<strong><em>Burden too great for lower income West Virginians<\/em><\/strong>\r\n<h1>Republicans in the U.S. House of Representatives released a long awaited bill yesterday to repeal and replace the Affordable Care Act.<\/h1>\r\n\u201cThis replacement bill reneges on President Trump\u2019s commitment to develop a replacement bill that is \u2018terrific,\u2019\u201d said Renate Pore, interim executive director of West Virginians for Affordable Health Care. \u201cThis bill isn\u2019t terrific and, if enacted, will harm West Virginians, particularly low-income West Virginians,\u201d Pore added.\r\n\r\n\u201cThe replacement bill will result in more West Virginians being uninsured, and those who do remain insured are likely to have fewer benefits,\u201d said Pore.\r\n\r\nThe 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.\r\n\r\n\u201cBy fundamentally changing how Medicaid is funded, Congress will shift the cost of Medicaid from the federal government to state governments, worsening West Virginia\u2019s current budget crisis,\u201d Pore said. \u201cThe bill promises greater flexibility in return for fewer dollars.\r\n\r\n\u201cGreater 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,\u201d Pore said.\r\n\r\nPore 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\u2019s a major problem, according to Pore. \u201cPeople gain and drop Medicaid coverage all the time,\u201d Pore said. \u201cThere\u2019s even a term for it. It\u2019s call churning.\r\n\r\n\u201cAs 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\u2019t there,\u201d Pore said.\r\n\r\nPerry 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.\r\n\r\n\u201cThe impact of this is to cut the amount of subsidy that lower-income West Virginians receive and provide greater assistance to higher-income people,\u201d Bryant said.\r\n\r\nA 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. \u201cThat makes coverage unaffordable and will result in more uninsured West Virginians,\u201d said Bryant.\r\n\r\n\u201cThe 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,\u201d said Bryant.\r\n\r\nBryant 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\u2019t cover. In most HSAs the money deposited into the account is not taxed.\r\n\r\n\u201cI have an HSA. The money I put into the account wasn\u2019t 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.\r\n\r\n\u201cIf it\u2019s 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,\u201d Bryant said.\r\n\r\nBryant called Congress\u2019 efforts to pass the replacement bill without having it reviewed by the nonpartisan Congressional Budget Office \u201clegislative malfeasance. No member of Congress should vote on a major piece of legislation - and this legislation affects one fifth of the country\u2019s economy and health insurance for millions of Americans - without knowing what the cost will be and how many people will lose coverage,\u201d Bryant said.\r\n\r\n\u201cClearly, the Republican replacement bill was developed by those who have good incomes and is being imposed on those who have too little,\u201d Pore said.\r\n\r\n\u201cCongress should be repairing the ACA and not replacing it with the bill they released today,\u201d said Pore.