What would repeal of the Affordable Care Act mean for Onondaga County?
By Joe Paduda
Contributing Writer
Congress’ inability to pass a repeal of the Affordable Care Act aka Obamacare gives us a chance to consider what would happen if/when the ACA is repealed. As a repeal is by no means certain, we should also think through the changes ACA needs if it is to better serve Onondaga County.
First, let’s remember the ACA is about much more than individual insurance plans. But only 6 percent of us get insurance that way. ACA opponents assert that insurers are pulling out of the individual insurance market – that’s true in some states, but not in Onondaga County. We have over 200 different insurance plans offered by several insurers to pick from.
For those of us that are insured in the individual market, let’s compare how individuals would fare under the current Republican bill (AHCA) vs ACA (the current law of the land). Under ACA, subsidies are based primarily on income level, with lower-income folks getting more financial help. That would change under AHCA as subsidies would be based primarily on age. In Onondaga County, a 40 year old making $30,000 receives a $4,850 subsidy towards insurance today; that would drop by $1,850 under the Republican bill.
Her 60-year old neighbor making the same amount would only lose $850, but their much wealthier friend earning $100,000, who currently doesn’t get a subsidy, would get a windfall of $1,500 under the Republican bill.
That’s only part of the story. Today, insurance companies can’t charge older people more than 3 times what they charge young folks. The Republican bill would allow insurance companies to change that to 5 times more. Combining the different subsidy level and the “5 times more” multiplier, a 64 year old who earns $26,400 and pays $1,700 in premiums today would pay about $14,600 if the Republican plan becomes law. Of course, premiums would decrease for younger members, which might encourage more to sign up. However, without a mandate (today you have to buy insurance or pay a tax penalty), it’s not certain how many younger people would buy insurance.
AHCA would also reduce funding for Medicaid in Onondaga County. Under Obamacare, the expansion of Medicaid to cover the “near poor” has helped more of our neighbors get healthcare insurance. More than 81,000 people in Onondaga County – one out of six of us – are now enrolled in Medicaid – that’s 20,000 more than before Medicaid was expanded. The Republican bill would eliminate funding for those 20,000 people.
Clearly many residents will lose – or not be able to afford – health insurance if the Republican bill becomes law. Because they won’t be able to “buy” health care, we won’t need as many health care workers. Health care is a big industry in Onondaga County, accounting for 6 of the 20 largest employers who alone employ over 22,000 workers. It’s also a good-paying industry with average wages in 2016 of $58,000, fully 33% above average earnings. 11 of the 15 occupations predicted to have the most job openings over the next six years are in healthcare.
If AHCA is passed and signed into law, by 2019 healthcare employment will likely drop by 4 percent – or about 1,040 lost jobs accounting for $60 million in wages.
Those lost wages won’t be spent on cars, clothes, food, entertainment, school supplies, houses, or taxes, affecting other parts of our economy as well.
Unlike much of what goes on in Washington DC, passing the AHCA would have a significant and almost immediate impact on all of us in Onondaga County. Any time politicians tinker with an industry that accounts for almost one-fifth of our nation’s economy and deeply effects each one of us on a very personal level, it’s well worth our attention.
Here are a few changes Congress should make to “fix” ACA if it isn’t repealed. First, restore the funding that kept Co-Op healthplans and other new insurers functioning. These new plans are essential to increasing competition in the individual markets. Second, fix the “family glitch” that makes some families pay more than they should for insurance. Third, require full pricing and outcomes transparency from healthcare providers so we can know what care will cost and what providers deliver the best results. There are several more changes that would make the ACA much more stable and lower costs; we’ll dig into those next time.
Joseph Paduda, principal of Health Strategy Associates, is a nationally recognized expert in medical management in group health and workers’ compensation.In addition to consulting with managed care organizations, employers, health care providers, insurers, and private equity firms, he was the 2012 recipient of IAIABC’s President’s Award, recognizing his efforts to identify solutions to the opioid problem in workers’ compensation. Before launching his consulting business in 1997, he held executive positions with major insurers, including Traveler’s, United Healthcare and Liberty Mutual. Paduda lives and works in Skaneateles.
