In January 2016, Congress passed a budget reconciliation bill repealing much of the Affordable Care Act by simply removing the funding for it. President Obama vetoed the bill. Now congressional Republicans threaten to do the same in the upcoming new session.
Most likely, Congress will not have a replacement for the ACA ready to go for quite some time. Republican leaders propose to make some provisions of the repeal effective immediately and defer the effectiveness of other provisions until a replacement bill can be passed.
A repeal through a reconciliation bill can only affect those provisions that have an impact on the federal budget. Among those is the expansion of Medicaid adopted by 31 states, including West Virginia. A recent study by the Urban Institute details the disastrous effects on the nation’s healthcare system of a repeal by reconciliation, even if the effectiveness of major parts of the repeal is delayed two years.
The bottom line is that repeal by reconciliation will hit states like West Virginia the hardest because these states would lose the most federal funding. Even if the elimination of funding for Medicaid expansion were to be delayed until 2019, the number of uninsured in West Virginia would rise from 88,000 now to 272,000 in 2019 – an increase of 208%.
Who will become uninsured? The Urban Institute study predicts that nationwide 82% of the newly uninsured would be members of working families and 56% would be non-Hispanic whites. A majority of the newly uninsured – 53% –would have earnings between 100% and 400% of the federal poverty level. Another 25% would be people with incomes below the poverty level.
One effect of the loss of health insurance is that people who need to see a doctor simply won’t. These people are at risk that their health status and earning capability will decline. And uninsured health emergencies are often the cause of a breakdown in family financial stability. Others will get emergency treatment at hospitals and clinics, but will have no insurance to pay for it. This is called uncompensated care.
How does uncompensated care get paid for? The people receiving care may pay out of their pockets. More likely, state and local governments or the hospitals and clinics themselves could be forced to absorb the cost. On December 6, 2016, the two main hospital trade groups sent a letter to President-elect Trump and congressional leaders stating that repealing Obamacare could cost hospitals $165 billion by the middle of the next decade and trigger “an unprecedented public health crisis.”
A recent op-ed piece in the Charleston Gazette by Renate Pore, Chairwoman of the West Virginia Medicaid Coalition, said correctly that “[h]undreds of thousands of lives — pregnant women, children, working parents, seniors, people in nursing homes and who need long-term care – every family in West Virginia has a real stake in this debate.”
West Virginia voted for President-elect Trump, and our congressional representation is heavily Republican. Now is the time for them to help West Virginia avoid the financial disaster that would occur through a repeal of Obamacare that does not simultaneously replace it with acceptable policies and federal spending to insure the poor and middle class.