“Doc, you gotta help. My back – it is killing me!”
Greetings such as these are common in my work as a family doctor. I must differentiate run-of-the-mill complaints from dangerous conditions. This patient gave a funny feeling, so we got an MRI that showed progressive slippage of bones in the spine. If left alone, the process could cause debilitating nerve damage. We discussed (an expensive) surgery at our next visit.
“Am I ever glad I could get back on insurance,” he replied gratefully, practically singing out his enthusiasm about being approved for Medicaid after years uninsured.
Not everyone is so fortunate. For years, covering Idahoans in the gap — those who earn too much for Medicaid and too little to afford insurance on the exchanges — has stalled in the Idaho Legislature.
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Meanwhile, efforts to repeal the Affordable Care Act continue in Congress with versions of the American Health Care Act (AHCA). Our health care system needs improvement. However, the AHCA would represent a giant leap backward for health care costs and coverage.
The nonpartisan Congressional Budget Office estimated the AHCA would result in 14 million newly uninsured Americans in the first year and 24 million by 2026. Does the AHCA lower insurance premiums? No. The average American buying on the individual market could expect to pay 15-20% more in 2018-2019. Claims that premiums would decline in later years are misleading — premiums would be lower only because insurers could offer skimpy plans with higher out-of-pocket costs.
Under the AHCA, changes to Medicaid’s financing structure in the form of a “per capita cap” would end Medicaid as we know it. Today, federal funding for Medicaid increases when needs increase. Under a per capita cap, federal funding does not keep up with rising costs in health care. Idaho would be left to shoulder those additional costs. Children, people with disabilities, and seniors would risk losing coverage.
Recent changes to the AHCA only make a bad bill worse. States would be allowed to eliminate protections for people with pre-existing conditions, perhaps drop requirements to provide essential health benefits (emergency care, prescription coverage and mental health coverage, etc.), and establish high-risk pools where people with cancer could face unaffordable premiums.
I’m worried about my patients and what they stand to lose in this proposal. Idaho’s health care system has improved in recent years. Compared to 2010, the fraction of uninsured people in Idaho diminished by 27 percent. Over 90 percent of eligible children in Idaho access health care through the Children’s Health Insurance Program (CHIP). Nearly 700,000 Idahoans now have access to preventive services like mammograms and flu shots. The average family pays $3,600 less annually than they would under pre-ACA growth rates.
We need to build on this progress, not reverse it. Contact Idaho’s members of Congress and urge them to reject the amended AHCA because it reduces affordability and access to health care. Let us move toward common-sense solutions such as abandoning the fee-for-service reimbursement model, adding more healthy people to the insurance pool, decreasing administrative complexity and overhead, and accepting the Medicaid expansion.
Dr. Scott Hippe is a physician at the Family Medicine Residency of Idaho. He lives and practices in Boise.