BLOOMINGTON — If the Affordable Care Act is repealed, key provisions should be retained in any replacement law, say Central Illinois health care and benefits' planning leaders.
In separate interviews last week, health care and benefits planning professionals agreed that the following ACA provisions should be kept:
- Requiring insurers to offer health insurance to people with pre-existing medical conditions.
- Allowing parents to keep adult children on their health insurance until age 26.
- Allowing low-income people to afford health insurance through lower, subsidized rates.
But the best way to pay for the third provision remains a subject of debate.
And there is less common ground on what other aspects of Obamacare should remain. For example, there is disagreement over whether insurance coverage should be mandated and whether insurers should be required to include coverage of certain screenings and treatments.
"No one is saying the Affordable Care Act is perfect," said Walt Howe, director of the McLean County Health Department. "But I would like to see the positive aspects maintained."
"OSF HealthCare recognizes that, since its implementation, the Affordable Care Act contains a number of flaws, but has provided greater access to those who could least afford insurance," said OSF Chief Operating Officer Bob Sehring.
"We always knew that the Affordable Care Act would be a work in progress," added Colleen Kannaday, president of Advocate BroMenn Medical Center, Normal.
As President Donald Trump and Republican majorities in Congress deliver on their promise to repeal Obamacare, health care and benefits planners agreed that ACA shouldn't be repealed without an immediate replacement.
"We should have a replacement plan in place when the repeal happens or people will lose confidence in the process," said Jeff Gilmore, president of Benefit Planning Associates, Bloomington.
"The replacement needs to be figured out before the repeal happens or else people would be in limbo," agreed Kannaday. "It becomes a time of great uncertainty and no one wants that."
"If the whole thing is scrapped, we're in a worse position than prior to anything passing," said Angie McLaughlin, executive director of the Community Health Care Clinic, Normal, that serves about 1,000 low-income residents who are uninsured or under-insured. "You would get people in a world of unknown and that's never a good thing."
"Repeal without an appropriate replacement or proper funding mechanism in place would be disruptive to the nation's health care system," Sehring said.
The Affordable Care Act expanded health insurance to 20 to 30 million people, but also required people to obtain health insurance or face a penalty, required many employers to provide insurance and has resulted in premium increases for policyholders who are helping to cover those receiving subsidized premiums.
"We need to continue to provide financial support to people who got insurance the last few years — through tax credits or Medicaid expansion — otherwise there would be a vacuum," Gilmore said. "If they (Congress and Trump) don't address that, there will be major disruptions in the insurance market."
According to McLean County's 2016 Community Health Survey, 21 percent of survey respondents were without health insurance in 2013 and 8 percent were without health insurance in 2015. People bought private insurance or qualified for the expanded Medicaid program.
"The expansion of Medicaid and the availability of insurance through the exchange have permitted many hundreds of people to access medical and behavioral health services just at Chestnut Health Systems," said Chief Operating Officer Alan Sender.
At Immanuel Health Center in Bloomington, since the ACA took effect, the percentage of patients on Medicaid has increased, while the percentage of self-pay patients has declined and the percentages of Medicare and private insurance patients have remained steady, said medical director Dr. Trina Scott.
"The ACA has been good for our patients because, before the expansion of Medicaid, a lot of them weren't getting preventive care — such as mammographies, colonoscopies and diabetes screening — and they weren't getting help with chronic conditions, such as high blood pressure, diabetes and mental illness," Scott said.
"For the individuals, their quality of life is much better, which means the community is healthier and safer," Scott said.
If they lose coverage, they wouldn't get coordinated, preventive care and would return to episodic, expensive hospital-based care where they would rely on hospital charity care programs, Scott said.
"If preventive services continue, eventually we'll see a pay off," Howe said. "As we take care of ourselves and our community, the cost of health care goes down. It's important that we maintain a requirement that individuals be insured."
But if requiring people to get insurance or face a penalty remains, "they'll have to figure out a way to pay for it," Gilmore said. Now, subsidized coverage is covered through higher premiums paid by small businesses and individuals not receiving subsidies, he said.
"We are concerned about the increases in insurance premiums, deductibles and other out-of-pocket costs which has impacted the ability for some, particularly those who receive a limited or no subsidy, to have access to affordable health care," Sehring said.
While Medicaid expansion and insurance offered through the exchanges has encouraged people to seek care sooner, "affordability of both Medicaid and benefit plans offered through the public exchanges must be addressed," Sehring said.
Gilmore would like to see an end to many ACA business regulations, including requiring employers of 50 or more employees to provide coverage to employees who work 30 hours or more a week.
He'd also like to see a relaxing of coverage requirements. "If you don't want maternity coverage, you shouldn't have to buy it," he said. "That adds to cost."
"Insurance companies should cover pre-existing conditions, but I'd also like to see some underwriting process where, if individuals make the right lifestyle choices, they get better premiums," Gilmore said.
The ACA is transitioning health care providers to being reimbursed for value rather than volume of care. It's succeeding in improving care and saving money, Kannaday said.
"Obviously, this is a complex issue that's not going to be fixed the day it (the ACA) is repealed," Gilmore said. "It'll take time and tweaking."
"No matter what happens, we can't expect federal legislation to solve every single health care problem in the U.S.," McLaughlin said.
"There are a lot of patients who are concerned about what will happen," Scott said. "I tell them 'Ultimately, God is in control and we will figure it out together. If you lose your insurance, you can still come here.'"