Health care legislation draws close look at local impact

As the U.S. Senate prepares to debate controversial health care legislation, health care advocates are looking at how the proposed U.S. House and Senate bills would affect area residents.

In Missouri, there are 244,382 people currently enrolled in the marketplace under the existing Affordable Care Act, which mandates insurance coverage for every American.

The existing policy could be repealed if the Senate passes its draft of the Better Care Reconcilitation Act, which would go into effect in 2020. The House has already approved its proposal in the Affordable Health Care Act.

The Senate on Tuesday delayed a voted on the AHCA until after the July 4 recess, with Republicans hoping to rally enough votes to open debate on the bill.

Missouri Hospital Association officials are concerned about the implications of the changes in both bills.

"The tax credits are entirely inadequate and would lead to increased out-of-pocket costs for most Missourians when compared apples to apples with the ACA," said Dave Dillon, MHA vice president of public and media relations. "The hardest hit would be individuals between the ages of 50-64, and especially those between ages of 60-64. The cost to a 60-year-old will nearly double from 9 percent to 16 percent of annual income. Obviously that's not sustainable."

Sen. Roy Blunt, R-Missouri, has said he plans to review the Senate draft to ensure it addresses the problems Missourians are facing under Obamacare.

"Year after year, Missouri families have had to worry about their health plans being canceled, their options and access being taken away, and their premiums going up," Blunt said in a statement. "In our state, 25 counties have no companies willing to offer health care coverage on the exchanges next year and premiums are up 145 percent, on average, since 2013. The status quo is far from what was promised and it is unsustainable."

Democratic Sen. Claire McCaskill is opposed to the Senate's bill as it stands, as she believes it would harm older seniors and those in rural communities with limited insurer options.

"Any health care bill that would force older Missourians to pay double-digit premium increases should end up in one place only - the trash can," McCaskill said in a statement.

She believes it would be better to fix problems in the existing health care law. She has introduced legislation that would grant individuals with no insurers in their counties access to the marketplace used by federal employees.

Policy consumers in Cole County could lose out on up to $900 in tax credits, according to a report released by the Kaiser Family Foundation. Seniors age 60 and over lose up to $11,730 in tax credits.

For example, the overall premium rate for a person age 40 with an annual income of $30,000 would not change from $6,380 regardless of whether they were covered under the ACA or the AHCA, but that person would see a 36 percent change in tax credits - which translates to $3,000 under the AHCA.

For seniors age 60 with an annual income of $30,000 in Cole County, their premium increases from $13,550 under the ACA to $18,210 under the AHCA.

Currently, ACA consumers who fall under the same demographic are receiving an average of $11,070 in tax credits, which would be reduced to $4,000 under the ACHA.

Dillon noted the association's concerns with language in both bills that allows states to waive 10 essential health benefits - such as maternity and newborn care, prescription drugs, emergency services - covered under the ACA.

That's not counting the list of pre-existing conditions that could result in 1.2 million Missourians being denied coverage under the AHCA, according to a MHA policy brief released in June.

Blunt said the Senate's draft bill actually would preserve access to care for those with pre-existing conditions. He also listed the legislation's ability to strengthen Medicaid without bringing changes to Medicare, to provide people more health insurance choices and to allow young adults to stay on their family health insurance plan until they are 26 years old as key parts of the bill he supports.

As the bill moves through the legislative process, Blunt said, members of both parties will have an opportunity to offer amendments.

Another major concern for the MHA was the individual mandate that would be omitted from the newer drafts of legislation. In 2015, Missouri hospitals alone provided $1.2 billion in uncompensated care.

Dillon said this means fewer young and healthy individuals would participate, which would shift the risk pool toward individuals in poorer health and drive up costs.

"If the goal of these bills was to help reduce the cost of coverage, for a portion of the population and for their premium dollars, they may accomplish that objective," Dillon said. "However, the expected deductibles are much higher, and the 'hidden health care tax' to cost-shift care for those without insurance will be felt by all."