The Pulse: What's At Stake For Rhode Islanders If Obamacare Is Repealed?

Dec 8, 2016

Credit Kristin Gourlay / RIPR

State health care leaders are keeping a close watch on the future of the Affordable Care Act.

 President-elect Donald Trump and a Republican congress say they want to repeal most of the law and replace it with something else. 

But that could impact health care for Rhode Islanders in significant ways. Rhode Island Public Radio’s Kristin Gourlay joins Chuck Hinman to talk about what’s at stake.

Here's a transcript of their conversation:

HOST: Kristin – let’s jump right into the heart of the matter. What could Rhode Islanders lose if the Affordable Care Act is repealed?

KRISTIN: A lot. Whether you support it or not, Obamacare is much more than just the law that extended health insurance coverage to millions of people who didn’t have it. It affects the kind of coverage we all have and what we pay for it.

HOST: So give us some examples. How many people has the law affected here in Rhode Island and what’s on the line for them.

KRISTIN: Obamacare expanded eligibility for Medicaid – the state health insurance program for the poor. Tens of thousands of Rhode Islanders gained health insurance under this expansion – those are people who may not have been able to afford health insurance before. Policy expert Linda Katz with the Economic Progress Institute told me she’s worried federal funds for that expansion could dry up – and that’s more than 90 percent of what’s paying for the expansion right now. Obamacare also provides subsidies to help people buy insurance on the exchanges – ours is called HealthSource RI. And the question is: what is the plan to help the 30,000 Rhode Islanders who receive those tax credits afford coverage on their own?

HOST: You mentioned Obamacare care affects the kind of coverage we all get – those of us who have insurance, whether it’s private or publicly funded.

KRISTIN: Right. President-elect Trump has expressed an interest in keeping some of these features. But let me give you a sense of what they are. Under Obamacare, kids can stay on their parents insurance through age 26. That also applies to youth who age out of foster care. Trump says he wants to keep that. He says he wants to keep the provision that insurers cannot deny coverage to someone with a pre-existing health condition. But here are some other features we haven’t heard the incoming administration weigh in on. Obamacare makes sure all health insurance plans cover 10 so-called “essential” benefits – and those include things like paying for pregnancy and childbirth care, prescription drugs, mental health care. It makes preventive care free – with no co-pay. Birth control is completely covered. And the ACA prevents insurers from charging women more than men, which was the case before the law was enacted. All of that is on the line if Obamacare is repealed.

HOST: Kristin Gourlay, so that’s what’s at stake for patients. What are health care providers keeping an eye on? Doctors, for instance.

KRISTIN: One of the signatures of Obamacare is trying to steer the health care system towards paying more for the quality of care rather than the quantity. Lots of money has flowed from the Affordable Care Act into all of these experiments testing new models for doing this. The goal is reduce costs and improve care. So far costs haven’t really come down, but many people in the health care industry believe these experiments haven’t had time to really prove themselves. Dr. Al Kurose is head of a big primary care practice here in Rhode Island. They participate in one of these programs called shared savings. It goes like this: if Coastal keeps their patients healthy and saves money in the process – by avoiding expensive emergency room visits, etcetera, they get some of that money back. Kurose is hopeful these kinds of programs will survive a new administration because they’ve gotten bipartisan support. But it’s not a sure thing. There are lots of other health care providers involved in payment experiments like this, all funded by the Affordable Care Act. So there’s a lot at stake for them.

HOST: Do insurers have anything to lose if Obamacare is repealed? They’ve benefited from all of the new customers, and from some of these payment experiments, haven’t they?

KRISTIN: Definitely. But they haven’t necessarily had a windfall. They’ve taken on more customers, but many of them have been sicker than the general population. And that’s what this next concern is about: how to handle a situation where the individual mandate is repealed. That’s the feature of the Affordable Care Act that requires everyone have insurance or pay a fine. The idea is that if everyone has insurance – people who are very sick and cost a lot of money, mixed in with people who are pretty healthy and don’t generally cost insurers a lot of money – the system will be affordable for everyone. But if you take away that mandate, there’s a concern that only sick people will want to buy insurance. And that could drive up costs for everyone. Republicans say health care costs – including the cost of insurance – have gone up anyway. But there’s no agreement on the best way to bring those costs down. Not everyone is worried, though. The head of Neighborhood Health Plan of Rhode Island, Peter Marino, tells me he’s confident their company can continue to provide affordable care and that they can adapt to change.

HOST: Kristin, what will hospitals be keeping an eye on as Obamacare is debated in the new administration?

KRISTIN: Hospitals have done well under Obamacare in some ways. They’ve benefited from the fact that more people have insurance and can pay for their care. They’ve received some incentives to provide higher quality care. But they haven’t necessarily gotten paid more to provide that care – and they’ve complained that the Affordable Care Act hasn’t helped their stability across the board. We’re still seeing hospitals looking for partners, shutting down services. So their future is unclear if Obamacare goes away or is retooled.

HOST: OK. Thanks Kristin. Kristin Gourlay covers health care for Rhode Island Public Radio.