Burlington County Times

Trump's Health Policies Still Hazy

Burlington County Times — January 16, 2017

By Jenny Wagner, staff writer

Asking Congress to repeal the Affordable Care Act was a Day One priority outlined on President-elect Donald Trump's campaign website.

And while Trump's statements since the election and the policies posted on his transition website have pulled back on that plan, area health care providers and organizations say much still is unknown about what will happen to the health care law also known as Obamacare, and about other health policies.

"None of us know what's going to happen," said Paula Sunshine, chief marketing officer for Independence Blue Cross. The insurance company covered nearly 384,000 people in small group and individual plans on and off the HealthCare.gov exchange in 2016, and it's continuing to encourage them to shop and sign up for plans in 2017.

"Everyone is asking us, and the answer that we're giving them is make sure you have coverage," Sunshine said. "We're also telling people to make sure that they're connected with us ... because as soon as we know anything, we're going to make sure our members know."

Sunshine declined to speculate about what would happen to people's coverage if the ACA was immediately repealed, but she said IBC is asking for time. On Thursday, the Senate narrowly passed a budget resolution to put in motion the drafting of legislation to repeal the law. The House could vote on the resolution Friday.

"We feel like repeal — just immediate repeal, blanket repeal — by itself would be a bad thing and that it would jeopardize some of the programs that are in place," Sunshine said. "What we need more than anything is time; time to make the right decisions and to get all the considerations on the table for everybody to end up with the coverage that's going to be right for them and their families."

Some organizations aren't waiting.

New Jersey Citizen Action, which leads the health care consumer coalition NJ for Health Care has been working to send a message to the state's elected officials about what repeal would mean for hundreds of thousands of individuals and their families, said Maura Collinsgru, the organization's health care program director.

"This is not a political issue, this is an issue of people's life and death," she said. "We want (elected officials) to know, this is the number of constituents in your district that would lose coverage."

Collinsgru said the law isn't perfect and some things need to be fixed, "but you don't throw out all the progress that we've made and start where, nowhere?"

She and others have been concerned about a repeal without a replacement.

On Wednesday, Trump said a simultaneous "repeal and replace" plan would be proposed after U.S. Rep. Tom Price, R-Ga., is approved as secretary of the U.S. Department of Health and Human Services.

Not immediately having a plan to replace the ACA would mean more than 700,000 people in New Jersey could lose coverage, and it "could be financially devastating for our healthcare system," New Jersey Hospital Association President and CEO Betsy Ryan said in an email.

New Jersey hospitals alone have sustained $1.4 billion in federal funding cuts over the last eight years, Ryan said, with the expectation they would be balanced by more patients with health insurance. "If the ACA repeal does not coincide with a replacement plan, then those funds must be restored to hospitals to help them care for the new influx of people without health insurance," she said.

Ryan added that the hospital association has been encouraged by some of Trump's statements about reducing government mandates and bureaucracy. "Health care is one of the most heavily regulated industries, and if we could streamline some onerous regulations, it would relieve the red-tape burden," she said.

Some in life sciences and biotechnology also said they're encouraged about opportunities for those industries under Trump.

"If there's any type of economic support or development and incentives for a lot of our smaller companies that are trying to get off the ground, that would be beneficial," said Lou Kassa, chief operating officer of the Pennsylvania Biotechnology Center in Buckingham.

On the other hand, Kassa said, some people in the center and the biotech field in general are concerned about cuts to research funding, specifically because much of it comes from the National Institutes of Health, which had a 2016 budget of $32 billion and is the "largest single public funder of biomedical research in the world," according to its website.

"If the pool shrinks, competition to get whatever dollars are out there is going to increase, and it could have a significant impact on some businesses, definitely," Kassa said.

Overall, the incoming administration has been vague about its policies related to science and research, Kassa said, and it's unclear what will happen.

"Everybody is really in a wait-and-see mode," he said.

The Pennsylvania Medical Society has been of of those organizations watching to see what will happen in Washington, said President Dr. Charles Cutler, a Lower Merion resident and internal medicine specialist with Einstein Physicians Norriton.

Cutler noted the society's position has been that the Affordable Care Act needs to be improved, but many parts of it need to stay, he said, pointing to coverage for preexisting conditions and inclusion for adult children on their parents plans until age 26.

Shortly after the election, Trump made statements indicating interest in keeping those two provisions. But Collinsgru said they can't be "siloed" and still stand on their own.

"You can't have people with preexisting conditions buy into the market without having healthy people (also insured), which is what the mandate (that everyone get coverage) did," she said, noting that insurance coverage for those with existing ailments used to be "astronomical."

According to Trump's transition website, the administration will work with Congress to replace the ACA "with a solution that includes Health Savings Accounts, and returns the historic role in regulating health insurance to the states." The website also states the administration also will work to allow people to purchase insurance across state lines, and give states "maximum flexibility" in how they administer Medicaid programs, "to experiment with innovative methods to deliver healthcare to our low-income citizens."

Unless the federal government continues to provide funding after a repeal, states that expanded Medicaid under the Affordable Care Act could be forced to pick up the entire bill or drop coverage for those who were brought into the programs. In New Jersey, Ryan said that could mean losses of $3 billion a year, and she worries about the impact on the state's government and taxpayers.

"The writing is on the wall. If the feds do repeal Medicaid expansion the ... federal dollars that are now going to every expanded Medicaid recipient would be at risk," Collinsgru said, adding that means nearly 600,000 people in New Jersey.

On Wednesday, the Pennsylvania Health Access Network held a teleconference for reporters highlighting a study by Harvard Medical School and New York University that found more than 180,000 people in Pennsylvania with mental illnesses or substance use disorders would be at risk of losing coverage.

"From Philadelphia to Scranton to Pittsburgh, the opioid epidemic is devastating families throughout Pennsylvania. Mothers, fathers, and children are losing their lives to addiction, but Congress's plans to repeal the Affordable Care Act without a replacement would leave them in the cold, without access to the treatment they need," Antoinette Kraus, executive director of the Philadelphia-based enrollment assistance and health care consumer network, said in a statement.

Repeal of the ACA wouldn't affect access to services at the HealthLink Dental Clinic these days, but enactment of the law years ago changed everything there. Dr. Bernie Dishler, a volunteer dentist and president of the clinic's board, remembers when people began to get coverage under marketplace plans and Medicaid expansion. The clinic, which provided medical care as well at the time, was nearly empty.

"They didn't need us any longer. We decided instead to expand our dental clinic because there is no dental care for most of the people that we serve," Dishler said. The clinic, which is funded through donations, announced Wednesday that it had provided $720,853 worth of free dental care to low-income adults in Bucks and Montgomery counties last year.

While Dishler hasn't heard any conversations about the clinic once again offering medical care, he said that may have to happen if people lose their insurance.

"Our board is going to have to decide if the Affordable Care Act really goes away and depending on what it's replaced with, if there's a great need again, we might have to do something," he said. "There's so many unanswered questions and it's just a shame for the people who are covered by the Affordable Care Act."

Trump has suggested federal money could continue to flow in the form of block grants, but Collinsgru worries about how it would be distributed to those on Medicaid, including children, older adults in nursing homes, working people and others.

"We'll be playing a game of life boat — who gets coverage and who doesn't?" she said.

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