Teresa Huggins is CEO of Stigler Health and Wellness Center in eastern Oklahoma.

Teresa Huggins

Being raised in small town, rural Oklahoma comes with its benefits.  Among those benefits are the close friendships, supports and cohesiveness of knowing everyone; however, many communities face extreme poverty and lack access to basic medical care, not to mention specialty care for the diverse needs and populations that reside in the rural landscapes of Oklahoma.

The Affordable Care Act (ACA) was enacted to help ensure that Americans are able to access affordable health care, regardless of their residence or income status.  Millions have gained coverage through the ACA, and the law is helping shift the health care industry toward more preventive care instead of waiting to address health issues until something has gone seriously wrong.  In part thanks to the ACA, our health center has experienced a drop in uninsured patients, from 26 percent in 2013 to 19 percent in 2016.  Many of the patients newly enrolled in insurance may not have received care if not for the ACA.  Our health center has helped 2,749 patients obtain insurance, many through the individual marketplace created under the ACA. These patients will certainly be in jeopardy of becoming uninsured again if the ACA is repealed.

As with all major reforms, the ACA comes with its own set of pros and cons. In the first phase of the ACA, many who entered the insurance pools were the sickest of the sick who had not been able to afford coverage in the past and had not received proper care to control or prevent serious health issues like uncontrolled diabetes, COPD, or heart disease.  In addition to increasing individual health center costs, this limited the immediate returns of health improvement from the investment of the ACA (it takes time to improve the health of people who have gone without care for so long). It also may have contributed to insurance carriers leaving the individual marketplace in states like Oklahoma that already had poor health status and a shortage of doctors and other providers in large parts of the state.

Unfortunately, the “Repeal and Replace” proposals coming out of Congress would just shift the costs of the plans while doing nothing to address the real shortcomings of our health care system.  The most recently released Senate plan (BCRA 2017) would increase costs for families and further devastate the already struggling state budget, causing more cuts to services that are a lifeline to much of our rural population. The bill’s deep cuts to Medicaid would likely force the state to cut back on the essential health benefits that Medicaid  covers. When that happens, preventive measures are often the first to go. That drives people into emergency departments at a higher cost over the long run.  This in turn endangers our small rural hospital partners due to rise in costs and bad debt.

This would be another blow to rural hospitals that are already facing hard times. Our service areas initially included five rural hospitals.  To date, one has closed, one is in dire jeopardy of closing, and three are struggling. Given that most Community Health Centers (ours included) have a significant portion of patients covered by Medicaid, we too are at significant risk of being able to continue the level of services currently offered if Medicaid makes more cuts.

Oklahoma is at particular risk, given the current budget shortfall that has already caused Medicaid cuts, capping of services, and even elimination of programs serving those most in need.  The majority of patients in Community Health Centers are considered “the working poor” population.  As Medicaid benefits are reduced, the hardship faced by this population is far reaching.  I shudder to think about the patients who will fall through the cracks of our safety net system due to further cuts. 

A prime example of the impact of cuts to Medicaid services can be seen in one of our patients who needed a stint placement.  This service was denied due to requirements of documentation and alternative treatment methods.  As a result, the patient suffered a heart attack, was sent to intensive care, and now has permanent heart damage.  This will cost our state more in the long run and affect the patient negatively for the remainder of their life. 

For many in our older generations who are living on a fixed income, a loss of tax credits or a reduction of covered prescriptions that would happen without the ACA will lead to the patient not taking their preventive medications and ending up in the emergency room for a preventable episode.  For others, it may mean not turning on their air conditioner for fear of not being able to afford the electric bill.  This can lead to devastating effects for patients with COPD or asthma.  Sadly, I’ve also seen these patients make a choice of buying medicine or buying groceries.

In summary, both the repeal of the Affordable Care Act and the replacements suggested by Congressional Republican leaders would harm the average citizen in our state and cause many Oklahomans to lose health care coverage. They would take away our opportunity to expand Medicaid to cover the working poor and limit and in some cases eliminate Medicaid for seniors, children, and Oklahomans with disabilities. They would reduce essential health benefits, rural hospital funding, tax credits for families, and funding streams for mental health and opioid addiction treatment, all to provide tax benefits for wealthy individuals, insurance companies, and drug manufacturers who are already doing quite well.

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