In a recent interview with the Centre Daily Times, Congressman Glenn Thompson shared his views of the Affordable Care Act. “We either repeal and replace, or we allow it to implode, which is going to hurt a lot of people.” Telling his constituents that the ACA will self-destruct is a convenient, misleading way to duck responsibility for hurting lots of us with “repeal and replace.”
Not once in the interview did Thompson offer facts or evidence from the 5th District or Pennsylvania to justify the destruction and promised rebuilding of our current access to health care. Instead, he relied on half-truths and false arguments fed to him in Washington, where lobbyists for insurance companies, drug companies and others making big money on health care are busy peddling misinformation to members of Congress.
Here’s what local data show. First, the biggest source of new coverage from the ACA, the Medicaid expansion for poor and near-poor adults, is not about to implode — unless Congress stops funding it. Pennsylvania’s Medicaid expansion is a big success, and covers about 25,000 working-age adults in the 5th District.
Our district includes three of the 10 Pennsylvania counties with the biggest gains in Medicaid coverage as a share of population — Erie, Clearfield and Cameron. Statewide, about a third of people added to Medicaid have been diagnosed or treated for substance abuse or mental illnesses. This part of the ACA is critical in fighting our opioid crisis, along with other addictions and mental illnesses that keep people from working and contributing to our community.
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Thompson claims that because Medicaid has traditionally been underfunded, “Access to care really wasn’t expanded by providing coverage through Medicaid. New individuals who now benefit from that coverage…they’ve compounded the barriers to quality care.” State data show that Thompson is wrong.
According to the Pa. Department of Human Services, health care providers received nearly $2 billion in new payments for services to new Medicaid enrollees in the first year, entirely funded by the federal government. Hospital losses from free care and bad debt, which would have been shifted to other patients and their insurers or to taxpayers, dropped by $92 million.
About 16,000 people in the 5th District now have private insurance from the ACA marketplace. Thompson says the ACA is “already hurting a lot of people” with “average increases of 25 percent in premiums” and “’significant’ increases in deductibles.” However, the ACA protects many of his constituents against increases in premiums and deductibles.
Four of five Pennsylvanians insured through the marketplace get federal tax credits to help with premiums. These credits limit each family’s premium contributions to a specified share of its income. The Feds pick up all premium increases beyond that. The majority of Pennsylvania enrollees also get cost-sharing subsidies that pay for modified plans with low deductibles and low caps on out-of-pocket spending.
Other people, with too much income to qualify for substantial subsidies, really are facing high and increasing premiums. Unfortunately, with 20 percent of the U.S. population generating 80 percent of total medical costs — an eye-popping “true fact” — the ACA hasn’t signed up enough cheap, healthy people to share the costs of the expensive few. That problem is real, but it could be solved without repealing the ACA.
Many of Thompson’s statements about replacing the ACA are contradicted by the “replacement” legislation that he cosponsored, the Empowering Patients First Act of 2015. He says that he supports affordable coverage for people with pre-existing conditions, but his “replacement” veers away from the increases in premiums and taxes that are required. No matter to Thompson that everyone benefits, because we all risk developing a costly health problem — often through no fault of our own.
Thompson says that parents should be able to cover children up to age 26, but his “replacement” repeals that ACA requirement. He says that he opposes lifetime limits on insurance payments, especially “egregious” limits on mental health, but his “replacement” repeals the ACA prohibition on lifetime and annual limits, along with the ACA requirement for identical coverage of mental and physical illnesses.
What Thompson isn’t saying should also worry everyone in the 5th District. More of us live on limited incomes than in Pennsylvania generally. Consequently, more of us benefit from ACA subsidies that are heavily tilted toward working families and the poor. However, Thompson isn’t saying that he wants especially to protect his constituents who can least afford insurance or health care.
His “replacement” repeals the income-related Medicaid expansion, income-related cost-sharing subsidies and income-related premium credits. His “replacement” gives everyone the same limited subsidies, without regard to income.
Nor is Thompson talking about protecting health care jobs. Health care is the second largest employer in the 5th District, according to Census data. With full repeal and little replacement, Pennsylvania is likely to lose 137,000 jobs. That figure accounts for effects on our economy of job-losses in neighboring states, ripple effects of health care lay-offs on other businesses, and lost tax revenues affecting employment of teachers and other public workers.
Don’t think that jobs outside of health care are safe: Fewer than half the jobs at risk of being repealed are in health care.
Pamela Farley Short, Ph.D., is a retired professor of health policy who directed Penn State’s Center for Health Care and Policy Research from 1997 to 2014.