The mad dash for Congressional approval has left experts, consumer advocates, health care providers and others scrambling to grasp the implications for Georgia, The Atlanta Journal-Constitution has found.
Some people — especially older folks who live in rural Georgia where insurance premiums are often far higher than in metro areas — could lose thousands of dollars in federal tax credits that make buying health insurance possible. Meanwhile, the GOP plan offers more generous tax credits to the younger and wealthier as an enticement to get covered.
It could mean major cuts in funding and medical services for the state's Medicaid program that provides health care to about 2 million poor children, pregnant women, the elderly and disabled. The state could also get new flexibility in how it provides that coverage.
The state — which has the third-highest rate of uninsured in the country — could see that number swell under the plan.Hospitals could end up caring for and losing money on scores of those newly-uninsured patients, a burden that could have dire consequences for many of the state's rural hospitals already in financial straits. By one estimate, 300,000 or more Georgians could lose their insurance.
MAP: Changes to tax credits in Georgia
But the GOP plan would also keep intact many of the widely-popular aspects of Barack Obama's Affordable Care Act. Parents could still keep kids on their insurance until age 26. Insurers could not reject people with heart disease, cancer and other pre-existing conditions outright. There would be no cap on lifetime benefits for people with towering medical expenses that otherwise might plunge them into bankruptcy.
Paul Ryan says his current plan to repeal and replace Obamacare involves more than the budget reconciliation bill currently up for debate.
It would also eliminate certain elements of the ACA loathed by some Americans, including the individual mandate that forces people to buy health insurance if they can afford it or else pay a penalty.
Proponents say the new plan isn’t about taking insurance away from people but allowing patients to make their own health care choices without government interference.
“It’s a mixed bag,” said Karen Pollitz, a health care expert at the nonprofit Kaiser Family Foundation. “This is not a finished product.”
‘The best insurance we ever had’
Before the Affordable Care Act came along, Joel and Katie Blevins watched as their health insurance costs rose year after year until they simply couldn’t afford it.
The North Georgia couple — Joel, a 64-year-old, semi-retired carpenter, and his 63-year-old wife, Katie, who suffers from psoriasis, a painful skin condition — went three years without insurance. Until Obamacare.
March 10, 2017, Tunnel Hill - Joel Blevins, right, and his wife Katie Blevins, left, pose for a portrait in their home in Tunnel Hill, Georgia, on Friday, March 10, 2017. After not having health insurance for 3 years, the Blevins were able to be insured under the Affordable Care Act. The current administration is working towards repealing and replacing the law, which would greatly impact them. “It’s terrifying not to have insurance,” says Katie. “In our community I meet people that just don’t have any insurance…I worry about them. I worry about their kids and their family members,” says Joel. Katie works as a freelance artist and Joel works as a carpenter, and they rely on the ACA subsidy to be able to afford health insurance. “If we were to lose the subsidy, we’re looking at losing our health insurance,” says Joel. (DAVID BARNES / SPECIAL)
Today, they pay $170 a month instead of the nearly $1,600 price tag they faced without their Obamacare tax credit.
“It’s the best insurance we ever had,” Joel said.
Under the current health law, the amount of tax credits people get are based on age, how much a family makes and the cost of insurance. So people with low incomes tend to benefit more.
The GOP plan also offers tax credits but in a very different way. It would give people a lump some based mostly on age and less on income.
Here’s an example of how this key difference might look like in Georgia according to an analysis by the Kaiser Family Foundation.
A 27-year-old in Cobb County making $30,000 a year would see his credit increase by $170, from $1,830 under Obamacare to $2,000 under the new plan. Meanwhile, a person the same age but making $20,000 would see his credit decrease by $1,350.
Older Cobb residents would get hit even harder. A 60-year-old making $20,000 a year would see her credit slashed by more than $6,000, while someone the same age making $50,000 would see his credit reduced by about $2,000.
The plan also allows older people to be charged as much as five times more for insurance than younger consumers, up from a limit of three times more under Obamacare.
