Burlington County Times

NJ Think Tank Continues To Warn Against Affordable Care Act Repeal

Burlington County Times — February 21, 2017

By David Levinsky, staff writer

TRENTON — Republican leaders have only just released some of the broad strokes of a prospective plan for replacing the Affordable Care Act after it is repealed, but a left-leaning New Jersey think tank and other health care advocates already are panning it.

Despite President Donald Trump's and other GOP leaders' promises that millions of Americans insured under provisions of the Obama administration's signature law will not be left behind by its repeal, the advocates suggest that the Republican proposal still will leave hundreds of thousands of New Jersey residents without coverage.

"The bottom line is the Affordable Care Act has improved the lives of millions of Americans by allowing them to obtain affordable and quality health care," said Jon Whiten, vice president of New Jersey Policy Perspective, on Tuesday during a conference call with New Jersey reporters.

"It represents a tremendous step forward for social progress in America. The fight to save the Affordable Care Act is the political fight of our generation," he said.

The conference call coincided with the release of the think tank's latest report and data on the potentially dire consequences that repeal might have on New Jersey and, in particular, Burlington County.

The report estimates that about 20,000-plus county residents enrolled in Medicaid might lose that tax-funded health insurance, and another 10,500 middle-income residents and families would lose the federal subsidies they receive for purchasing coverage from plans offered on the federal marketplace.

In addition, about 11,000 county seniors and disabled residents on Medicare could face higher out-of-pocket costs for prescription drugs because of the coverage gap in the Part D drug plan, also known as the "donut hole" that the Affordable Care Act is in the process of closing.

Statewide, about $4.2 billion in federal benefits could be lost, along with as many as 86,000 jobs, the report says.

The report does not account for any type of replacement health care plan that Trump and the Republican-controlled Congress have promised to approve.

Instead, it assumes that the ACA's expansion of Medicaid to additional low-income families and individuals will be rolled back, and that the tax credits offered to residents who purchase insurance on the federal exchange will be eliminated and not replaced.

A replacement plan has not been unveiled, and Republican leaders have only just begun outlining what a new plan might look like.

"We still don't know what the replacement is going to be," said Ray Castro, an analyst with New Jersey Policy Perspective.

But Castro and other advocates on the conference call stressed that the ideas floated by U.S. House Speaker Paul Ryan and Tom Price, Trump's recently confirmed secretary of Health and Human Services, would not likely provide the same level of coverage as "Obamacare."

"There is no fix that maintains the level of coverage and benefits in New Jersey and across the nation," said Maura Collinsgru, health care program director for the advocacy group New Jersey Citizen Action. "There are alternative policies, but not alternative solutions."

Castro agreed, saying the GOP proposal to revamp Medicaid, the state-run insurance program for the poor, likely would require states to take on a greater share of the expenses by transforming the federal share into a block grant or per-person sum.

The Affordable Care Act gave states the option of expanding their Medicaid programs to insure more low-income residents, with the federal government covering most of the additional expense. New Jersey has enrolled over 550,000 more residents in Medicaid thanks to the expansion, officials said.

Changing the program to either a block grant or capped per-person payments will limit the federal expense, but likely will cause states to have to either take on more of the costs or reduce benefits, Castro said.

"It has the same net effect, because they're going to set the (federal payment) level below the need," he said. "It's going to be a huge cost for the state."

Likewise, Castro said, the Republican plan to give consumers tax credits to buy private insurance likely won't match the subsidies residents receive under the Affordable Care Act, which increase as incomes decline. The Republicans' proposed tax credits would increase based on age, but would not vary based on income.

"It'll be a lot less," Castro said.

The average New Jersey senior will have to pay $1,241 more per year in prescription drug benefits if the ACA's protections against the "donut hole" payment gap are not maintained, he said.

The Republican-proposed expansion of tax-free health savings accounts won't be enough, since most low- and middle-income residents already have difficulty saving in a high-cost state, Collinsgru said.

Peter Kaprielyan, vice president of government relations for the Inspira Health Network, which operates hospitals in Gloucester, Salem and Cumberland counties, warned that hospitals and other providers are extremely concerned about the possible changes.

He said that Inspira already is receiving millions less in reimbursement for care of Medicare patients, and that the possible loss of coverage could send more patients to emergency rooms for primary care, which is both expensive and not necessarily the most effective way to deliver patient care.

"There's a tremendous ripple effect if people lose coverage," Kaprielyan said, adding that hospitals likely would need to cut programs.

The New Jersey Policy Perspective report's release coincided with a recess in Congress when most representatives and senators are back in their home districts. Some are being pressured to oppose repeal of the health care law.

Castro said opposition to repeal appears to be growing as more residents learn more about the law's benefits.

"I think it's starting to sink in," he said. "The ACA is getting more popular as people find out what they are going to lose."

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