Repeal and replace debate filled with unknowns

March 11--TUPELO -- Efforts to repeal and replace Obamacare could offer some potential benefits, but they also come with plenty of concerns and loads of unanswered questions.

Wally Davis, North Mississippi Health Services vice president for managed care, spoke at Friday morning's Wake Up! Tupelo event sponsored by the Community Development Foundation. He offered an overview of the Affordable Care Act and the proposed American Health Care Act, which is currently being debated in the U.S. House of Representatives.

"There are too many unknowns to make a solid prediction," about the final form of the American Health Care Act and if it will pass both houses of Congress, Davis said.

The Affordable Care Act was an incredibly complex, far-reaching piece of legislation that went far beyond health insurance exchanges.

"It was a massive change," Davis said. "The ACA touches so many people."

The American Health Care Act doesn't address every aspect of the Affordable Care Act. The debate around the repeal and replace bill in many ways hinges on how much oversight should the federal government have in health care, Davis said. The proposed repeal and replace legislation currently keeps some popular elements of the original, like allowing young adults to remain on their parents insurance and guaranteed coverage for pre-existing conditions.

If it becomes law, it would eliminate individual and employer mandates. It would retroactively eliminate the penalty for not having insurance, although it would allow insurance companies to assess penalties for those who haven't maintained coverage. The legislation would phase out the Medicaid expansion and cap federal Medicaid spending.

The American Hospital Association, American Medical Association and AARP have all voiced opposition to the American Health Care Act, citing the loss of insurance by an estimated 20 million Americans and failure to repeal cuts in Medicare reimbursements instituted under the Affordable Care Act.

Increases in the number of uninsured could have impacts on individuals and on hospitals. There are 380,000 uninsured individuals in Mississippi, which opted not to expand Medicaid, Davis said. Much of the $70 million in charity care that North Mississippi Health Services provided last year went to people without health insurance, Davis said.

Because of proposed changes in how tax credits are calculated for people who purchase their own insurance under the American Health Care Act, many people in North Mississippi would see additional tax credits, particularly younger adults and those who have higher incomes.

"That could be positive for lots of Mississippians," Davis said.

However, low-income adults and older adults could see smaller tax credits than they are currently getting under the ACA to purchase insurance through the exchanges.

The employer mandate under the ACA didn't significantly change the number of large employers offering health insurance, because health insurance is a valuable retention tool, Davis said. The proposed changes under the American Health Care Act could reduce the administrative burden on employers who had to show they met minimum coverage standards.

Some elements of the debate on repeal and replace aren't addressed in the American Health Care Act right now, such as selling health insurance across state lines, Davis said.

"It would certainly increase competition," Davis said.

Although the Affordable Care Act is often blamed for rising insurance premiums, Davis said it's worth noting that the five largest health insurance companies posted record profits last year, while paying top executives salaries between $17 and $20 million.

"They paid out more than $30 billion in stock dividends," Davis said.

Although health care and insurance leaders are watching Washington, D.C. closely, it doesn't negate the need for Mississippians to move ahead with reforms.

"We're not going to be able to wait on insurance companies and people outside Mississippi to solve our problems," Davis said.

michaela.morris@journalinc.com

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