Consumers, health care leaders in the Rockford area fear Trumpcare would curtail insurance coverage

May 21--ROCKFORD -- Anxiety and fatigue are among the symptoms Jessica Caruso battles since she was found to have an autoimmune disorder in December.

Caruso, a Freeport resident, was able to stay on her parents' health insurance plan until she was 26. She's now 29, and like millions of other Americans, is able to afford medication and routine health care thanks to the Affordable Care Act.

Lately, Caruso's anxiety has a new source: Capitol Hill. The U.S. House passed a bill last month to repeal and replace the health care law, commonly known as Obamacare. Caruso is a hairstylist and also manages a yoga studio. Access to health insurance allows her to juggle her routine food, gas, living and business expenses.

"My medication costs are affordable now, but I don't know what will happen if the health care law changes," Caruso said. "My health insurance is totally important. What I'm worried about is my rights being taken away and not being able to afford the health care I need."

Health care executives in the Rockford area are a bit nervous, too. Health care is a pillar of the regional economy, with more than 30,000 working in the industry in Winnebago, Boone, Stephenson and McHenry counties.

Statewide, the economic impact of Obamacare is enormous. Illinois would lose between 55,000 and 60,750 jobs and up to $8.4 billion a year in economic activity if the law were repealed, according to the Illinois Health & Hospital Association, which represents more than 200 hospitals and health care centers in Illinois.

SwedishAmerican, a division of UW Health, could stand to lose many millions of dollars if key provisions of the health care legislation are repealed, Dr. Bill Gorski, the organization's CEO, has said.

"Physician leaders are not in favor of this latest House bill because the consensus is that somewhere between 20 million to 24 million Americans will lose coverage and the burden seems to fall disproportionately on the poor, the disabled and the elderly," said Dr. Michael Born, chief medical officer for SwedishAmerican.

"And when you shift the cost burden to your community's most vulnerable populations, they are more likely to neglect or postpone their treatment or their care."

Those who neglect their medical care tend to pay more when they finally get it because the cost of care is higher when a sickness or disease is diagnosed late and requires a higher level of care.

Critics say millions of Americans will lose insurance if Congress rolls back provisions of Obamacare and, without coverage, they'll simply flood hospital emergency rooms for primary care.

SwedishAmerican is taking steps to avoid that situation regardless of Obamacare's fate. It has partnered with Aunt Martha's, a nonprofit based in the Chicago area that will open an outpatient clinic at SwedishAmerican Hospital this summer. The clinic will provide primary care and mental health and women's health services in an effort to change the behavior of people who use emergency rooms for primary care.

Up to 74,000 people visit Swedes' emergency room every year. Patients who visit Swedes' ER will be referred to the clinic, where they'll get help managing their medical conditions so they might not require repeated ER visits.

"We're always going to need emergency room visits, but the strain on emergency room visits isn't relieved by insurance coverage alone," Born said. "When we talk about providing more people with care, the ACA is just one piece of it. If the patient doesn't have a primary care doctor or they do but they can't schedule an appointment for two weeks because the doctor is booked, then what do you do?"

FHN, the largest employer in the Freeport area with about 1,400 employees, is serving more patients who have at least some coverage to pay for their care since the passage of Obamacare, said Mark Gridley, the health system's president and CEO. While the law isn't perfect, Gridley said he and many of his peers worry that the cost-saving fixes Congress is trying to make would do more harm than good.

The bill passed by the House would eliminate $880 billion in revenue from taxes that were put in place to pay for coverage expansion under the Affordable Care Act. It would be difficult for health systems to make up the difference, Gridley said. Roughly 40 percent of Illinois health systems, including FHN, operate on margins of less than 2 percent, he said.

"What most likely would happen is there wouldn't be enough money to go around to pay for everything and health systems would have to ask how do we continue to operate and what services do we continue to subsidize or not," Gridley said. "Because we're treating everyone, regardless of ability to pay."

An additional lingering criticism of Obamacare is that providers are dropping out of the federal and state insurance marketplaces across the country, leaving consumers with fewer choices for health insurance plans.

"People talk about how terrible it is that we're losing providers, but the question is really what's happening to the size of the risk pool," said John Frana of The Frana Group, a Rockford-based health care consulting company.

"If more people sign up for insurance, the insurers have a bigger pool and that lowers their risk," Frana said. "Lots of providers is good as long as you have lots of participants. But there are many counties in rural areas that may have a population of just 500 people. So having just a couple of providers in some areas may be fine."

The Congressional Budget Office is scheduled to score the House bill this week, which will shed light on how much the bill would cost. The Senate won't likely craft its own bill until June, and House Speaker Paul Ryan has indicated that whatever Congress does to change the Affordable Care Act may not take effect for a year or two.

The House bill would do away a slew of consumer taxes on medical devices, some insurance plans and prescription drugs and even indoor tanning services. Additionally, Obamacare included tax increases that affect wealthy Americans most in order to pay for coverage expansion. The House bill would get rid of those taxes, which amount to hundreds of billions of dollars. Frana said the House bill offers little detail as to how the federal government would replace those lost revenues to pay for coverage.

"I don't see any changes happening to the law, logistically, this year or in 2018," Frana said. "It's too big, too complicated. They just don't have enough time."

Isaac Guerrero: 815-987-1361; [email protected]; @isaac_rrs

Five things to know

The American Health Care Act passed by the U.S. House would make many changes to Obamacare if it becomes law. Here are five of those changes:

1. Mandate eliminated

Obamacare requires every American to obtain health insurance or pay a penalty. That requirement would go away under the House bill. However, the bill creates a financial incentive to encourage individuals to maintain health insurance coverage. Insurers would be allowed to charge a 30 percent penalty on those who buy insurance after a gap in coverage of more than 63 days.

2. Tax credits replace subsidies

Subsidies for helping some individuals pay for health insurance would be replaced by tax credits for anyone who isn't covered by an employer or through a government program. The tax credits would range from $2,000 to $14,000 a year based on age, and families would receive larger credits than individuals.

3. Medicaid expansion ends

Obamacare provided money to states to expand Medicaid. The House bill would repeal this expansion and instead give states a fixed amount of money per beneficiary. States could also choose a lump-sum block grant.

4. Older adults pay more

The Affordable Care Act limited insurers to charging older adults a maximum of three times the insurance rates charged to younger adults. The House bill raises the ratio limit from three to five.

5. Pre-existing conditions

Under Obamacare, health insurers are prohibited from charging higher premiums for individuals with pre-existing conditions. The House bill would allow states to obtain waivers to allow insurers to charge more for people with pre-existing conditions who have a gap in coverage. Additionally, the federal government would provide $8 billion for states that obtained the waiver to aid individuals with pre-existing conditions who don't maintain continuous coverage. An additional $130 billion pool of cash would be available to states for expanding coverage or reducing health care costs in other ways.

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