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Trumpcare not good for N.C., say observers


As with the rest of the nation, North Carolina policy analysts and elected officials are up in arms over the recent Republican House proposal to repeal the Affordable Care Act (ACA) – which currently more than 500,000 North Carolinians depend on - and replace it with what many are calling “Trumpcare.”

There is no question, they say, that the poor, elderly and people of color will be negatively impacted, forcing many to choose between medical attention, shelter and food.

“The ACA has played a significant role in reducing worry among Americans who previously struggled to pay unaffordable medical bills when they got sick,” Congressman G. K. Butterfield (D-NC-1), told the House Committee on Energy and Commerce last week.
 “We cannot afford to go back to the days when Americans were forced to pay more money for less coverage, and when insurance companies rationed the care people received.”

Under the current Affordable Care Act, enrollees get generous government subsidies or tax credits to help cover the cost of health insurance premiums, thus keeping the cost of health care affordable.

Trumpcare, if adopted, cuts those subsidies, putting enrolled North Carolinians at risk.

“My constituents do not want to go back to the days where health care emergencies could bankrupt families,” Butterfield added. “This harmful bill rolls back the clock and will rip health care away from my constituents.” 

Officially known as “the American Health Care Act, (AHCA)” the proposal, backed by House Speaker Paul Ryan, would reduce the federal deficit by $800 billion over ten years if enacted, by eliminating a number of broad-based taxes currently in the ACA, thus benefiting many of the rich.

That’s widely considered the “good” news.

But Democrats, and even some Republicans, have been quick to echo the findings of the nonpartisan Congressional Budget Office (CBO), which scored the bill this week, and determined that it would also leave more than 24 million people uninsured over the next ten years than under the current ACA– 14 million alone by 2018.

That dire forecast, despite Pres. Trump’s defense, is sending conservative and moderate Republicans in Congress running for the exits, forcing legislative leaders to consider changes to the proposal to ensure passage in the House, and the GOP-led Senate.

The CBO analysis also projected that the cost of health care will jump dramatically for the working poor and the elderly, with premiums up to five times higher for older enrollees than younger ones (currently, the ACA caps a premium increase at three times higher for older enrollees).

“Trumpcare would dramatically the amount of financial help that North Carolinians receive to help purchase private health insurance on the individual market,” Brendan Riley, policy analyst with the nonpartisan, nonprofit N.C. Justice Center in Raleigh says. “As a result, we’ll see the average subsidy go down dramatically, and more North Carolinians would find their coverage unaffordable.”

Riley added that North Carolina, according to a study by the Center for Budget and Policy Priorities, would be the “second biggest” losing state in terms of subsidy amount under Trumpcare…falling more than $5,000 a year.

And even more troubling for the poor and elderly – many of whom live in the inner cities and rural communities - observers say, is that Medicaid spending under the proposed law will be cut dramatically. It eliminates Medicaid expansion for those states that did (North Carolina did not expand its program), which means far fewer poor people – three out of five N.C. senior citizens, and two out of five with disabilities - will get government-sponsored health insurance, and what funding that will be available will be capped, and rationed on a per capita basis.

North Carolina would have to make up for any cost overruns out its own budget.

“The CBO report confirmed our worst fears-millions of Americans will lose their health coverage if the Republican bill to repeal the ACA is passed,” said Congresswoman Alma Adams (D-NC-12). “This bill fails working families by giving a tax break to the wealthy, increasing premiums, and ending Medicaid as we know it.”

“By next year, an estimated 14 million people would be without health insurance and premiums would be an additional 15- 20 percent higher. This is unacceptable,” Rep. Adams maintained. “Instead of playing politics with our healthcare, the GOP should be working to build on the progress of the ACA and not moving backward.”

According to Prof. Mark Hall, director of Health Law and Policy at Wake Forest University School of Law, “hundreds of thousands of North Carolinians would lose their insurance…” under the AHCA, as proposed. “Simply because they could no longer afford it,” Prof Hall said.

Dr. Peggy Valentine, a local health care educator, echoes the concern about how the AHCA would negatively impact the elderly, and communities of color, where resources are low, and health disparities, and the need for aggressive health care is optimum.

“There are a lot of limitations when we look at all of the gains that were made from the Affordable Care Act,” Dr. Valentine continued, referring to the ability of most people to enroll and qualify. “It seems like all of those gains have been reversed.”

“My concern is what will do to the communities that are already disenfranchised?”

“Some people will be better off, and more people will be worse off,” Prof Hall of Wake Forest School of Law said. “Younger, healthier people will be better off, and the opposite of all of that will be worse off.”