What could ACA repeal mean for Lodi?

Jan. 27--Just a week after the inauguration of President Donald Trump, policy regarding health care is changing. To what degree that will affect the health coverage of local residents, however, is currently up in the air.

Some local health agencies and organizations believe that a flat repeal and scale back to the law before the Affordable Care Act (ACA) would increase premiums and hinder patient access to preventative care. Others say it's too soon to tell what will happen.

Republicans have taken steps to repeal the ACA, also known as Obamacare, but have not yet announced a clear strategy to replace the health care law.

The 2010 health care law has extended coverage to more than 20 million previously uninsured Americans.

At the same time, the law's financial aid and consumer protections -- including bans on annual and lifetime benefit limits and guaranteed coverage, even for people who are sick -- have eased financial pressure on many households, even though high premiums continue to plague some.

The share of adults who skipped care because of costs dropped by nearly one-fifth between 2013 and 2015, according to a recent report from the nonprofit Commonwealth Fund.

However, critics of the ACA believe it is unsustainable. Expenses for the ACA are expected to reach $2 trillion to maintain coverage for the many patients who are extended subsidized health care, according to projections from the Congressional Budget Office.

Daniel Wolcott, President and CEO of Lodi Health, is one of several agencies watching to see what policy decisions will be put in place.

With what information is known about how health care policy affected the insured and uninsured before 2010, Wolcott gave his projections for what a repeal sans replacement plan would mean for Lodi Memorial Hospital.

"If we actually go back to where we were before the Affordable Care Act, we would change from having 2 percent of patients not having insurance and go to 8 percent of patients not having insurance," he said.

Nearly 40 percent of San Joaquin County is covered under Medi-Cal, which supports low-income individuals. Without the extended coverage funded through ACA, a number of low-income patients who become uninsured would be limited in their access to preventative care, Wolcott said.

These uninsured patients would be forced to receive care through the emergency room.

Another factor in a repeal would be the change in how hospitals receive payments from the Medi-Cal and Medicaid programs. Through the health care law, the government reduced payments in Medicaid to offset the cost of providing insurance and making payments for low-income patients, Wolcott said.

Medicaid cuts were made in a gradual manner, but even that change put some hospitals at risk, he said, due to hospitals receiving less funding for those seniors, disabled patients and children in the program. Wolcott envisions a similar risk if funding isn't restored back into Medicaid as it was before ACA.

Rep. Tom Price (R-Georgia), Trump's pick for health secretary and an advocate for slashing federal health care spending, crafted a 2017 budget blueprint that includes a plan to cut federal Medicaid spending by close to 40 percent over the next decade.

Price and other fiscal conservatives say that with new flexibility to redesign their health care programs, states will create less costly ways for Americans to get health insurance.

Still, not all Republicans have come to an agreement on what should be done with health care coverage, especially considering their constituents may lose health care coverage.

Over the last several weeks, GOP governors whose states have expanded their Medicaid programs through the law -- including Arizona, Michigan, Nevada, Ohio and Massachusetts -- have voiced opposition to federal Medicaid cuts.

California, which offers its own health insurance marketplace through Covered California, is also pushing back on the idea of federal funding cuts.

The organization revealed the results of a new study Thursday which also shows the potential for rising premiums for more than 50 percent of consumers insured through Covered California if federal officials eliminate direct federal funding to reduce cost-sharing.

Not only would it increase premiums for consumers, but the study also suggested a repeal would increase federal expenses by $221 million or 29 percent, since Advanced Premium Tax Credits are tied to health care premium costs. The study and further analysis of an Affordable Care Act repeal can be found on coveredca.com.

Some agencies like San Joaquin County Public Health Services are still waiting for the final policy decisions before they make any judgments on what may or may not happen.

"At this point, until there is an actual replacement plan or other directives, any projections would only be speculations. We hope to know more by mid-February," said Krista Dommer, public information and communication coordinator for Public Health Services.

However, each entity that helps people in the Lodi area with health care is paying attention and preparing for big changes to happen.

Looking back on the ACA reform, Wolcott believes there were good parts to the reform and also parts that were very difficult.

"There's still quite a bit of uncertainty about what might happen," Wolcott said. "We're looking to see how these policies will come out. We're confident that we will be able to provide good quality care to the community."

Noam N. Levey from the Tribune Washington Bureau contributed to this report.

Contact reporter Christina Cornejo at christinac@lodinews.com.

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