There’s no guarantee that the American Health Care Act will pass the Senate in its current form. But if it does Teton County will probably see an increase in uninsured residents.
“What we are going to see over time is that healthy people who are just barely making it or healthy people who are doing well are going to think, ‘I don’t think I’m going to get sick, I’m going to go without health care for a while,’” said Dr. Paul Beaupre, CEO of St. John’s Medical Center. “As that begins to occur these high-risk pools will become more costly because there is no money coming in to offset the care of people with pre-existing conditions.”
The AHCA is the Republican Party’s bill intended to repeal and replace the Affordable Care Act or ACA, sometimes known colloquially as Obamacare.
In Teton County, 1 out of every 9 people, nearly 3,000, are covered by the ACA. The national average is closer to 1 in 33 people.
Highlights of the AHCA include removing the tax penalty for failing to buy health insurance, eliminating income-based tax credits and subsidies and replacing them with age-based tax credits, eliminating most of the taxes in the ACA to pay for insurance subsidies and rolling back Medicaid expansion.
Under the AHCA states could apply for waivers that would allow insurance companies to charge older people much more than younger people for the same policy, eliminate coverage for maternity care, mental health and prescription drugs, which was required under the ACA, and charge more or deny coverage to people with pre-existing health conditions — of which there are a long list.
While the AHCA passed the House of Representatives on May 4, many believe it will be substantially altered in the Senate. There is no firm timeline for when a vote might be expected.
Congresswoman Liz Cheney voted for the AHCA.
In a statement she said that “no state has struggled more under the burdens of this failed health care law than Wyoming” and that the AHCA “puts patients and their families in the drivers’ seat.”
According to Joseph Jackson, Cheney’s press contact, the congresswoman hopes the Senate will address providing health insurance coverage across state lines and tort reform in its iteration of the bill.
U.S. Sen. John Barrasso, of Wyoming, is one of 13 Republican senators working on the replacement bill.
He said that overall, “our focus must be on lowering the cost of insurance and the cost of care.”
“As a member of the Senate health care working group I believe the bill will be improved so it better meets the needs of people living in rural America,” Barrasso said in a statement to the News&Guide. “I believe it is also important to maintain the new authorities given to states to regulate insurance markets.”
Barrasso said that at events this month around the state he has heard that “Obamacare is collapsing” and that when insurance companies leave the market, patients in Wyoming are stranded.
“In Wyoming we have just one insurance carrier willing to sell Obamacare policies,” he said, referring to Blue Cross Blue Shield — one of his top five campaign contributors between 2011 and 2016.
Barrasso defended the legislation passed by the House, saying that it “protects people with pre-existing conditions” and that he looks forward to building on their work.
“As a doctor, making sure patients with serious illnesses can get coverage is an important personal priority of mine,” the orthopedic surgeon said.
The AHCA has a last-minute amendment that would allow a state to seek permission to allow insurance companies to charge patients more, based on their health history, if their coverage lapses more than 63 days. This is worrisome to some patients with pre-existing conditions.
Beaupre predicted that if the new plan gets passed as is, “you’ll probably see cuts in mental health and preventative care,” but he has faith the Senate will try to address those issues before it votes.
“If they follow historical trends we’re not really doing what’s right for those people in the margins,” he said. “They suffer because of these kind of cuts, and that’s disturbing.”
Beaupre said that without the mandate for people to be insured, “we’ll see more uninsured patients in Jackson” but that the hospital will not turn them away.
“St. John’s pre-existed Obamacare,” he said. “We won’t refuse to treat those patients, and we have never refused to treat patients based on their ability to pay.”
Beaupre added that the hospital has funds to help offset charity care but it would immediately look for ways to operate more efficiently.
“It doesn’t necessarily mean we would curtail services,” he said. “But, unfortunately, what would happen would be more of our savings going toward caring for the uninsured rather than keeping our costs down.”
Beaupre, however, wanted to be reassuring.
“What I think Jackson is concerned about is, will everyone who needs care to continue to get it?” he said. “The answer to that is yes, they will. Without a question.”