Health Appeal

Future of ACA remains uncertain under a Trump administration

The Affordable Care Act may not be perfect, but it probably saved Aaron Parkey's life.

The 44-year-old real estate agent woke up in 2013 to discover that his body was numb. Turns out that he was suffering from a condition called transverse myelitis, a neural injury to the spinal cord.

And to make matters worse, the single dad has since developed MS.

As a result of his illness, "I lost everything," he said. "I had to go on food stamps for my kid. I was homeless. I had to bounce around on people's couches. I got separated from my child. His grades went down, so that affects society. Everything gets affected."

But because he got health insurance through the Affordable Care Act, he was able to get treatment, get back on his feet and get his real estate license. He now earns more than $100,000 a year and depends on provisions in the ACA that require insurance companies to provide coverage to people with preexisting conditions.

As the new GOP-lead Congress and the incoming Trump administration prepare to repeal the Affordable Care Act without a clear plan of what they will replace it with, people like Parkey are wondering what the future holds for them. An estimated 20 million people were able to get health insurance since the healthcare overhaul was passed by Congress in 2010. Some had preexisting conditions that made insurance unaffordable; some were able to finally afford insurance because of subsidies and the online marketplace; and some qualified for Medicaid (or as it's known in Arizona, AHCCCS), at least in states that decided to accept federal dollars to expand healthcare coverage for low-income residents.

Healthcare industry leaders are also worried about what the future holds. Dr. Doug Spegman, the chief clinical officer at El Rio Community Health Center, said that that after Arizona expanded Medicaid under the ACA and the online marketplaces offered an alternative for people shopping for insurance, the level of uncompensated care provided by the clinic dropped from 26 percent to 12 percent. Given that the clinic serves nearly 100,000 patients a year, that was a significant financial boost for the clinic.

Spegman said any changes to the ACA should preserve provisions that prevent insurance companies from refusing to cover people with preexisting conditions; allow parents to keep their children on their insurance plans through age 26; preserve the Medicaid expansion to provide health insurance to anyone below 138 percent of the federal poverty line; and prohibits the lifetime caps that used to allow insurance companies to stop covering sick people if the costs rose above a certain level.

Local business leaders are also concerned. Mike Varney, president & CEO of the Tucson Metro Chamber, said that a recent survey of his members showed a sharp uptick among those who are concerned about healthcare costs. Many of them, although they want to be able to provide insurance for their workers, are unhappy with some of regulations that came along with the ACA and increases in the cost of premiums. "The ACA probably isn't working for those who are paying the freight," Varney said.

But Varney added that repealing the ACA without a clear replacement is also a bad strategy for business.

"What you call 'repeal and delay' would just throw them into a cauldron of confusion," Varney said. "Just knowing where things are going, even if you know you're going to have an increase, if you know it's going to be a reasonable one—a middle or low single digit increase—most companies could probably deal with that."

Chamber members, who advocated expanding Medicaid eligibility, would like to see that remain in place, according to Varney.

"I have seen any suggestion that the chamber would change its position on supporting a robust AHCCCS program in the state of Arizona," Varney said. "Hospitals and health systems like El Rio and TMC have seen the percent of uncompensated care go down and that's a good thing. At one point in time, I heard a presentation from a local hospital exec and he said, just imagine if you run a business and one out of 10 people who come and buy a car or furniture of whatever it is, they just don't pay their bill. And you have to sell them the furniture or the lunch or the dinner or the car or whatever."

Lea Marquez Peterson, the president and CEO of the Tucson Hispanic Chamber of Commerce, likewise said that her members are struggling with some aspects of the ACA but there have been positive benefits as well.

"Our chamber supports the position of a thoughtful repeal and simultaneous replacement," Marquez Peterson said. "The Affordable Care Act has not been affordable for a majority of our small businesses. However, the reduction of uncompensated care for our hospital members and the realignment from quantity to quality health care have been positive effects of the ACA. It's a complex system that needs practical, affordable, patient-focused modification."  

Exactly what Republicans are planning for the future of the ACA remains a mystery. While the Senate and the House both voted to take steps toward repeal last week, no clear consensus for replacement has emerged. Some GOP senators have begun to express concern that a replacement plan should accompany repeal, but that hasn't slowed down the move toward scrapping the ACA.

