The Atlanta Journal-Constitution
What comes next for health care?
As Congress returns to work, Georgians wonder what to do.
Carol Lander’s family premiums went up by $500 a month
this year alone. Deb Vance lost her job, her employee health insurance — and because she lost her income, she lost her eligibility for an Obamacare subsidy. So then she lost her doctor. Some Atlanta small businesses need to nail down their next health insur
ance plans fast, but can’t, because the ground is shifting so much.
With the smoking ruins of the GOP’s effort to repeal and replace Obamacare behind them, members of Congress return to Wash- ington this week after a month away, facing a stark political landscape on health care.
Amid mixed messages from the White House, more insurers have pulled out of the nation’s health care markets. Others, including Georgia’s Blue Cross Blue Shield, have announced substantial premium hikes for the upcoming year. This month, regulators and insurance companies must finalize health insurance rates for 2018. Open enrollment is weeks away.
A small, bipartisan band of senators has announced plans to begin talks to stabilize Obamacare’s markets in the weeks ahead. But lawmakers from both sides are facing political pressures and
a tightening timeline that could preclude any sort of modest agreement.
Meanwhile, parallel deadlines for raising the country’s borrowing limit and funding the government threaten to suck up the political oxygen on Capitol Hill this month.
But whatever they do or don’t do, Georgia patients and people involved in shaping the state’s health care system and making it work day-to-day say the problems are real and systemic and important — and can be fixed. They may disagree on what exactly that means, but they agree that it is urgent.
The only question is, whether the lawmakers who can do it agree.
“I don’t know how Congress and the Senate can say let’s forget about health care,” said Chris Kane, a consultant based in the Atlanta area. “I can assure you as an adviser in the health care industry, the physicians, the executives, the lay board members that serve on these community hospital boards, all understand how complex health care is. And as advocates for communities and as stewards of not-for-profit hospital assets, they’re expecting Washington to figure this out and at least show incremental progress and effort to refine what we have.”
‘Catch-22’
The problems are wellknown and growing more urgent to families each month.
Like more than half of Georgians, Lander, her husband and their two children don’t have employer-based health insurance. So they buy their policies on the individual market, and like most Georgia policyholders, they’ve seen their premiums rise by significant amounts over time. But last year was unbelievable: The increase alone was $500 per month. They’re now paying $20,000 a year for health insurance.
“I can suck it up and pay for it,” she said. “Most people can’t.”
Subsidies on the Affordable Care Act exchange market only go to households with incomes up to around $50,000 a year.
Now the coup de grace. The company that offered her that policy, Blue Cross Blue Shield, is pulling out of the individual market altogether next year in the county where she lives, Fulton. The remaining two companies, Kaiser and Ambetter, don’t include her family’s doctors in their coverage.
“The fact that it looks like for 2018 I won’ t be able to, for any cost, buy even a high-deductible policy with a single one of the doctors my family uses blows my mind,” she said.
Vance is also in metro Atlanta, with very different but equally galling problems. A couple of years ago she lost her job. In Georgia, when her income went to zero that meant she no longer qualified for any subsidized health insurance. She couldn’t get Medicaid, either. Obamacare expected that states would expand Medicaid to cover working-age adults such as her, but Georgia decided not to, citing concerns about future costs.
Vance was trying to deal with hepatitis C and then cancer, but after she couldn’t pay, she couldn’t get her specialist to see her anymore.
“I couldn’t get Obamacare because I didn’t make any money,” Vance said. “It was like a Catch-22.”
Vance went searching for options and eventually got a hospital to donate part of her cancer surgery. A couple of thousand dollars’ worth of radiology and other services accompanying her surgery were performed without payment but billed. Now those costs sit on her credit record and will likely be eaten as bad debt by the professionals who provided the care.
For Vance, getting the health care she needed has put her back on a path to stability. She’s gotten her life together, has a new job and will qualify for Obamacare health insurance subsidies again. She has been able to take her grandson in again and raise him herself rather than relying on others.
But for those out there who are where she was two years ago, she says something must be done. “That’s the coverage of our nation, of our people,” she said.
Insurance subsidies
There are things lawmakers and policymakers could do to deal with all of that, from the small-scale to the sweeping.
The AJC interviewed officials who provide care, who represent taxpayers and patients and insurers.
