A day after U.S. House GOP leaders unveiled a long-awaited plan to replace the Affordable Care Act and U.S. Sen. Shelley Moore Capito, R-W.Va., came out in opposition to the bill over concerns for the Medicaid-covered population, a nonprofit consumer advocacy group also came out against it, based on concerns for low-income West Virginians.
Rep. Evan Jenkins, R-W.Va., was the only member of the West Virginia congressional delegation to send answers to questions Tuesday.
One of the key proponents of the ACA was expansion of Medicaid to millions of low-income Americans. About 170,000 West Virginians are enrolled as a result of Medicaid expansion, according to the state Department of Health and Human Resources.
Simon Haeder, a health care policy researcher and professor of political science at West Virginia University, said the American Health Care Act, the GOP’s proposal, doesn’t only roll back the expansion of Medicaid but also makes big changes to how Medicaid is funded.
“They’re making significant changes to the program that have nothing to do with the Affordable Care Act,” he said.
The bill would prohibit new people from signing up for expanded Medicaid after 2020, “with the idea all those individuals will go off the program eventually,” he noted.
He also noted that, in 2020, the state no longer would receive matching federal funds for Medicaid. The state would receive a lump sum, instead, which he said would be “definitely less” than what it receives now.
“That would require states to make hard decisions, in terms of how many people they would like to cover and the benefits they would like to provide those individuals,” he said.
Renate Pore, interim director of West Virginians for Affordable Health Care, noted that the state is facing a budget crisis. The consumer advocacy group held a news conference Tuesday afternoon.
“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,” she said in a statement. “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.”
The bill also removes the individual mandate, but allows insurance companies to require people who have lapses in coverage to pay 30 percent surcharges.
“It’s an individual mandate,” said Perry Bryant, president of the WVAHC board of directors. “Instead of paying a fine to the government, now you’re going to pay a fine to the insurance company. It acts like a tax.”
Both the Affordable Care Act and the American Health Care Act include tax incentives. But according to the Henry J. Kaiser Family Foundation, most West Virginians would receive less assistance.
Thomas Bias, a health policy researcher and professor at WVU’s School of Public Health, said the bill likely will substantially change, but that if the surcharge remains, it could dissuade some people from paying for coverage, although he said he understands that it’s meant to serve as an incentive.
“That would worry me the most,” he said.
Haeder expressed concern with removing two ACA provisions of particular concern in West Virginia — one affecting the aging population and one affecting people with mental illness and/or substance abuse issues. He noted that, under the ACA, the oldest people on the plan may be charged only up to three times as much as younger people for coverage. He said the new bill would allow older people to be charged five times as much.
He noted that he understands the reasoning, because “the hope is that more young individuals would sign up for it.” But he also noted why that change could be of particular significance in West Virginia, because the state has one of the oldest populations in the country.
West Virginia also had the highest overdose death rate in the country in 2015, according to the Centers for Disease Control and Prevention.
“Phasing out mental health benefits, combined with reductions in Medicaid enrollment, will provide a significant setback for the fight against the opioid epidemic, as insurers will not be required to cover treatment and as fewer individuals would have coverage,” he said, in a statement WVU sent earlier in the day.
Capito, in the letter she sent with three other senators to Senate Majority Leader Mitch McConnell on Monday, also mentioned concern for people covered by Medicaid and people battling addiction.
“The Medicaid population includes a wide range of beneficiaries, many of which cycle on and off Medicaid due to frequent changes in income, family situations, and living environments,” the statement said. “The [U.S.] Department of Health and Human Services reports that nearly one-third of individuals covered under the Medicaid expansion have a mental health or substance use disorder. As the largest payer of mental health and substance use services in the United States, it is critical that any health care replacement provide states with a stable transition period and the opportunity to gradually phase-in their populations to any new Medicaid financing structure.”
The letter also said the senators support repeal and replacement of the ACA.
Jenkins’ email said he is “carefully reading and reviewing this bill to make sure it meets the needs of West Virginians, which includes empowering families to make their own healthcare choices, protecting patients with pre-existing conditions, and ensuring access to care for low-income individuals.”
“We must make sure people are protected with a reasonable transition period and that patients and doctors have time to choose the plans that work for them. Americans deserve access to health care that is truly affordable, allows them to make choices that fit their needs, and keeps Washington out of the doctor-patient relationship — all of which Obamacare has failed to deliver.”
In response to questions about Medicaid and about the surcharge, his office stated:
“One reason Obamacare is failing is because some people wait to sign up for insurance only when they need it, then drop their insurance after being treated,” he said of the surcharge. “I understand that many people do have legitimate reasons for gaps in coverage, and there are protections available for them. A surcharge is an effort to encourage continuous insurance coverage, which lowers costs for everyone.”
“Medicaid is on an unsustainable financial path,” he said. “Through an open and transparent process, we will empower states and shore up the financial future of this critical program. We will make sure that those on Medicaid will not have the rug pulled out from beneath them and that the program is preserved for those it is meant to protect.”
Rep. David McKinley, R-W.Va., sent a statement late Tuesday, saying health care costs have skyrocketed over the past eight years and that working families can’t keep up with rising premiums and deductibles from the limited plans available to them. He said it is clear, after speaking with constituents, medial professionals and business leaders that reform is necessary.
“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,” he said in the statement. “Over the next few weeks, the House bill will be making its way through other committees and be subject to amendments and modifications before heading to the floor for a final vote.”
Sen. Joe Manchin’s office sent a statement saying he still is reviewing the legislation but is concerned about its potential effects.
U.S. Rep Alex Mooney’s office did not provide a statement.
DHHR spokeswoman Allison Adler said the agency still is reviewing the proposed legislation.