During his 2016 reelection campaign, Sen. John McCain said that he didn't think it was necessary to require insurance companies to provide coverage to people with preexisting conditions, such as cancer survivors and diabetics. Instead, McCain suggested that the federal government leave the responsibility of providing health care to the states, which would have the option of setting up high-risk insurance pools at their own discretion—an effort that was tried before the ACA but became so expensive that state lawmakers balked at the expense.

Congresswoman Martha McSally (R-AZ02) has voted for the full repeal of the ACA during the Obama administration but has also said she supports popular provisions like banning insurance companies from denying coverage to people with preexisting conditions and allowing young adults to remain on their parents' healthcare plans.

McSally was among the majority of Republicans who voted last week in support of a GOP budget reconciliation package that sets the stage for a fast-tracked repeal of the ACA. The measure was opposed by all of the congressional Democrats and nine GOP House members.

"Southern Arizonans deserve access to affordable, quality health care that provides them with choice and meets their needs," McSally said in a prepared statement after the vote. "Obamacare, which was flawed from the beginning, is collapsing under its own weight—and nowhere have families and individuals been hit harder than Arizona, where premiums are rising faster than anywhere in the country. Today's vote is the first step to repealing the failing Affordable Care Act and replacing it with legislation that brings down costs, increases competition, and ensures Americans have access to quality health care. Like many I've spoken to in Southern Arizona, I have concerns about providing for the transition to a better health care system, and throughout this week, I have engaged with House leadership and my colleagues to voice and address those concerns."

McSally spokesman Patrick Ptak said it was premature to discuss the details of what the replacement to ACA would look like.

"The new Administration has yet to take office, and Congress and the Administration-elect are still working through the exact process and timing," Ptak said. "Right now, Congresswoman McSally's focus is on making sure the families and individuals she represents have access to the health care they need. She will thoughtfully consider each step as it comes before the House."

Congressman Tom O'Halleran (D-CD01) said he was not comfortable with moving with a repeal without a replacement plan.

"I don't think anyone should be comfortable with that approach," O'Halleran said. "First of all, as I'm sitting here, I can't tell you what their plan looks like, other than almost everyone I talk says they don't have a plan. ... We need to fix it, but we need to fix it in a responsible way, and not having a plan to take its place, not having an option but making changes that are going to impact it, is just not acceptable."

A Public Policy Polling survey of Arizonans conducted earlier this month showed that 79 percent of Arizonans wanted to preserve protections for people with preexisting conditions; 80 percent opposed elimination of provisions that provide routine checkups such as cancer screenings; 75 percent opposed reversing the Medicaid expansion; and 74 percent opposed the tax cuts for corporations and wealthy Americans that would accompany a repeal of the Affordable Care Act. In addition, 64 percent opposed eliminating funding for women's health care at Planned Parenthood health centers.

The PPP survey, conducted on behalf of the Alliance for Healthcare Security, a coalition of nurses, caregivers, patients and healthcare advocates that is advocated against repeal of the ACA, interviewed 954 Arizonans and had a margin of error of plus or minus 3.2 percent.

Aaron Parkey is among those Arizonans who would prefer to see the law improved rather than scraped. Before the ACA came along, Parkey only had access to heath care though a federal program called Indian Health Services that is available to Native Americans.

He recalled a visit to a Houston hospital when he had a herniated disc in his back.

"They gave me 20 Vicodin and told me I had degenerative disc disease, go home and get used to it," he recalls. "With Obamacare, they set me up with a Cortisone shot in my lower back that worked for me and kept me from being an opioid addict."

As someone with MS, he knows that healthcare coverage allows him to continue to earn a living, pay taxes and take care of his kid.

"There's no substitute for healthcare," Parkey said. "For the country that we are, everybody should have health care before everybody has their own reality TV show. I'll roll over tomorrow and curl up in my bed in pain and tell all you guys you need to write me a check for disability if that's what you want me to do. But I don't want to live in a little apartment on disability. I've always been a Republican and I'm all about competition and free markets. But there is something to be said to look at the next guy and say, 'I'm going to help you because it's better for all of us.'".