North country health at stake in ACA fight

Jan. 08--Tweet

Following through on President-elect Donald J. Trump's campaign trail promises, Republican members of Congress began efforts to demolish the Affordable Care Act on Wednesday with a private meeting with Vice President-elect Mike Pence.

Concrete details that might shed light on a new health care law, or a plan to replace what is commonly called "Obama­care," however, have not been released.

Also on Wednesday, Gov. Andrew M. Cuomo announced the tremendous impacts a repeal of the Affordable Care Act would, as it stands, have on New York state.

According to Gov. Cuomo, if the repeal were enacted, an estimated 2.7 million New Yorkers would lose their coverage. The state would also lose more than $595 million in federal funding that goes directly to counties, and residents would lose $250 million in tax credits.

"The cost of a repeal of the Affordable Care Act, to state and local budgets and to the New Yorkers who depend on its health care coverage, is simply too high to justify," Gov. Cuomo said in a prepared statement. "Since its implementation, the Affordable Care Act has become a powerful tool to lower the cost of health insurance for local governments and New Yorkers, and it is essential that the federal government does not jeopardize the health and livelihoods of millions of working families."

Since the ACA was passed, the New York State of Health exchange has cut the percentage of uninsured residents in half, from 10 to 5 percent.

In the event of a full repeal, in Jefferson, Oswego, Lewis and St. Lawrence counties, 37,518 people would potentially lose their health coverage. In those same counties, $5,740,663 in direct federal funding is at risk.

"A complete repeal without an alternative in place would absolutely create chaos," Carthage Area Hospital Chief Financial Officer Robert Bloom said. "Without a well thought-out plan it will be a disaster."

Mr. Bloom said a repeal would affect Carthage Area Hospital's insurance reimbursements in unpredictable ways; it has been a critical access hospital since 2014. "There are so many variables, it's hard to put a dollar amount on it. It's an unknown," he said.

Joey M. Horton, executive director of North Country Family Health Center, agreed that getting rid of coverage provided by the ACA would create uncertainty.

"Without insurance, people delay care and avoid the preventive services which help keep them healthy," Ms. Horton said.

ACR Health is a nonprofit organization in Central and Northern New York that, in part, helps connect and enroll residents in health insurance though the state health exchange. Since October 2013, ACR Health has helped enroll approximately 3,500 Jefferson County residents, 1,400 St. Lawrence County residents, and 300 Lewis County residents in health plans.

"The north country has limited access to physicians, dentists and specialists in the first place. Without coverage ... the health of the north country is going to suffer greatly," said Steve D. Wood, director of insurance programs for ACR Health. "Seniors and others on Medicare will be dramatically affected as well."

House Speaker Paul Ryan, R-Wis., has proposed Medicare be converted to a "voucher" system. In an interview with the Illinois News Bureau, Professor of Law Richard L. Kaplan explained that beneficiaries would used fixed price vouchers to obtain health insurance in the private marketplace, making Medicare's financial commitment predetermined.

The vast majority of people on Medicare, however, would find a voucher-based approach very different and fraught with uncertainty, Mr. Kaplan said. "To be sure, many critical details will need to be formulated to account for expensive pre-existing conditions and other factors. Otherwise, many Medicare beneficiaries will find that the amount of the voucher they receive will be inadequate to secure appropriate health insurance."

President-elect Trump has yet to voice his opinion of the plan, however, and has in the past declared that he didn't want to touch entitlements such as Medicare.

"There is still much that is unknown in regards to what will happen to the ACA." Ms. Horton said. "Our patients count on us to give them access to affordable and accessible health care services. Our focus on our mission will be more important than ever before."

As a federally qualified health center, North Country Family Health is required to treat all patients regardless of their abilities to pay. In return, it receives federal support.

Uninsured patients are charged on a sliding scale. If a repeal is passed, the clinic could see a significant decrease in insurance reimbursements and an increase in sliding scale fee payments, which are priced lower for the same services.

According to Ms. Horton, this could result in higher out-of-pocket expenses for patients. "We know that cost is a barrier to care which could result in delaying necessary medical care and preventative visits which can lead to poor health outcomes," she said.

Ms. Horton also said it's possible that the federal grants may be converted into a state block grant system.

"Right now our big focus is on uncertainty," Ms. Horton said. "Reimbursements could change, grants could change, fewer people could be treated and more could be uninsured."

"There are good and bad impacts of the ACA, of course," Mr. Bloom said. "We know there has been an increase in access to insurance, but not necessarily an increase in quality of health care."

Many of those ACR Health helps to insure in the north country are farmers and agriculturists with high-risk jobs, Mr. Wood said, people who truly need their affordable insurance.

St. Lawrence County Public Health Director James O. Rich also said he believes lawmakers need to think before they act.

"I believe a decision to repeal the Medicaid expansion before the enactment of a thoughtful and permanent replacement would lead to significant disruption. Legislative and administrative change made will be difficult to implement rapidly. I hope Congress will consult with all key stakeholders throughout the process in order to take the time needed to develop and enact effective and realistic policies to ensure continuous coverage and access to affordable care," Mr. Rich wrote in an email.

"Very few Americans want nothing," Ms. Horton said, citing a Kaiser Family Foundation poll released Friday. According to the extensive poll, 75 percent of Americans either oppose the repeal entirely or want to keep the law until it can be replaced.

Certain elements of the ACA are widely popular with Americans who fall on either side of the aisle, including mandating coverage for those with pre-existing conditions and allowing young adults to be covered by family insurance plans until the age of 26.

However uncertain the future, health officials say it's not time to panic.

"It's pretty clear Congress will be acting quickly, but pretty doubtful [a repeal would] take immediate effect." Ms. Horton said. "The idea is that developing a well-thought-out and sustainable plan must be a priority for maintaining access to care."

Most experts agree that even if Congress acts to fully repeal the ACA, Republicans have yet to create a replacement and will support a "repeal and delay" strategy that will uphold current plans provided by the ACA until 2018.

"People are afraid," Mr. Wood said. "We don't know what's going to happen, but we say it's business as usual. Open enrollment isn't over until Jan. 31, and we will keep getting people covered. Health care is a right, not a privilege."

North country residents at risk of losing coverage:

Jefferson County: 10,955

Lewis County: 2,932

Oswego County: 12,568

St. Lawrence County: 11,063

Direct county funding at risk:

Jefferson County: $1,601,068

Lewis County: $294,378

Oswego County: $2,281,144

St. Lawrence County: $1,564,073

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