While they may differ on which solutions they support, they were fairly united in insisting health care must stay on the front burner and see action.
As a first priority, many urged Congress and the White House to quickly signal in strong terms what will happen to cost-sharing reductions, one of a couple of subsidies that make Obamacare insurance affordable. The Trump administration has threatened to stop paying them, and insurance companies such as Blue Cross have said they are pricing that uncertainty into their proposed rates for 2018, raising rates and stopping coverage in some areas as a direct result.
A larger, tougher issue is covering the very poorest in states that did not expand Medicaid, such as Georgia. The vast majority of Georgians support doing that by having the state expand Medicaid. Others suggest working with Health Secretary Tom Price to get a waiver to experiment with Medicaid dollars, saying that would be more efficient.
Lt. Gov. Casey Cagle has held Senate hearings over the past year delving into waivers and other options the state may have on health care as it waits to see what Congress does.
Lander, the mother with the skyrocketing premiums, doesn’t focus on politics, she just wants the system fixed. She’d like a practical system where her family can see the doctors they need — anything from going back to the system before Obamacare to going to a single-payer system if it works.
Dr. Steven Walsh, a Roswell anesthesiologist and head of the Medical Association of Georgia, agreed that others may disagree about fixes, but the important thing is to get moving. From the insurance market uncertainty and narrowing insurance networks to unfunded care and bureaucracy, Walsh said, “All these issues impact our daily practice.”
Bipartisan talks
There is a first step. This week, a group of senators is about to embark on a gambit Congress hasn’t seen on health care in years: hearings with stakeholders, experts and bipartisan buy-in.
Senate health committee Chairman Lamar Alexander, R-Tenn., and his Democratic counterpart, Patty Murray of Washington, have scheduled two hearings featuring governors and insurance commissioners from across the country with the goal of cutting a deal within weeks to help stabilize Obamacare’s individual insurance market and health care premiums.
“There are a number of issues with the American health care system, but if your house is on fire, you want to put out the fire, and the fire in this case is the individual health insurance market,” Alexander said in a statement. “Both Republicans and Democrats agree on this.”
Georgia U.S. Sen. Johnny Isakson, an ally of Alexander’s who sits on the health committee, said he’s open to working with Democrats on a stabilization bill now that the GOP repeal effort has collapsed.
The third-term Republican supported all his party’s bills to scrap the Affordable Care Act in July — he says the 7-year-old law is “terribly flawed” and “unconstitutional” — but said now that the repeal effort has stalled “it’s wise to fix problems” in the current system.
“What’s wrong is folding your arms and saying I’m not going to help,” he said. “What’s right is saying I’ll sit down at the table.”
Isakson’s fellow Georgia GOP senator, David Perdue, also appears to be open to some sort of deal. He told Atlanta reporters earlier this month of working with Democrats, “let’s both pony up and say now it’s time to really get together. And there couldn’t be a better guy doing that than Lamar Alexander.”
Across the Capitol in the House of Representatives, it’s still unclear how wedded GOP leaders are to the idea of an Obamacare repair effort, given pressure from Trump and his supporters to let the law fail. There are many Republican lawmakers wary of helping make function a law they have long loathed.
U.S. Rep. Buddy Carter, R-Pooler, said he is “not in favor of throwing good money after bad” by bolstering Obamacare.
Speaking in terms reminiscent of the summer’s battle to repeal Obamacare, Carter said in an interview last week: “I don’t think that we should be trying to fix the Affordable Care Act . ... What we need to do is to scrap it — it’s been a failed experiment — and start over.”
Carter agreed that Congress needed to stabilize the health insurance markets but said the House already did so by passing its Obamacare replacement bill.
In the meantime, the GOP’s effort to repeal and replace the Affordable Care Act is on the back burner. Some conservatives hold hope that leaders could return to it in the months ahead, should the political math in the Senate change. But for now leaders have begun to shift their attention and efforts to other issues such as taxes.
U.S. Rep. David Scott, a moderate Democrat from Atlanta, said the Senate stabilization effort is “a good first step” on health care.
“It is the uncertainty around payments that has led to both the increases in the premiums and increases of the insurance companies leaving the market,” he said, adding about the cost-sharing reduction payments, “you can’t go from month to month on something like this.”