Counting the cost of health care repeal

 It’s too soon to say, but the people who want to overturn the Affordable Care Act, a group that includes West Virginia’s attorney general, are closer than before to getting what they want, even in the midst of a pandemic that has already killed over 200,000 Americans.

Opponents of the ACA, often referred to as Obamacare, give many reasons for wanting to kill it, although I suspect that, for many, the main reason is that it can be associated with a Black man.

But what would it mean for ordinary Americans if the ACA haters get what they want? The answer is pretty grim, if you do the math.

One feature of the ACA is protection of people with preexisting conditions in qualifying for health insurance. According to the federal Department of Health and Human Services, as many as 133 million Americans, over half of the non-elderly adult population, have some such condition.

Given the frailties of the human body, it has been argued that “life is a preexisting condition,” or at least one waiting to happen. This was especially true for women before the ACA passed, for reasons of medical costs associated with pregnancy, breast cancer and conditions unique to them. The National Women’s Law Center said that before the ACA “just being a woman could be considered a preexisting condition.”

Then there’s Medicaid expansion, a part of the ACA that became a state option after a 2012 U.S. Supreme Court decision. According to the Kaiser Family Foundation, 39 states and the District of Columbia, have adopted this measure, which covers about 12 million Americans, most of whom are low-income working people and many of whom are the “essential workers” that everyone else depends on these days.

The ACA guarantees that states that adopt the expansion will never have to pay more than 10 percent of the costs. Without it, states would be unable to sustain coverage.

About 160,000 West Virginians are covered by the expansion at any given time and probably 200,000 or so are covered during a year. Aside from improving and saving lives, federal expansion funding also helps keep rural hospitals and health care facilities open and supports thousands of jobs.

Medicaid expansion has been a huge help in confronting the opioid epidemic. According to the Georgetown Center for Children and Families, “Medicaid expansion was associated with a substantial increase in opioid addiction therapies, particularly in states with high opioid overdose rates.”

Nationwide, about 800,000 Medicaid expansion recipients are dealing with opioid addiction.

A 2020 article in the Journal of the American Medical Association found that states that adopted Medicaid expansion had a decrease in opioid deaths, compared to states that hadn’t expanded Medicaid.

I’ve interviewed people in recovery about the role Medicaid expansion has played in their access to treatment. One woman summed it up neatly: “Without it, I’d be either dead or in jail.”

Then there are those who buy health care on the marketplaces. Kaiser reports that, in 2020, this amounts to 11.4 million Americans and over 20,000 West Virginians. Of these, an investigative article in The New York Times said that, “If the marketplaces and subsidies go away, a comprehensive health plan would become unaffordable for most of those people and many of them would become uninsured.”

The Times also reports that ACA repeal would hit Medicare recipients as well, affecting around 60 million Americans and over 440,000 West Virginians. Among other effects, if the law were struck down, “Medicare beneficiaries would have to pay more for preventive care, like a wellness visit or diabetes check, which are now free. They would also have to pay more toward their prescription drugs.”

Young Americans also would take a hit. The ACA allows about 2 million young adults to keep their parents’ health insurance up to age 26. The last numbers I could find suggest that about 20,000 young West Virginians are covered in this way. Without it, companies could withdraw coverage.

Killing the ACA also would dramatically increase the cost of health care, including uncompensated care, raising copays and premiums as these costs are passed on to individuals and families. The Urban Institute reports that “Demand for uncompensated care would increase by $50.2 billion, an increase of 82% compared with ACA levels.”

Oh yeah, and then there’s the prospect of millions of Americans losing health coverage while COVID-19 is still ravaging the country and the world.

To sum it all up about ACA opponents, and to paraphrase Winston Churchill, seldom have so few tried to do so much harm to so many. God help the country if they get what they want.

(This ran as an op-ed in the Charleston Gazette-Mail.)

Lotta ins, lotta outs

The ongoing health care controversy reminds me of a line from The Big Lebowski. But then, almost everything reminds me of a line from that move. The line is question is "This is a very complicated case, Maude. You know, a lotta ins, lotta outs, lotta what-have-you's." Some of those are laid out in this story from WV Public Broadcasting.

In the latest Front Porch podcast, I gave some props to WV Senator Shelley Moore Capito for her statement on preserving coverage for her constituents in the state. I'm hoping that wasn't a case of speaking too soon. It's a bit hard to interpret her latest statement on the subject.

Worst case interpretation: she votes for a bad bill after some cosmetic changes are made to the old ones. Better case is that she really does hold out until there are guaranteed protection for things like traditional Medicaid, Medicaid expansion, CHIP and opioid treatment.

In a rational world, not that one exists anywhere near this one, there would be some bipartisan problem solving to fix the parts of the Affordable Care Act that need fixing, such as the individual market, while keeping what is working.

Recently, we interviewed several people affected by the ACA in Kanawha County WV. Some loved the coverage they had. Some hated it. All seemed to agree on this core message: "Make it better but don't take anything away."