By LINDA COMINS
The Weirton Daily Times
WHEELING, W.Va. — Health care providers and analysts cite potential detrimental effects for West Virginians under the proposed American Health Care Act, particularly in terms of Medicaid expansion and insurance tax credits.
The plan, to replace the current Affordable Care Act, was unveiled last week by Republican leaders in Congress. The proposal is now under consideration in the House of Representatives.
Simon Haeder, an assistant professor and health care policy expert at West Virginia University, said the American Health Care Act could be “particularly harmful for West Virginia” in the loss of individual coverage and more than $1 billion in federal funds, as well as a possible loss of 15,000 jobs.
“With one of the oldest populations in the country, West Virginians would also be disproportionately affected by provisions to charge older individuals up to five times as much as younger ones,” he said.
A significant number of West Virginians — more than 30 percent — are on Medicaid. Haeder said, “It (the new plan) would basically undo the Medicaid expansion that has provided 180,000 West Virginians with coverage through the Affordable Care Act by freezing enrollment in 2020.”
He said, “The Republican House plan goes far beyond making changes to ACA. It would dramatically rework the Medicaid program overall.”
Currently, program costs are shared between states and the federal government, with poor states such West Virginia receiving federal funds to cover up to 75 percent of the costs.
However, he said, “The Republican plan would significantly alter that. A lump sum per enrolled individual would be given to states. States then would have to shoulder the rest of the burden. This is significant. Under the current program, there are no restrictions on the amount of services individuals are able to incur. … The Republican plan would basically put a lid on what the federal government is willing to spend.”
Haeder is concerned that the plan does not allow for additional federal funding if an epidemic occurs. Also, he said the plan does not account for significant medical breakthroughs that would increase costs, such as medical innovations that provide expensive cures to disease.
Amid the current opioid crisis, Medicaid has given access to addiction treatment to more than 20,000 West Virginians, Haeder said. “By taking away Medicaid coverage, and also capping the amounts that states would be able to spend, is concerning,” he said.
If fewer people have insurance, direct health care sector jobs would be lost in West Virginia, he predicted. Also, people with untreated illnesses might not be able to participate in the workforce.
Kathie Brown, executive director of Wheeling Health Right, said the biggest concern is the repeal of Medicaid expansion, which has provided access to care “for thousands of people in West Virginia alone. … Those are the people who have finally had access to insurance.”
If Medicaid expansion is repealed at the federal level, Brown thinks it is critical to maintain state funding for free and charitable clinics.
“I expect our numbers (of patients) to explode,” she said. Currently,Wheeling Health Right serves almost 19,000 patients.
Despite uncertainty over funding, Brown said, “We (Wheeling Health Right) will continue to be here, committed to providing care to people who are underserved in our community. We are going to continue to do what we’re doing, because that’s what we have to do. Our patients are our priority.”
Bill Childers, program director for physician assistants at West Liberty University, does see a few bright spots in the House proposal. The plan would allow people with pre-existing conditions and young adults, up to age 26, to keep their coverage. The plan also might abolish the tax penalty if people are uninsured.
However, Childers said people are concerned that federal premium subsidies could be eliminated and replaced with tax credits that are variable by age and slightly based on income.
The Kaiser Family Foundation has prepared maps to compare county-level estimates of premium tax credits consumers would receive under the Affordable Care Act in 2020 with what they would receive under the American Health Care Act. The maps include premium tax credit estimates by county for current ACA marketplace enrollees at age 27, 40 or 60 with an annual income of $20,000 to $100,000.
The foundation’s data indicates that a 27-year-old or a 40-year-old in Ohio, Marshall, Brooke and Hancock counties earning $20,000 would receive a lower tax credit under the new plan, but higher credits at higher income ranges. However, 60-year-old residents in the four counties would receive significantly lower tax credits at all salary ranges under the GOP proposal.
On the political side, U.S. Sens. Shelley Moore Capito, R-W.Va.; Rob Portman, R-Ohio and two other GOP senators sent a letter to Senate Majority Leader Mitch McConnell, R-Ky., outlining concerns that the draft health care plan from the House does not adequately protect individuals and families in Medicaid expansion programs or provide necessary flexibility for states.
Jonathan Kott, a spokesman for U.S. Sen. Joe Manchin, D-W.Va., said, “Senator Manchin is still reviewing the bill, but is very concerned about its impact on West Virginians.”
Calling for reform of the health care system, Rep. David B. McKinley, R-W.Va. said, “The American Health Care Act will protect patients with pre-existing conditions, allow young adults to stay on their parent’s plan and strengthen Medicaid so current enrollees do not have their coverage taken away from them.”
John O. Stapleton, McKinley’s communications director, referred a request for additional information to the House GOP’s website.
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