Cicilline: GOP’s replacement plan for Obamacare could be ‘devastating’ for R.I.

Feb. 18--PROVIDENCE, R.I. -- U.S. Rep. David Cicilline said Friday that a plan outlined by Republican leaders earlier this week to replace the Affordable Care Act could have "devastating effects" on Rhode Islanders.

"Republicans have begun the process for a full repeal and we're going to fight as hard as we can," Cicilline said during a roundtable discussion with about 20 health-care leaders and other stakeholders at the Providence Community Health Center. "We need to keep the pressure on."

The Republican plan relies heavily on tax credits to finance individual insurance purchases and sharp reductions in federal payments to the 31 states -- including Rhode Island -- which have expanded Medicaid eligibility.

The "Obamacare repeal and replace" proposal provides no details about how the plan would be paid for and no estimates of how many people would gain or lose coverage.

"Nobody I know thinks [the Affordable Care Act] is perfect," Cicilline said. "We should be willing to fix the things that are broken but keep the things that work. But the notion of repealing it in its entirety is something that we will [oppose] vigorously."

The landmark federal health-care law has extended coverage to 20 million people nationwide. That includes roughly 70,000 adults without dependent children in Rhode Island who gained insurance coverage through the state Medicaid expansion program, and another 22,000 in the state who have private insurance through the federally funded state exchange, HealthSource RI.

Under the ACA, Rhode Island's Medicaid enrollments climbed 48 percent -- the 11th-highest rate in the nation, according to the federal Centers for Medicare & Medicaid Services (CMS).

Medicaid expansion has been a major force in driving down Rhode Island's uninsured rate from 11 percent in 2012 to 4.5 percent in 2015 -- the sixth lowest in the nation, according to the U.S. Centers for Disease Control and Prevention.

The Republican plan released Thursday, Cicilline said, "would gut Medicaid expansion" by giving each state a fixed amount of federal money in the form of a block grant to provide health care to low-income people. The plan also provides no guarantee that people would be able to purchase an affordable health plan if they lost their job, he said.

Linda Katz, co-founder and policy director of Economic Progress Institute, projected that a repeal of the ACA will result in a $224-million loss in federal Medicaid funds to cover the roughly 70,000 people who gained coverage under the Medicaid expansion. Her estimate assumes that a repeal would mean the federal government reduces its cost-sharing for the Medicaid expansion population from the current rate of 95 percent back to its pre-ACA rate of 50 percent.

"Block grants is going to mean rationing," said Benedict Lessing, president and chief executive officer of the Community Care Alliance. "We've seen this before. [It means] telling whole populations we can't serve you...; low-income people don't matter; vulnerable populations don't matter."

A repeal of the ACA also would mean the loss of preventative primary care without cost-sharing, and new barriers to affordable contraception, said Craig O'Connor, director of public policy at Planned Parenthood of Southern New England.

For some adults, Medicaid expansion has enabled them to get dental care. "We have had adults who come to our dental center who have never been to a dentist," said Dennis Roy, president and CEO of East Bay Community Action Program. "It's really a battle now for the soul of America."

-- With reports by the Associated Press

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