OKPOLICY.ORG
By Randy Krehbiel
Oklahomans, on the whole, never professed much affection for the Affordable Care Act.
They may not like the current repeal-and-replace bill any better.
Policy experts say the American Health Care Act doesn’t do much to improve Oklahomans’ health care, and in some cases is likely to make it more expensive and harder to get.
That opinion was shared, to various degrees, across the board, from the conservative, free-market Oklahoma Council of Public Affairs to the left-leaning Oklahoma Policy Institute, and by health care providers and advocates.
The closest thing to an endorsement came from insurance underwriter Michael Stephens, who said he would like to see the ACHA pass because he thinks it could be a stepping stone to long-term improvements.
“Obamacare has truly almost destroyed the system, but this could be even worse at first,” Stephens said.
His hope, Stephens said, is that the federal government will eventually give up on the idea of dictating health-care access through private insurance “and let the free market take over.”
A major underlying criticism is that the ACHA appears to do even less to control costs than the ACA, or Obamacare.
“Obamacare did nothing to address costs,” Stephens said. “This new system does nothing to address costs. All they’re doing is talking about financing coverage.”
“The No. 1 problem is not coverage, it’s cost,” said OCPA President Jonathan Small. “Sixty percent of bankruptcies are because of medical expenses, and of those, 80 percent have major medical health insurance.”
From OCPA’s perspective, the new law depends too much on federally regulated health insurance and not enough on innovation and controlling costs.
“Some of the goals of the bill are good,” Small said. “Overall, though, (it) needs a lot more work.”
Carly Putnam, a policy analyst for the Oklahoma Policy Institute, said the AHCA puts “affordable health care out of reach for many Oklahomans.”
The proposal, she said, will hit older Oklahomans and rural parts of the state particularly hard. She referred to a Congressional Budget Office analysis that found a 64-year-old making $26,000 a year would pay more than half his income for health insurance, even after subsidies are figured in.
Asked about promises the ACHA will deliver better coverage at lower cost, Putnam said, “I don’t see a way this does any of that. I don’t see any way it doesn’t make things worse.”
While Putnam said the ACA did initiate some cost-saving measures, principally in the area of improved outcomes, Stephens said that from an insurance standpoint it actually encouraged inefficiencies. For instance, the requirement that at least 85 percent of premiums be spent on claims eliminated incentives for carriers to negotiate costs, he said.
“That means carriers have to operate on 15 to 20 percent,” Stephens explained. “Then the question becomes, would you rather operate on 15 percent of $250 million or 15 percent of $500 million.”
The proposed bill, he said, does not address that particular issue.
Most analyses of the bill predict fewer Americans — and fewer Oklahomans — would be covered under the AHCA than under the current law, and net cost to most of those buying insurance through the federal exchanges will be higher because of smaller premium subsidies.
In addition, many observers expect the AHCA will result in reduced Medicaid services. That’s because the bill transitions Medicaid from an entitlement, which means everyone who qualifies receives benefits, to a capped block grant in which each state receives only a predetermined amount each year.
Former Tulsa mayor and Oklahoma secretary of state Susan Savage, now executive director of Morton Comprehensive Health Services, says her experience suggests that when Washington talks about “increased flexibility,” it usually means more financial burden being pushed onto state and local governments.
“That adds up, to me, as unfunded mandates,” Savage said. “Someone will have to pay for the uninsured.”
That’s a concern for Morton, where half the patients have no insurance — meaning they don’t qualify for Medicaid or federal health-insurance premium subsidies — and assistance from the state’s Medicaid program has dwindled considerably in recent years.
“The problem has been kicked down to the level of the communities,” she said. “The philanthropic sector has stepped up to provide a certain level of support, but it’s not a sustainable model.”
Clinics like Morton, which serves primarily low-income patients, are not the only ones concerned.
Lucky Lamons, chief advocacy officer for St. John Health System, said his organization opposes the AHCA on several grounds.
“No health care reform legislation should reduce coverage for the most vulnerable populations,” Lamons said. “Unfortunately, the American Health Care Act does just that.”
Bluntly put, many providers are leery of a proposal that the CBO analysis says would take $1.2 trillion out of the nation’s health care system over 10 years.
For Erin Taylor of Oklahoma City, those figures are starkly personal. Her young son is significantly disabled and relies on Medicaid for daily living. Taylor fears a contraction of Medicaid funding to the state will mean not only a loss of her son’s assistance, but an even longer list of Oklahomans waiting for help.
“In our state, 7,500 are on the waiting list, and some of them have been on the list for 10 years,” Taylor said. “Some of these people are over 70 years old. You can presume their parents are dead, they have no one to take care of them.”
Putnam said there is no evidence that experimental block grant programs touted as potential models for Trump administration policy have in fact produced better outcomes.
Savage says lawmakers can’t lose sight of those most affected.
“We need to remember who is being served,” she said. “I know how difficult it is for some of our patients to even get here. We have a lot of folks for whom getting to a clinic is a real challenge, and health-care access is a daily struggle.”
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