The ‘domino effect’ of health insurance limits

Access to health insurance in the United States will undergo seismic changes before year’s end.

New federal tax and budget signed into law by President Donald Trump on July 4 will impact health insurance and by extension health care. To understand what the impact of government-funded insurance programs Medicaid and Medicare, as well as private insurance through the federal marketplace via the Affordable Care Act, The Post interviewed Joyce Palmer, founder and owner of JP Financial Group LLC in Charlotte. Estimates by nonpartisan and apolitical organizations as well as economists, predict millions of working class and low-income Americans, and hundreds of thousands of North Carolinians, will lose coverage. The cost of private insurance through the federal marketplace will also rise and the enrollment period will be cut in half to 45 days. Options for people who miss the deadline will be limited as well.

Responses are edited for brevity and clarity. Video of the interview is on The Post’s YouTube page as well as Facebook.

TCP: What's in the law, marketed by Trump as One Big Beautiful Bill, and how does it affect access health insurance moving forward?

JP: It is a big bill. I won’t say it’s beautiful, but it is big. As it pertains to health care, we can expect everything that we know and understand about the health care world right now to change. Right the landscape will be affected across the board, not just Medicaid, where the biggest cuts are coming from, but the health care marketplace, the Affordable Care Act, is being chopped up as well.

It's going to be affecting people that are under 65 and then it’s also going to spill over to everyone. As far as health care costs is concerned, because a lot of the costs will transfer and trickle down to private pay insurance, no one will get around not being affected by it. So, we’re looking at 9.1 million people projected to be uninsured by 2034, that's going to be a huge federal cut as far as saving money. But the question is, at what costs?

The bill is further going to impact the state of North Carolina. I think we’re looking at hundreds of thousands of people that will be losing health insurance coverage. It’s taking a step backwards in that we just got the North Carolina expansion of Medicaid for North Carolina. We fought so hard to get that, and so that will practically be reversed.

TCP: North Carolina law entails a claw back, where, if the federal government decreased its share of Medicaid coverage, the state would correspondingly cut money off as well. Can you explain a little bit further in terms of how that may impact people?

JP: The first part of it is Medicaid expansion. They’re adding additional requirements in order to even be eligible for Medicaid. They’re adding the work requirement, so if you’re a non-disabled adult between the ages of 19 and 64, you’ve got to work 80 hours or take some form of education, or schooling or something in order to keep your Medicaid. So that’s going to affect probably, just nationally, millions. I think the number was 4.8 million they expect to basically not be able to enroll or get disenrolled because of that.

The frequency of checks to make sure you're continuously eligible for Medicaid, right now, they do it annually, so they're going to increase that to every six months. The whole idea is to make it more difficult for you to maintain the coverage. They’re going to have some address verification process that you’re going to have to go through to verify your address and if you move frequently.

So, really, just adding extra layers of qualifying for Medicaid, and then, of course, taking people off Medicaid.

The federal matching contributions to help people that are getting coverage, they’re going to discontinue that or reduce it. Therefore, states like North Carolina that has the expansion would not be able to get that matching dollar, which means they’re going to pull back on the enrollment. They’re going to limit services.

This one is still trying to be determined, but a lot of the medical procedures like for women's health, for example, is being impacted greatly. Facilities that provide women's care or women's services like that, if they were getting funds from Medicaid, they're not going to be able to get those funds anymore, even for the non-abortion type procedures.

TCP: The poor, low-income folks in the rural residents of North Carolina, those are the folks who get hit hardest?

JP: What I share with people is that it’s a domino effect somewhere, somehow that cost has to be made up. So, what we’re already seeing with insurance companies, you're going to see your premiums go up. You’re going to see more things not covered because they’re going to have to make up the funding they’re losing from the federal government.

In order to do that and keep their doors open, they’re just going to charge private fee insurance persons more.”

TCP: What’s the difference between if you work for, let’s say, a Bank of America or Duke Energy, and a smaller business that has less than 20 employees? What’s the difference between working at the corporation and getting health insurance and working for a smaller company?

JP: The smaller companies will definitely not be able to sustain a lot of the cuts and expenses, because they don’t have the large pool of people to help keep the cost down. So now that cost has got to be spread among the few people, if they’re going to take any increases. The large corporations, they can leverage a little better because of the law of large numbers. They have more people. They can spread the cost around. The smaller companies are not going to be able to do that.

TCP: What happens if you miss the enrollment window?

JP: You have no coverage because there’s no special enrollment period. That’s the other thing. Before, if you didn’t get (enrolled) during that time period, you had another window of opportunity to get a special enrollment done based on your circumstances. Well, they’re going to minimize the special enrollment period, so that’s going to be shortened as well, and they’re going to take out a lot of the reasons where you could do a special enrollment.

It’s going to be limited to something like you just lost coverage, or you move to a new location, so a lot of the special enrollment provisions will go away.

TCP: What are people telling you, whether it’s clients or just interested bystanders, in terms of what does it mean, or what do I do now?

JP: I think a lot of people are not yet paying attention enough. So much is happening so fast, and this is just one facet of the Big Beautiful Bill. There’s a lot of other things like taxes, and then there’s all the other things the administration has going on that it’s hard sometimes to know where to focus and where to where to put your energy to pay attention.

The first thing I share with people is do your due diligence, pay attention. Read and seek out information. The more knowledge, the more understanding you have, the more you hear about it, the better equipped you’re going to be able to respond to it.

The next piece is I’m getting a lot of, how will this affect me personally if I’m not on Medicaid, or if I am on Medicaid, or if I live in a rural area, or if I have the Affordable Care Act, how will it affect me personally? And that's where we've got to get out and educate. We’ve got to get out and offer assistance. We’re all hands on deck.