance, compared to 8 percent under the Affordable Care Act. A 60-year-old with an income of $75,000 would pay 27 percent of his or her income, a reduction of $190 from the ObamaCare premiums.
Prices would be considerably cheaper for younger people with higher incomes across the board. A 27-year-old earning only $20,000 would pay 10 percent of his or her income, an increase of $990 a year. A 27-year-old earning $30,000 would pay 7 percent, a reduction of $530. A 27-year-old earning $75,000 a year would pay only 3 percent of his or her income, $2,340 less than under ObamaCare.
“The AHCA threatens healthcare for all of us,” Emily Beauregard, Executive Director of Kentucky Voices for Health another of the InsureKy partners, said in a prepared statement. “In its latest form, this bill no longer guarantees basic coverage for any Kentuckian or life-saving protections for more than 1.8 million Kentuckians with pre-existing conditions. If this bill becomes a law, it will strip insurance coverage from hundreds-of-thousands of hardworking families here in Kentucky and drive up premiums for thousands more, making access to care completely out-of-reach.”
The bill also cuts $880 million from the Medicaid program. If a state exceeds the per capita spending set by the federal government during a given year, the amount given to that state the following year will be cut by that same amount.
“The bill gives a massive tax cut to the rich and corporations, while devastating Medicaid with the most significant cut in the history of the program,” said Jason Bailey, Executive Director of the Kentucky Center for Economic Policy. “That means pulling the rug out from under some of Kentucky’s most vulnerable people – like children, people with disabilities and seniors in nursing homes.”
In Letcher County, Mountain Comprehensive Health Corporation hired about 100 people and increased the services it offers as a result of the ACA. The company said earlier it could lose those jobs. This week, it would not say directly what effect the AHCA would have on it, however CEO Mike Caudill said in a statement that company is “concerned with any change in the current system, and what its impact may be.”
“That is why we are working diligently with our state officials to minimize any negative effects ad maximize the opportunities that may present themselves during this transition, period,” Caudill said.
According to the InsureKy figures, MCHC would not be alone in being at risk for job losses.
The analysis projects Kentucky would lose 85,647 jobs, 2 percent of the workforce, by 2022 as a result of the ACHA.