The U.S. Senate recently released its draft of the “Better Care Reconciliation Act.” I’m an emergency physician. I practice in multiple West Virginia hospitals. Whether you look at the adjustments to the private insurance market or delve into the shockingly cruel cuts to Medicaid, I know one thing for certain: This bll does not give West Virginians better care.
Current Affordable Care Act law subsidizes health care for the working and lower middle class (between 133 percent and 400 percent of the poverty line). No matter how high your premiums rise, you will never pay more out of pocket than a set percentage of your income.
The new bill increases the set percentage of your income required to buy health insurance, so the working class will be paying more (some lose subsidies altogether). Your health care coverage would also be worse: The subsidies are tied to a “benchmark” plan (58 percent coverage in the new bill, compared to 70 percent now). Bottom line: If you make less than about $47,000 a year individually ($97,000 for a household of four), you would pay more money for worse health care coverage.
West Virginia’s median household income is $39,170, the third-lowest among states. West Virginia is also a relatively elderly state. The median age here is 41.6. This bill makes life harder for older West Virginians. Under the new law, older West Virginians could be charged up to five times that of the young. This is one of the reasons AARP is strongly opposed to this bill.
The BCRA’s Medicaid cuts would truly decimate West Virginia. The ACA expanded Medicaid. Medicaid now covers 29 percent of West Virginians (564,000 patients). Over 180,000 West Virginians are benefiting directly from the expansion.
The new Senate bill wipes out the Medicaid expansion completely by 2024. Over 180,000 West Virginians will lose health care if the new bill becomes law. In addition, everyone else on Medicaid is in danger: The bill would put a per-person cap on federal Medicaid funding to West Virginia.
The state would also be allowed to opt out of providing essential health benefits. With less federal money for Medicaid, the state would have to cut the number of people enrolled or cut benefits. One of the essential benefits protected under the ACA that could be taken away is emergency care. My patients could have to decide between seeing me or going broke. This is why the American College of Emergency Physicians also opposes this bill.
Medicare patients aren’t safe from this bill, either. Thirty-six percent of Medicaid dollars in our state goes to Medicare beneficiaries, to cover things like nursing home care.
These policies won’t just cause people to be crushed by debt due to illness: A lack of health care can cause people to die. This is common sense (maybe not to some lawmakers), but there are multiple studies on this topic, if you need them.
This would be even more devastating in West Virginia, because of the opioid epidemic. Medicaid covers opiate addiction treatment for many patients. In theory, the state of West Virginia could cover the Medicaid funds, but our state can hardly afford to bury all of the opiate addicts dying, so I don’t know where this money would come from.
I assume lawmakers are taking away care to cut taxes for wealthy people, because there’s a ton of that in this bill. They’d argue that tax cuts for the rich create jobs, so fewer people will need Medicaid anyway.
I wouldn’t bet lives on this: Some West Virginians are too sick to drop Medicaid to work, and even the most religious believer in “trickle-down economics” would understand multiple hundreds of thousands of new, health care providing, jobs being created in West Virginia’s stagnant economy is not plausible within a few years. Like I said, West Virginians are older, so most of us weren’t born yesterday.
The cold macroeconomic arguments for this immoral bill won’t fly in West Virginia. Despite her recent good will, I suggest we all continue to remind Sen. Shelley Moore Capito, R-W.Va.: Vote No. Don’t sacrifice West Virginia’s health to cut taxes for the rich.
This bill might be a “political win” for her party, but it’s a horrible loss for West Virginia. Recently, they’ve floated the idea of repealing the ACA altogether first, without a replacement, but that would be even more devastating.
Many of my patients supported President Donald Trump because he promised to save our state’s dying coal economy. If he signs this health care bill into law, then West Virginia will end up dying anyway, medically and/or financially.
Stephen Spencer, M.D., of Morgantown, is an emergency room physician and assistant professor at the West Virginia University School of Medicine.