What’s the story? Local hospital and health care foundation CEOs along with Congressman Emanuel Cleaver II express concern for patrons in the Eastern Jackson County area, especially those with Medicaid, in regard to having health coverage should the Senate version of the American Health Care Act pass.

Why does it matter to me? The bill, should it pass, could cause millions of people to lose their insurance and major cuts could be made to Medicaid programs in each state.

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Myriad U.S. citizens worry that the Republican-led replacement for the Affordable Care Act could cause millions of people to lose their health insurance. (Increased opposition from GOP senators Monday night has doomed the Senate bill for now. This article reflects local opinion prior to that.)

What do health care officials say about the implications in Eastern Jackson County?

Two local hospital CEOs, Kansas City Healthcare Foundation CEO Bridget McCandless and U.S. Rep. Emanuel Cleaver, D-Kansas City, voiced their concerns over the GOP replacement and how it could affect hospitals, clinics and patients in the area, especially those served by Medicaid.

The Senate bill is awaiting a vote, with passage not assured. Two Republican senators have said they would reject the bill and others have reservations. With no Democrats in support, a third no vote from a Republican would likely doom the bill.

A revised GOP bill was presented last Thursday and is awaiting a score from the Congressional Budget Office. Senate Majority Leader Mitch McConnell, R-Kentucky, has said it won't be considered this week because Sen. John McCain is out on medical leave.

Should a GOP health-care bill pass, it would, among other changes from the ACA – commonly called Obamacare – eliminate penalties for people who don’t buy health insurance. It would make federal health care subsidies to individuals purchasing insurance less generous; ease requirements for insurers to cover specified services like hospital care; cut back funding for the Medicaid program for the poor, disabled and nursing home patients; and phase out the ACA’s Medicaid expansion; according the Associated Press and Reuters.

So what do those who work in the health care business locally think of those changes?

 

MEDICAID CONCERNS

The main concern for St. Mary’s Medical Center CEO Deb Ohnoutka and Truman Medical Center CEO Charlie Shields is the health coverage of their patients, most notably those with Medicaid.

“My biggest concern is (the Senate bill) could trigger deeper cuts to the Medicaid program, especially (affecting) the elderly, those with disabilities, and those with chronic conditions,” Ohnoutka said.

“It’s still too early to tell how it will affect us and insurance companies and how we’ll get paid. I know we’re seeing the number (of) uninsured go up as folks are choosing not to participate in the exchange program because premiums are going up, as are deductibles. That’s not just in Kansas City, that’s nationwide.”

Shields expressed concerns about it taking "a significant amount of resources out of the Medicaid system,” over the next few years. “When you take money out of the Medicaid system, patients will suffer because they’ll have less access and less services provided by Medicaid.

“Hospitals, physicians and others who provide health care in the Medicaid system will see cuts. When you reduce the federal participation in Medicaid, that falls back on the state, and state budgets are already challenged, and Missouri is no exception.”

The Missouri Health Partnership agrees.

Information from the partnership said the passing of the GOP health care bill could put the state budget at risk and could affect 1 million Missouri residents who get health care through MO HealthNet, the state’s Medicaid program.

Medicaid has been a partnership between the federal government and the states since the 1960s. Each state pays a portion of the patient’s medical care, with no limit on spending. The Missouri Budget Project reports that 82 percent of Missouri Medicaid and CHIP (the program for children) comes from federal funds, with 17 percent coming from state general revenues.

For every dollar Missouri spends on coverage, the federal government provides $1.72. The GOP health care bill would alter the partnership and cap the federal share of Medicaid expenses, decreasing the federal contributions drastically, according to Missouri Health Partnership. This could force states to cut Medicaid benefits or eligibility, raise taxes or cut other parts of the budget.

In 2017 Medicaid provides coverage to one out of 12 Missouri seniors, one out of four people with disabilities and two out of every five children. It also covers half of all births in the state and pays for nearly two-thirds of nursing home care. In Jackson County, 19.1 percent of the population is currently enrolled in Medicaid.

In rural areas of Missouri, the cuts to Medicaid could have a negative impact on hospitals and clinics, Cleaver said.

“If this legislation goes through, it’s just a matter of time before many rural hospitals close,” said Cleaver, who has publicly voiced his displeasure about the Republican bill on his Facebook page. “(Rural hospitals) are having a difficult time as it is. You start draining the money from the Medicare and unextended Medicaid, those hospitals are through.

“That’s because the percentage of patients who can’t pay in rural areas is greater than it is in urban centers.”

Added Shields, whose Truman Medical Center is Jackson County's public hospital: “We have a bigger portion of our patients on Medicaid than any other hospital in Missouri. When you see reductions in the Medicaid system, you get concerned about that. How do you continue to provide services for that sector of your patients?”

 

EXCHANGES

Another concern about the GOP health care bill is the state of the insurance exchanges that the federal government provides to help patrons get health insurance. The current structure of government subsidies in the ACA, which are given to people based on income, would be altered.

According to a report by the Los Angeles Times, older and lower-income U.S. citizens would see their premiums soar under the GOP bill.

“They are not doing what’s necessary to maintain a stable insurance market for people who are buying on the exchange,” McCandless said. “That makes it much harder for people to know if there is going to be a stable market and whether the insurance companies will want to participate.”

The bill does, however, address a concern for Missourians by dropping Medicaid's exclusion of treatment for those with opioid addictions.

While there are concerns with the Senate version of the AHCA bill, Shields said modifying elements of the current Health Insurance Exchanges in the ACA would be beneficial to hospitals and patients.

“The other challenge is to fix the exchanges,” Shields said, “and make them more affordable for the people in the exchanges, and make it to where the insurance and the hospitals participating in the exchange market were not taking such a huge financial hit. Some insurance companies were dropping out of the exchanges and some hospitals started not participating.”

Iva Eggert, the director of social services for Live Well Community Health Centers, which has a clinic in Buckner, had another issue with the current exchanges.

“One of the biggest issues is making sure all of the premiums are affordable and making sure (patients) can access the benefits they access month to month,” she said. “They should be able to pick a plan that is in their network so they don’t have to drive miles and miles to get care. That’s not fair to them.

“Make it to where it works for everybody. I know you have to make $11,800 to be eligible to get insurance on the exchange. If you don’t and you make too much to qualify for Medicaid, you fall in that doughnut hole where you can’t get coverage. It doesn’t matter how much you make, if I want to pay for that premium, allow me to pay for that premium. I know that would benefit so many people.”

Cleaver acknowledges that Democrats made some assumptions when passing the ACA that “were inaccurate.” It was assumed that younger, healthier people would buy health insurance and that would drive down costs for older, sicker people.

But Cleaver said that some younger people still chose not get health insurance and just pay the penalty imposed by the ACA.

“The penalty was not high enough,” Cleaver said. “A lot of young people said, ‘OK. Two-hundred bucks for not having insurance? OK. I will do it.’ We have to figure out how to get younger, healthier people to buy health insurance. We have to go back and look at all the vulnerabilities that we created.

“The federal government and every state requires people to have liability insurance for their cars. So what’s the comparable to health insurance? Well, when people get sick and don’t have insurance, you and I are paying for them. We’re the one who ends up paying for that.”