During his campaign, president-elect Donald Trump promised to repeal the Affordable Care Act – a move many West Virginians say they support after facing rising premiums and deductibles. But a repeal without a replacement plan could be disastrous for the millions of Americans who have gained health insurance under the law, including 173,000 West Virginians newly covered under Medicaid expansion and 37,000 who have bought private insurance plans through the Marketplace. And Republicans have yet to release a replacement plan.
“I’m not going to throw 170,000 West Virginians - and another 40,000 on the exchange and another how many thousands of seniors - out in the cold unless I see a better plan,” said U.S. Sen. Joe Manchin of West Virginia during a press call.
Despite the outcry from Democratic members of the body, about a week ago Republican Congressional leaders plowed forward with the budget resolution that is in part designed to begin the process of repealing the ACA. So, what might this repeal look like?
“There’s a good model from what Congress passed last year in January of 2016 that was vetoed by president Obama,” said Edwin Park, vice president for health policy for the national Center on Budget and Policy Priorities.
“And that would have eliminated the Affordable Care Act’s Medicaid expansion, [and] the subsidies to help people buy private insurance through the new marketplaces. But those two repeals would be delayed for some period of time,” he said. “Under that bill it was two years, [but] there’s some talk of it being more than two years for this upcoming repeal package.”
If the new repeal looks like the one proposed in 2016, Park said the ACA requirements that individuals buy insurance or pay a penalty, and that large employers offer health insurance to their workers or pay a penalty, would be eliminated immediately. The vetoed bill also eliminated all of the taxes that are used to offset the cost of the major coverage expansions of the ACA.
But this resolution is unlikely to touch consumer protections such as the prohibition on insurers denying coverage to people with preexisting health conditions and children staying on their parents’ health insurance until age 26.
Still “the number one question on everyone’s mind was, ‘Will I lose my insurance?’” said Jeremy Smith, the outreach coordinator for a West Virginia nonprofit that helps people sign up for insurance through the ACA.
According to research recently released by the Urban Institute, the answer to that question is, “Not right away.” But by 2019, 184,000 West Virginians would lose coverage under this resolution. Additionally, the state would lose $164 million in federal funding, uncompensated care costs would rise, and moderate-income working families would lose the subsidies that now on average help them pay nearly three-quarters of their monthly premiums.
In West Virginia, open enrollment for the 2017 marketplace is currently underway. Interestingly, after Trump won the election, “we saw an unprecedented number of people reaching out to our organization to get help signing up,” said Smith.
Smith said that’s because people think that if they are already signed up they won’t lose the coverage they have, but if they don’t sign up they might get frozen out of coverage once the repeal takes effect.
Some Republicans, including President-elect Trump, may be getting cold feet about pushing through a repeal without a replacement, though. According to the Washington Post, Trump is leaning on Senator Rand Paul from Kentucky to persuade the rest of the GOP not to vote on the budget resolution with language in it to repeal the ACA. That is, until a replacement plan is in place.
The Post said that Trump did not give details on what he would like to see in the replacement plan, but that he did not appear concerned about either the lack of a replacement plan or growing national worries about a repeal.
Appalachia Health News is a project of West Virginia Public Broadcasting, with support from the Benedum Foundation, Charleston Area Medical Center and WVU Medicine.