“Our members are on high alert,” said Melissa Sinden, advocacy manager for AARP Georgia. “There’s a fear that more out-of-pocket costs would make it tough for people to acquire health insurance.”
She added that many older Americans do not have the kind of savings needed to pay for additional medical expenses.
Roughly 85 percent of the nearly half a million Georgians who get Obamacare insurance benefit from the tax credits.
Insurance is especially important for Katie Blevins whose condition causes pain and extreme skin problems. Katie and Joel are just shy of qualifying for Medicare, the government health program for Americans 65 and older.
Under the GOP plan, the Blevinses stand to lose thousands of dollars in tax credits they get now under Obamacare. They worry the resulting high premiums would mean borrowing money to pay for insurance or — more likely — just dropping it altogether.
Joel fears if he and Katie are forced to go uninsured, a major accident or health care scare could bring medical expenses they can’t afford to pay.
“If we had a big bill, we would end up with a lien on our home,” he said. “We wouldn’t be able to leave any money to our sons.”
What You Need To Know: American Health Care Act
‘Obamacare needs to be done away with’
While Georgians, like the Blevinses, could be devastated by changes under the GOP plan, others — especially high middle-income earners — would benefit significantly.
Right now, individuals who make more than roughly $48,000 generally don’t qualify at all for tax credits under Obamacare and bear the full cost of premiums that have been on the rise. The new plan, however, would provide financial assistance for individuals who make upwards of $100,000 in certain cases.
Betsey Weltner is among those happy to see Obamacare dismantled. She says the health care law has forced her to buy more expensive health insurance that she doesn’t need.
“I’m one of those people who have been seriously slammed by cost increases,” said Weltner, 64, of Colquitt County.
Betsey Weltner preferred her bare-bones private insurance plan before Obamacare. Now her premiums are much higher.
Before the health law, insurance cost her $289 a month. It was a catastrophic plan with a $10,000 deductible.
She saw one of her initial health insurance policies cancelled, then another.
She now pays $1,100 per month. But she says the plan includes all kinds of mandates that she doesn’t want or need. And it has a $6,000 deductible.
Weltner, who has her own public affairs consulting firm, said the existing system has robbed independent business owners of their ability to choose.
“I want to make decisions for myself,” she said.
The new plan will unfortunately come on line after she enrolls in Medicare in April.
Still, she believes it will benefit her as a taxpayer.
“By having a more realistic understanding of the marketplace and risk management, it will be a more efficient system,” she said.
The GOP plan could also be a boon for some businesses.
It eliminates the requirement that companies with 50 or more full-time employees provide health insurance or pay a penalty.
That matters to Brookhaven resident Cade Joiner who owns a paper-shredding business and is a fan of the Republican plan.
When he was covered under Obamacare some years ago, he had one policy and then another cancelled. He was single back then, carrying catastrophic-level insurance, with a high deductible of about $10,000 and a low premium.
“It was a big hassle,” said Joiner, 38. “Obamacare needs to be done away with, or change. There’s a lot of problems.”
Obamacare didn’t so much affect his business in those years, since he only has about a dozen employees.
But he sees his company growing, and should he add enough employees to where he might be affected by a government health plan, he feels he’ll be better off under the new Republican program.
“There will be less red tape,” he said. “The less time I have to deal with government regs, the more time I can spend selling my business.”
No ‘magic wand’ for states
Another major component of the GOP health plan could deal a drastic blow to funding for Medicaid programs — leaving states on the hook for billions of dollars.
Nationwide, the Medicaid program provides health care to roughly 70 million low-income Americans, including about 2 million people in Georgia, most of them children, pregnant women, the elderly and disabled.
For one, the plan ends Medicaid expansion by the end of 2019. After that, expansion enrollment would be frozen with the idea that those numbers would gradually decrease as individuals’ incomes change.
Georgia has, so far, refused to join the more than two dozen states that have grown their Medicaid programs. Gov. Nathan Deal and other conservative leaders argue the state can’t afford to expand an already bloated and inefficient program, even though the federal government would be picking up most of the price tag.
The plan would also fundamentally change how much money states get from the federal government to keep their Medicaid programs going.
