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    Friday, December 08, 2023

    Connecticut health care leaders unhappy with GOP proposal to replace Obamacare

    As the proposed replacement for the Affordable Care Act begins to make its way through Congress, it’s attracting few fans among hospitals, physicians and others involved in health care policy in Connecticut.

    “This does not achieve the goals of increasing insurance coverage, access to care or decreasing costs,” said Matthew Katz, executive vice president and chief executive officer of the Connecticut State Medical Society, which represents 6,000 doctors and physicians-in-training. “The Affordable Care Act in no way solved all the problems, but it was a first step forward. This is in some respects a move backwards. But we don’t think this is the end of the discussion.”

    Republicans on Monday unveiled their long-awaited proposal for replacing the ACA, also known as Obamacare, with a replacement plan they are calling the American Health Care Act. The bill would cut Medicaid funding, which expanded under the ACA, and provide tax credits based on age for private health insurance, instead of the income-based tax credits provided by ACA. In addition, it would eliminate the ACA’s cost-sharing subsidies. The ACA’s individual mandate, which requires most people to have insurance or face a tax penalty, would be gutted, and its repeal would be made retroactive to the beginning of 2016, among other provisions.

    Lt. Gov. Nancy Wyman, head of the board of directors of Connecticut's online health insurance marketplace, Access Health CT, created as the state's response to passage of the ACA in 2010, said the current replacement proposal would raise costs for many residents who keep health insurance, and cause many people to drop coverage altogether.

    “Older adults would pay double for their insurance, and more people will be losing their insurance and using emergency rooms more,” she said.

    About 85,000 residents of the approximately 100,000 who purchased private insurance through Access Health CT are receiving a government subsidy to help pay the cost. The tax credits that would replace the subsidy, Wyman said, would be much less and threaten to put insurance out of reach for many.

    She also is concerned about reductions in federal Medicaid subsidies to states. About 217,000 residents are newly covered by Medicaid thanks to the Medicaid expansion that Connecticut and 30 other states took advantage of under the ACA. A total of 768,000 state residents are covered by Medicaid, the government insurance program for the poor.

    Under the current version of the replacement plan, the expansion would be eliminated in 2018, Wyman said. Instead of receiving federal funds based on the numbers of people qualifying for Medicaid, states would receive a fixed amount as a block grant that is likely to be much less.

    “That could hurt us dramatically,” Wyman said.

    She emphasized that everyone currently insured with an Access Health CT plan is secure for the rest of this year, but beyond that, the future is uncertain. The state, she said, is working to find a way to preserve the current offerings as much as possible, but insurance companies are becoming increasingly wary of instability in the marketplace being created by the uncertainty.

    “Will our insurance companies pull back for next year? Who knows?” Wyman asked. “How can we save our program?”

    Mark Masselli, president and chief executive officer of the Community Health Center, said assessing the full impact of the replacement proposal is impossible because it was released without sufficient analysis. The Congressional Budget Office has not yet completed its estimates of how the replacement would affect the nation’s uninsured rate, or the federal costs of the program. The Community Health Center operates 14 health care clinics statewide, including facilities in New London and Groton.

    “The efforts to replace the ACA appear troublesome and are not reflective of Connecticut’s commitment to our Medicaid population and the medically underserved — the population cared for by CHC statewide,” Masselli said.

    Elliot Joseph, chief executive officer of the Hartford Healthcare network, also pointed to the absence of the CBO analysis as “troubling.”

    “The proposal, as currently drafted, has significant flaws and unanswered questions,” he said. His network, which includes The William W. Backus Hospital in Norwich, agrees with the position of the American Hospital Association and the American Medical Association that the replacement is likely to make it more difficult for people to obtain health insurance.

    “We know that without coverage, many patients will not receive preventive care, and will arrive at our hospitals and emergency rooms sicker — creating higher cost and less healthy people,” he said.

    Cuts to Medicaid funding are a particular concern for the state’s hospitals, said Michele Sharp, spokeswoman for the Connecticut Hospital Association. Medicaid reimbursements to hospitals already cover only about half of the cost of care, she said, and the replacement plan only would worsen that situation, potentially reducing access to care for the poorest residents and threating hospitals' financial stability, she said.

    Vincent Petrini, spokesman for the Yale New Haven Health network that includes Lawrence + Memorial Hospital in New London, noted that under the replacement plan, states would be responsible for covering about 50 percent of the Medicaid reimbursements, a significant increase over the current formula. Now, states pay about 10 percent of Medicare reimbursement costs, while the federal government covers the rest. Given Connecticut's current financial situation, the state would be likely to try to trim its Medicaid rolls rather than increase the amount it spends if the federal government shifts costs to the states, he said.

    “This would have a huge effect on the entire system, including Lawrence + Memorial,” Petrini said. “We would see increasing demand for free and charity care, at a time when there are already extreme financial pressures on hospitals.”

    Any replacement plan, he said, should be crafted with the intent of ensuring that the number of people with health insurance is the same or better than under the ACA.

    The local and statewide critics of the plan have allies in the state’s congressional delegation. Sens. Richard Blumenthal and Chris Murphy, as well as Rep. Joe Courtney, D-2nd District, all have pledged to fight the replacement plan.

    “This plan is dead on arrival and I will do all that I can to ensure its defeat,” Blumenthal said, adding that it would be an “assault on women’s health” by defunding Planned Parenthood, and would benefit the wealthy and big insurance companies at the expense of middle-class families and seniors.

    Murphy said the plan would “strip coverage away from millions of Americans and drive up costs for millions of Americans."

    “There is no credible way to look at this replacement without seeing the devastation that would be wrought,” he said.

    Courtney said that while the ACA is imperfect, many constituents have been sharing heartfelt stories with him and other congressmen at recent town hall meetings about how the current law has helped them.

    “Yes, we can improve the law, and there are many ideas we can work together on, and that is what we should be focused on,” he said, “not butchering the law, which this proposal seeks to do.”

    Katz, the state medical society head, said one of the key improvements that should be made are programs to provide more access to health care. While more people got insurance through the ACA, many still face difficulty in getting care from doctors in certain specialties and parts of the country. Loan forgiveness programs provided by the ACA for physicians who agree to practice in shortage areas was an important step, but more needs to be done, he said.

    “Coverage does not necessarily mean access,” he said. “There need to be increasing focus on access.”


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