Ending Obamacare for South Carolinians: ‘It’s a matter of life or death’

Jan. 28--Marie Stallworth learned she had ovarian cancer last June. Within two weeks, the 32-year-old Columbia resident had surgery.

"When it happens, it's fast and furious," said Stallworth, who also has undergone numerous chemotherapy treatments and just last week was declared cancer-free.

One thing has comforted Stallworth and her husband over the last few months: They have health insurance through the Affordable Care Act. "When you're going through something that is just a marathon of being physically and mentally drained, to have that kind of peace of mind, it means the world," said Stallworth.

Now, as Republicans in Congress and new President Donald Trump work to repeal and replace the health care law, Stallworth fears her insurance will go away, forcing her to shop for insurance in a market where she may not be able to afford coverage or could be denied because her cancer is a pre-existing condition.

Trump has said he wants to keep the law's protections for people with pre-existing conditions. He says his plan will include affordable "insurance for everybody."

But with few details available about what repealing and replacing the law will mean -- and with nothing set in stone -- Stallworth is waiting anxiously to see what becomes of the health care law and her coverage.

She's not alone.

-- More than 200,000 South Carolinians are among the 22 million Americans who have bought health insurance as part of the health care law.

-- College-aged adults could lose the ability to stay on their parents' insurance until they are 26, if Congress chooses to repeal that provision of the law.

-- Hospitals could see their losses go up if patients lose their insurance and are unable to pay for treatments, one Midlands hospital chief executive said. Health care providers also are awaiting news on what a repeal will mean for the millions of dollars that they have invested to comply with the law's requirements.

Health care plans OK for now

Consumers who have plans through the Affordable Care Act, also known as Obamacare, do not have to worry about losing their coverage anytime soon.

The health insurance marketplaces still are enrolling people through the Jan. 31 deadline, even as Congress moves quickly to lay the groundwork for repealing the law. In the interim, Trump has issued an executive order directing federal agencies to reduce the law's financial burdens in any way they can.

But in two or three years, consumers should expect to see changes in their insurance, said Robert Hartwig, a University of South Carolina finance professor and insurance expert.

Hartwig said the health insurance market after Obamacare is repealed likely will look more like it did before the Affordable Care Act, with many more types of plans offering varying degrees of coverage.

The changes could mean that people with pre-existing conditions and women are no longer protected from being charged more for the same type of coverage.

Subsidies that have helped most of the more than 200,000 South Carolinians obtain coverage also could go away, making plans less affordable.

Trump and Congress must decide what to do about the chronically and seriously ill people who are among the more than 20 million people who have signed up for Affordable Care Act insurance, Hartwig said.

Politics may force Trump and Congress to find a way to keep protections for people with pre-existing conditions. Doing anything short of that would be politically unpopular, USC's Hartwig said.

The question then becomes: "How is that going to be financed? That's what everyone is waiting to see."

Coverage for young adults a question

Also at stake is the coverage of young adults who have been able to stay on their parents' insurance until they are 26, something the law requires.

The law had a positive impact on college-age students who, before the Affordable Care Act, aged out of coverage on their parents' plans and faced obstacles in finding affordable insurance.

At the University of South Carolina, where 44,000 students go to school, only 3 percent of students said they lacked health insurance in 2015, down from 7 percent in 2010, the year the law took effect.

And 69 percent of USC students reported having insurance through their parents two years ago, up from 63 percent in 2010.

Having health insurance helps students get preventive care, lowering the cost of staying healthy later on, said Deborah Beck, head of the University of South Carolina's student health services center.

Being insured also helps students stay enrolled in school, she said.

The university provides basic health care to students as part of their tuition. But if uninsured students have more serious health issues -- such as asthma or diabetes -- they could face high costs if they have to go off campus to see a specialist and pay out of pocket, she added.

When the health care law was just an idea more than a decade ago, between 12 percent and 14 percent of USC students were uninsured, Beck said. Back then, not having insurance took its toll on some students.

"We feel like we lost students because they either had to pay their health care expenses or they had to pay their tuition."

Hospitals could see higher costs

For health care providers, the threat of people losing insurance could means higher costs and larger losses.

"Palmetto Health has benefited by having more citizens in our local area and in the state having insurance coverage than not having insurance coverage," the Midlands hospital's chief executive officer, Charles Beaman, told The State newspaper.

"If, in the future, there is any reduction in the number of people insured, I have a feeling it's going to be a negative impact on providers," he added.

Beaman said hospital bad debt -- medical bills patients and insurers do not pay -- will go up. And the cost of health services may not be as affordable, he said.

"While the (Affordable Care Act) is not perfect, it has some very good parts to it, and it's things that I hope the new administration will build on," Beaman said, adding it is hard to say what the impact replace and replace will be before Trump or Congress have shared details of their plan.

Matter of 'life or death'

Recently declared cancer-free, Stallworth knows what comes next: Cancer screenings for years or worse, if her cancer returns.

Stallworth said she feels fortunate that she had a support network to help her afford her nearly $7,000 deductible so that she could get treatments.

Stallworth, who works for a local nonprofit that promotes sustainability, also received a federal subsidy, made possible through the law, to help lower the cost of her insurance.

Not everyone is so fortunate, she said.

For some, the price of repealing the health care law, especially if it is not replaced with affordable access to insurance for everyone, will cut deep.

"For some people, it's a matter of life, or death or bankruptcy," Stallworth said.

Jamie Self: 803-771-8658, @jamiemself

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