President-elect Donald Trump says he plans to completely repeal and replace the Affordable Care Act, a law that has allowed tens of thousands of West Virginians and millions across the country access to health insurance.
Trump has promised to replace President Barack Obama’s signature health care law within the first 100 days of his presidency.
As of Monday, 172,790 West Virginians had enrolled in expanded Medicaid, a provision of the ACA, according to the state Department of Health and Human Resources. Another more than 35,000 residents purchased ACA-compliant plans last year on the state’s health insurance marketplace.
It’s not clear what would happen to those insurance plans if Trump makes good on his promise that, on “day one” of his presidency, he would ask Congress to repeal the Affordable Care Act.
“No person should be required to buy insurance unless he or she wants to,” Trump’s campaign website says. The website offers few details about what would happen to Medicaid, except that it would be issued in block grants to the states.
“Nearly every state already offers benefits beyond what is required in the current Medicaid structure,” Trump’s website says. “The state governments know their people best and can manage the administration of Medicaid far better without federal overhead. States will have the incentives to seek out and eliminate fraud, waste and abuse to preserve our precious resources.”
If Medicaid expansion is repealed, West Virginia’s free clinics expect to see an influx of newly uninsured patients.
“I think we’re gonna be more important than ever,” Angie Settle, CEO of WV Health Right, a free clinic on Charleston’s East End, said of a potential repeal.
Before Medicaid expansion, Health Right accepted only patients with no insurance. After the ACA the clinic began accepting Medicaid patients too, Settle said. The clinic gets only a small reimbursement from Medicaid and it doesn’t make an impact on its budget, she said.
Health Right has around 18,900 patients. Thirty percent of its budget is from the state. The state funding for clinics has decreased from $4.75 million to $2.75 million in recent years, in part because of the passage of the Affordable Care Act. State officials reasoned that, under the ACA, there would be less need for the clinics, Settle said. The state funding formerly supported 10 clinics, but recently two of them closed, Settle said.
Settle said the challenge would be treating all the new patients with the same amount of money. Settle said she hopes clinics will not have to cut services to accommodate more patients. Under the worst-case scenario, Settle said, the clinic would have to freeze its patient load.
“We’re determined,” she said. “We’re going to take care of as many people as we can. That’s all we can do.”
Patricia Rouse Pope, executive director of the West Virginia Association of Free & Charitable Clinics, said the Affordable Care Act was the first thing she thought of when she heard the news about Trump being elected.
“Until we know what happens, it’s going to be a hard read, but we will take care of them, one way or another,” Pope said of the expected influx of patients.
Pope said the clinics already make the most of their state money — for every state dollar they use they provide $25 worth of health services, she said.
In fiscal year 2016, the state’s 10 free clinics served more than 42,000 patients, she said.
Terri Giles, a director of West Virginians for Affordable Care, said an ACA repeal would be “devastating” to West Virginia.
“As you know, the Medicaid expansion was a great boon to the citizens of this state, and now there’s uncertainty and fear, I believe, about what’s going to happen to their lives,” Giles said. “The reality of this election will be felt relatively quickly.”
Giles said health officials would have to wait and see what Trump and Congress does with the law. A complete repeal would be a “massive undertaking,” she said, but it’s not impossible.
Giles said WVAHC would continue to fight for affordable health insurance for West Virginians.
“We’re nonpartisan,” she said. “We’ll work with everyone. Our constituents are the people in West Virginia, and we’re going to fight for them, no matter who it is.”
The federal government has, so far, paid for 100 percent of the cost of states’ expanding Medicaid to those who make up to 138 percent of the federal poverty line. That is supposed to change beginning in fiscal year 2017, when states will be required to pay a 5 percent match. The state’s match will gradually increase through 2020, when it peaks at 10 percent.
Sen. Shelley Moore Capito, Rep. Evan Jenkins, Rep. David McKinley and Rep. Alex Mooney, all R-W.Va., have supported repealing the health reform law.
Under the ACA, West Virginia’s overall uninsured rate has gone down more than any other state in the nation. In 2013, the Mountain State’s uninsured rate was about 29 percent. Last year, that rate had fallen to 9 percent.
The health care reform law also mandated that those with pre-existing conditions, such as pregnancy, diabetes or heart disease, no longer may be denied health insurance because of that condition.
“The one thing people agree on is that pre-existing conditions should be covered,” said Joel Thompson, a Kenova-based health insurance broker who has been in the industry about 25 years. “Trump is going to find [that] the market for health care is not what he thinks it is at all.”
Thompson, who is licensed in five states, estimated that, before the Affordable Care Act, 90 percent of the people who called him to purchase individual health insurance plans could not do so because they had pre-existing conditions.
The individual mandate, which requires that most Americans purchase health insurance or pay a penalty, is closely tied to allowing those with pre-existing conditions to purchase insurance, he said. Without the individual mandate, only those who are sick would purchase health insurance, causing the rates to go up, he said.
The law has been criticized most recently because of rising insurance rates. Rates for plans from CareSource and Highmark Blue Cross Blue Shield — the only companies to offer plans on West Virginia’s marketplace, will increase this year by more than 30 percent, but subsidies from the federal government also are to increase, to offset the rate hikes.
Thompson said his hope for the Trump administration is that it keeps the parts that work, including the individual mandate and allowing those with pre-existing conditions to buy insurance.
“One hope I have ... is that the good things accomplished by the ACA will not end, as a result of the election,” Thompson said.
Despite the uncertainty cast on the future of the law, the U.S. Department of Health and Human Services said Thursday that it plans a “robust outreach strategy” during the open enrollment period, which is going on through Jan. 31.
“This is coverage that is vital to millions of Americans, and that is being proven yet again as more people sign up, including yesterday, when more than 100,000 people signed up for coverage, the highest single-day total so far during this Open Enrollment” DHHS Press Secretary Marjorie Connolly said in the statement.
Highmark Blue Cross Blue Shield, the only company to offer health insurance plans in all 55 counties of West Virginia, also said it would continue with open enrollment.
“Highmark Blue Cross Blue Shield West Virginia remains committed to our members and the marketplace,” spokeswoman Cathy McCallister wrote in an email to the Gazette-Mail. “We look forward to working with all state and federal elected officials to ensure West Virginians have access to affordable, high-quality health insurance coverage.”
Reach Lori Kersey at Lori.Kersey@wvgazettemail.com, 304-348-1240 or follow @LoriKerseyWV on Twitter.