Burden too great for lower income West Virginians

Republicans in the U.S. House of Representatives released a long awaited bill yesterday to repeal and replace the Affordable Care Act.

“This replacement bill reneges on President Trump’s commitment to develop a replacement bill that is ‘terrific,’” said Renate Pore, interim executive director of West Virginians for Affordable Health Care. “This bill isn’t terrific and, if enacted, will harm West Virginians, particularly low-income West Virginians,” Pore added.

“The replacement bill will result in more West Virginians being uninsured, and those who do remain insured are likely to have fewer benefits,” said Pore.

The replacement bill proposes to severely cut federal Medicaid dollars through a per capita cap meaning West Virginia will get a fixed dollar amount for each person on Medicaid regardless of the actual cost of providing health care.

“By fundamentally changing how Medicaid is funded, Congress will shift the cost of Medicaid from the federal government to state governments, worsening West Virginia’s current budget crisis,” Pore said. “The bill promises greater flexibility in return for fewer dollars.

“Greater state flexibility means West Virginia will be forced to decide which people and services to cut from our Medicaid program. The Governor and our state legislators will face very, very painful decisions,” Pore said.

Pore pointed out the highly successful Medicaid expansion program, which provides coverage to 175,000 West Virginians, will be eroded. After 2020, the only people who will be funded by the 90 percent federal match will be people who are continuously enrolled in Medicaid. That’s a major problem, according to Pore. “People gain and drop Medicaid coverage all the time,” Pore said. “There’s even a term for it. It’s call churning.

“As people drop Medicaid coverage, the promised federal assistance stops. If a person regains Medicaid coverage, their coverage would require even more state dollars. Money that really isn’t there,” Pore said.

Perry Bryant, president of the WVAHC Board of Directors, said the change in subsidies for policies sold in the Marketplace will also harm moderate and low-income West Virginians. ACA premium assistance is based on income, while the replacement bill provides premium assistance based almost exclusively on age.

“The impact of this is to cut the amount of subsidy that lower-income West Virginians receive and provide greater assistance to higher-income people,” Bryant said.

A recently released Kaiser Family Foundation report compares tax credits to assist with premiums under the ACA and an earlier draft of the replacement bill. This report shows that a 40-year-old living in Kanawha County who makes $20,000 a year will lose $3,590 in assistance under the draft replacement bill. “That makes coverage unaffordable and will result in more uninsured West Virginians,” said Bryant.

“The ACA also provides assistance to many West Virginians to reduce their deductibles and copays. That assistance disappears completely under the replacement bill. That is a huge loss,” said Bryant.

Bryant also said health savings accounts (HSAs), which are encouraged under the replacement bill released yesterday, benefit people with higher incomes. An HSA is a high-deductible insurance plan. A person can put money into a savings account to pay for health care bills the plan doesn’t cover. In most HSAs the money deposited into the account is not taxed.

“I have an HSA. The money I put into the account wasn’t taxed, and so I saved 15 percent. HSAs benefit people who have disposable income, but are worthless for people living paycheck to paycheck. If your choices are keeping the electricity on or paying future health care expenses with pre-tax dollars, then HSAs do nothing for you.

“If it’s between feeding your children and squirreling away money for future health care expenses, we all would choose to put food on the table for our children,” Bryant said.

Bryant called Congress’ efforts to pass the replacement bill without having it reviewed by the nonpartisan Congressional Budget Office “legislative malfeasance. No member of Congress should vote on a major piece of legislation – and this legislation affects one fifth of the country’s economy and health insurance for millions of Americans – without knowing what the cost will be and how many people will lose coverage,” Bryant said.

“Clearly, the Republican replacement bill was developed by those who have good incomes and is being imposed on those who have too little,” Pore said.

“Congress should be repairing the ACA and not replacing it with the bill they released today,” said Pore.