Repeal efforts are looming large in Congress, but the Affordable Care Act remains the law of the land for now. And with the final enrollment deadline for 2017 Health Insurance Marketplace coming up quickly on Jan. 31, Asheville ACA advocates are encouraging and helping people to enroll so that contract law will keep their plans valid through this year, regardless of what happens to President Obama’s controversial law. These advocates are also asking concerned constituents to contact their lawmakers to tell their stories and to be heard as to why they favor preserving all or parts of the ACA.
In an effort to emphasize the importance of access to affordable health insurance coverage for North Carolinians, Pisgah Legal Services held a press conference Tuesday in partnership with the North Carolina Justice Center. Speakers included political and legal advocates for the ACA, as well as residents who offered stories about their experiences with affordable care and health insurance. Buncombe County Commissioner Jasmine Beach-Ferrara spoke at the event about the universal and lifelong stakes at issue. “Every single one of us needs healthcare from the day we were born,” she said, adding that the ACA helps people from all walks of life to get access. She also noted that, like President Obama, she would be prepared to get behind a different plan that offers better, more affordable coverage, but is very concerned about repealing the plan with nothing to take its place.
Since implementation of the ACA, the uninsured rate in Buncombe County has dropped dramatically. According to Jaclyn Kiger, a managing attorney at Pisgah Legal Services, the uninsured rate has dropped 8 percentage points since 2013, resulting in nearly 20,000 more people now being insured in the county. Before the ACA was implemented, 19 percent of county residents were uninsured, she said.
The most significant remaining coverage gap is due to the North Carolina state legislature opting not to expand Medicaid coverage as the had ACA intended [see Falling through the cracks, Xpress, Dec. 9, 2015].
Audience member Terry Call said he is particularly concerned about rural hospitals being able to operate under the strain from a rise in uninsured patients and that there might be even less care for areas outside of urban centers. “One of the big things is prenatal and post-natal care,” he said, noting that people already struggle with not having as much access to care in rural areas. “That’s why we have such a lousy history of infant mortality and poor infant health.”
Hospitals everywhere may suffer if they don’t have a stable solution. “The burden on emergency departments can be overwhelming,” Kiger said. “If we don’t have as many people in Buncombe County insured as are currently insured, that means that more people will be going to emergency departments in crisis,” she explained. Alternatively, they might wind up at area safety-net providers, like WNC Community Health Services, which could become similarly overloaded. She warned of significant local consequences if we end up back at pre-ACA numbers of uninsured.
It would be hard to say, Kiger said, whether repeal would put the county back to pre-ACA conditions. “People’s lives have been saved, people have access to coverage right now, and this is good thing. … I don’t know what will happen and what it will look like,” she said. Pisgah Legal Services will continue to be involved, she promised, helping people navigate health insurance, regardless of the legislative outcome.
Another significant potential impact would come from the loss of federal funds going to states for ACA subsidies and ACA-related jobs. North Carolina stands to lose more than 76 thousand jobs, including over 26 thousand jobs in the health care industry if repeal goes through, according to a new joint study by The Commonwealth Fund, a private foundation that focuses on health care systems, and Milken Institute School of Public Health at the George Washington University.
Eliminate the negative
The ACA’s days look numbered, with both House and Senate having voted to begin the repeal process through budget measures. Among those leading the charge for total repeal is North Carolina District 11 Rep. Mark Meadows (R), who says he expects full repeal to be entirely in effect within two years. “While Republicans continue to debate how to best repeal and replace Obamacare, we agree on the big picture: Our current system does not work,” Meadows said in a statement issued to the press Jan. 13, after the house voted to begin the repeal process. “Obamacare is flawed, failing and not fixable — and it needs to be fully repealed. Americans cannot afford to bear the burden of its failure any longer,” he said.
What will stay and what will go, however, is still up in the air for Congress, where there is little agreement on the specifics of what a replacement will look like. Meadows’ press release says he wants to see a replacement bill immediately after a successful repeal measure. “I believe it is critical that we give the American people a clear direction and assurance of a smooth transition toward a sound, high quality and affordable healthcare market — especially so the most vulnerable can get the coverage they need,” he said.
Meadows’ neighboring colleague in the 10th district agrees that new laws are needed to make quality health care more affordable. In a statement released the same day as Meadows’, Rep. Patrick McHenry said, “Now the hard work begins. Over the coming days and weeks, I look forward to working with my colleagues to pass bills that actually reduce costs and improve healthcare for all Americans.”
Neither representative’s statement offered specifics on a plan they would support.
“Obamacare was sold as a plan that would reduce costs and improve the quality of healthcare for all Americans. Here in Western North Carolina, it has done the opposite: canceling popular plans, driving up costs and leaving my constituents worse off,” said McHenry’s statement to the press.
There is ample evidence of opposition in North Carolina to certain parts of the law, especially the ACA mandate that everyone must have insurance. And many people, especially those in the upper-middle-class who are not eligible for subsidies through the marketplace, have seen their deductibles and premiums rise to unprecedented levels since the advent of the ACA.
Accentuate the positive
However, even as the repeal process gains momentum, according to one recent national poll conducted by NBC News and The Wall Street Journal, the ACA is more popular now than it has ever been, with 45 percent of respondents from the nationwide poll saying that the law is a good idea, compared to 41 percent opposing. Furthermore, 50 percent of respondents said they “have little to no confidence that Republican proposals to replace the law will make things better,” according to the NBC report on the poll, while 26 percent have a “great deal” or “quite a bit of confidence.”
Katie Russell Miller, a local breast cancer survivor who spoke at the press conference, is part of that growing support for the ACA. She said that throughout her treatment, for which she had insurance coverage, she was concerned for the well-being of people who were not able to get coverage. She had found the passage of the ACA to be heartening, and said she is distraught at the idea that it may be fully repealed. Especially important to her, she said, are the rules prohibiting insurance companies from denying coverage based on preexisting conditions or setting lifetime maximum coverage amounts. Loss of those kinds of protections offered by the ACA are scary, she said. “We cannot go back to a place where people fighting for their lives cannot get coverage.”
Getting your say
Policy analyst Brendan Riley from the N.C. Justice Center, said his organization is working with partners across the state to show healthcare consumers the impacts of repeal in an attempt to keep Congress from repealing the law without a suitable replacement. “We hope to slow down the process and urge our elected officials to continue treating this with the seriousness it deserves,” he said at the press conference. Riley said because of Congress’ chosen method of repeal through the budget process, there is time for negotiation and time for constituents to tell their stories to lawmakers and have their preferences heard.
As for locals who want to be heard on the matter, Jim Barrett, executive director of Pisgah Legal Services, asked those in attendance to reach out to their representatives. One audience member countered that telephone calls and messages don’t make a difference with members of Congress. Barrett disagreed. “I do think they pay attention to how many calls they get,” he countered, saying elected officials do pay attention to the volume of calls and when people show up at their offices to tell their stories. “I think those are very powerful messages,” which should be shared with every member of the House and Senate, Barrett said.
Beach-Ferrara, a longtime activist and leader of the Campaign for Southern Equality, agreed that those traditional methods of influence are important. In the today’s political climate, she urged people to use every tool available to affect policy, saying “that can mean being in the streets, it can mean lobbying, it can mean litigation — it can mean a full array of things. We can’t always predict which combination of those ways that citizens can use … will have an impact on specific policy issues.”