Right now, the feds pay states a certain percentage of any Medicaid costs they incur. But the GOP plan would shift to providing states a flat rate for each Medicaid enrollee, which doesn’t account for changing demographics or states with aging populations with more expensive health care needs.
Consumer advocates warn such a move would almost certainly lead to major cuts to medical services and to enrollment for America’s most needy citizens as states look for ways to save money.
“Governors can’t waive a magic wand and implement Medicaid cuts without direct cutbacks in the health care that the 70 million Americans rely upon,” Joan Alker, head of Georgetown University’s Center for Children and Families, wrote in an recent analysis of the plan.
Overall, the plan would shift an estimated $370 billion in Medicaid funding onto states over the next decade, a report by the Center on Budget and Policy Priorities.
Under the current system, if you are eligible, then Medicaid will pay for the care that you need; that’s a commitment, said Cindy Zeldin, executive director of advocacy group Georgians for a Health Future. The GOP plan would take away that commitment and if people run out of money, they won’t be able to pay for the care their need, Zeldin said.
When cuts hurt care
Hospitals — some of them already in dire financial straits especially in rural areas — could face having to care for a slew of newly-uninsured patients.
In 2015 alone, they provided roughly $1.75 billion in care to patients without insurance.
The Georgia Hospital Association objects to many of the plan’s sweeping reforms, arguing they could lead to payment cuts for health care providers, hurting access to emergency and trauma care, preventive services and other critical services for patients.
“Georgia’s patients, communities and businesses rely on our hospitals and health care providers to ensure access to care, 24 hours per day, seven days a week,” said Earl Rogers, the association’s president.
That’s especially true in rural areas of the state where many hospitals are already struggling to remain open. Losing more paying patients could be the final blow to those already on the verge of closure.
Bill Custer, a health care expert at Georgia State University, estimates 300,000 or more Georgians could lose their insurance under the new plan. That, he said, would lead to higher costs for people with insurance in the form of higher premiums and hospital bills.
“The more uninsured, the higher the cost to people who do have coverage,” Custer said. “That’s a direct relationship.”
So what’s next?
The American Health Care Act is in no way guaranteed to pass.
Hardline conservatives have balked at House Speaker Paul Ryan’s plan, arguing any GOP solution should abolish Obamacare in its entirety — upholding a key campaign promise to voters.
They see the continuation of tax credits in any form as tantamount to a new federal entitlement program and say Medicaid expansion should be eliminated immediately too.
Two conservative Georgia Republicans, U.S. Reps. Barry Loudermilk of Cassville and Jody Hice of Monroe, say they cannot support the bill in its current form.
“In Georgia, we took a stand and said we weren’t going to expand the Medicaid rolls. We took the lumps,” Loudermilk said. “And yet (the bill) is going to reward the states that didn’t by allowing them to continue to expand Medicaid, which further increases the rolls and the costs of this.”
National health care groups, including the American Medical Association and the American Hospital Association, have come out against the plan too, saying millions of Americans would lose access to health care because of it.
Meanwhile, the plan faces stiff opposition in the Senate from several moderate Republicans from states that have benefited from Medicaid expansion.
Conservatives and Democrats alike have also raised concerns over the plan’s cost. Congress’ nonpartisan scorekeeper on proposed legislation, the Congressional Budget Office, has yet to estimate how much the proposal would cost taxpayers or how many Americans would lose or gain insurance under it. Those estimates could come this week.
Republicans have also not said how they plan to pay for their plan, which eliminates many of the taxes levied under Obamacare that help pay for the health law.
The GOP plan, which is currently two bills, will head this week to the House Budget Committee to be stitched together before ultimately heading to a vote on the House floor.
Despite major pushback, Speaker Ryan has said emphatically that he believes conservatives will come together in the end to support the plan.
“This is a once-in-a-lifetime opportunity,” Ryan said Thursday in a meeting with reporters. “This is the closest we will ever get to repealing and replacing Obamacare … the time is now.”
— Staff writers Ariel Hart and Tamar Hallerman contributed to this report.