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Pluses, minuses weighed as replacement health care plan is scrutinized

Pluses, minuses weighed as replacement health care plan is scrutinized


Worries about continuing health care coverage for herself, her two daughters and her 83-year-old father did not go away for Keene business owner Katie Wilson when the Republicans introduced an alternative to the Affordable Care Act, also known as Obamacare, on Monday.

“I’m uninsured,” she explained in an interview on Thursday, adding that her daughters were covered under their father’s plan at work and are now covered through their stepmother’s plan. “At times due to a miscommunication, the insurance lapsed. With the new 63-day lapse (clause), I realized that there would be a 30 percent increase in the premium and that is one huge concern for me.”

The Republican alternative to the Affordable Care Act, the American Health Care Act, currently in Congressional mark-up sessions, is facing opposition by individuals like Wilson, some Democratic and Republican lawmakers and major players like the American Medical Association, the American College of Physicians, the American Hospital Association and AARP.

“Healthcare experts across the country have rejected the Republican plan outright citing the devastating impact on patients ... Health care is a human right, not a luxury,” said Gov. Andrew Cuomo in a Thursday afternoon statement. “After seven years of progress under the Affordable Care Act, the Republican Congress has proposed an inadequate, ill-conceived and unacceptable plan that places the coverage of more than one million New Yorkers in jeopardy.”

The Governor continued.

“Once fully phased in, (the plan) would shift more than $2.4 billion in costs onto taxpayers and hospitals each year,” he said.

In a Thursday afternoon press briefing, Nancy LeaMond, AARP executive vice president, said that the proposed plan weakens Medicare, increases insurance premiums and does nothing to lower drug costs.

“We are in opposition to the American Health Care Act because it makes health care less secure for older Americans, especially those aged 50 to 64 years old,” LeaMond said.

Right now Wilson’s father’s Social Security pays his living expenses, but after paying those bills, he’s left with only $250 to cover everything else.

With the AHCA, a fee that went to Medicare under ACA would be repealed, leaving Medicare more fragile. LeaMond said losing that fee means there would be less years of Medicare solvency, paving the way for potential voucher programs.

“With Medicare (changes), it could run out really quickly,” Wilson said, referring to so many older Americans needing care. “My father could never pay additional expenses. He would have to move in with me.”

In a letter to Congress, the American Medical Association predicts that Americans will lose coverage with the Republican alternative.

“More than 20 million Americans currently have health care coverage due to the Affordable Care Act, and among the AMA’s highest priorities for ongoing health system reform efforts is to ensure that these individuals maintain that coverage,” wrote Dr. James Madara, executive vice president and CEO. “While we agree that there are problems with the ACA that must be addressed, we cannot support the AHCA as drafted because of the expected decline in health insurance coverage and the potential harm it would cause to vulnerable patient populations.”

Tax credits and funding cuts

At issue between the two plans are the way tax credits are calculated and increasing premiums as individuals age, as well as cuts to Planned Parenthood, tax credits to drug companies and subsidy cuts.

“This plan is a direct assault on New York values (by) defunding Planned Parenthood, restricting access to abortion and reproductive health services, and eliminating $400 million in means tested credits that lowered insurance costs for low-income New Yorkers,” Cuomo said.

Both the AHA and AHCA offer tax credits.

An individual tax credit, different from a tax deduction, is the amount a taxpayer can reduce the amount they owe in federal income tax. For example, if a person owed the IRS $3,000 and were eligible for a $2,000 tax credit, that person would only owe $1,000 after taking the credit.

Currently, the ACA tax credits, which can be taken upfront to help pay premiums or at the end of the year on tax returns, help those with lower incomes the most.

ACA tax credits are based on a complex algorithm taking into account income, region of the country to account for higher premiums in certain areas, and age. That means people with lower incomes earn a higher tax credit, while those with incomes over 400 percent of the poverty level receive no tax credit under the existing ACA.

If the proposed AHCA is adopted, starting in 2020, it would replace ACA income-based tax credits with a flat tax credit adjusted for age with no income consideration up to incomes starting at $75,000. When incomes reach $75,000, the credits begin phasing out, and for a 29-year-old, they stop at incomes of $96,000; for someone age 60 or older, credits stop at $115,000.

Annually, the flat tax credit for the AHCA would be $2,000 per individual up to age 29; $2,500 per individual age 30-39; $3,000 per individual age 40-49; $3,500 per individual age 50-59; and $4,000 per individual age 60 and older.

Additionally, with the AHCA, families could claim tax credits for up to the five oldest members of the household, up to limit of $14,000 a year.

According to a Kaiser Family Foundation policy analyst, the current ACA also helps with out-of-pocket expenses through subsidies.

“Those benefiting the most from the ACA are not necessarily the ones who will benefit from the AHCA,” said Michelle Long in an interview Wednesday evening. “Older folks look great with a $4,000 credit, but they will be paying so much more for premiums. Without subsidies to help, it may become unaffordable.”

Long continued.

“Younger folks may see a lower premium, but they need to look at it down the line,” she said.

More locals insured under ACA

Currently, under ACA, many more Americans have health insurance coverage, despite its detractors.

Locally, Hudson Headwaters Health Network founder and CEO Dr. John Rugge said that since the ACA went into effect, they have seen a real difference in the number of uninsured patients they treat.

“We had a two-thirds reduction. In 2010 it was 14 percent,” Rugge said in a Wednesday interview. “Currently, it is 5 percent.”

Rugge said when patients are insured they show up for care.

“We are seeing people with pent-up needs now being treated,” he said. “And they are still working and caring for their families.”

And Rugge also pointed out that this region has a disproportionate number of older individuals.

“We are the second oldest area to the Gold Coast of Florida,” he said. “We have a disproportionate number of older people and a disproportionate number of self-employed and small employers who don’t have health insurance provided by big corporations.”

For older individuals in other states, the AHCA proposes a premium cap for older individuals at five times that of a younger person. For someone currently paying $3,000 a year, their premium could increase up to $15,000.

But in New York state, that will not happen, said Long.

“In New York and Vermont, they have to charge the same premium for all ages,” she said. “I don’t see anything in the AHCA that pre-empts that. So it won’t have as big an impact on people living in New York.”

‘Take a deep breath’

Rugge said that right now is too soon to know the ramifications of the proposed plan.

“The immediate response is to take a deep breath to understand the ramifications and the Congressional Budget Office to run the numbers to help us understand them,” he said. “And we have to engage one another and ask ‘What does this mean for me?’ ‘For my family?’ ‘My budget?’ We need to make sure our voices are heard.”

And he credits Rep. Elise Stefanik, R-Willsboro, with paying attention to what area providers are concerned about.

“Congresswoman Stefanik has been speaking with us and is really looking at how this affects the area,” he said. “She has been very receptive.”

Stefanik, through a spokesman, said Thursday afternoon that Obamacare needs to be repealed and replaced, but she is reaching out to constituents and stakeholders across her district to gather their input about the new legislation.

And the Governor is urging New York’s lawmakers to take a stand.

“As bad as this bill is, it may get worse. Far-right opponents of the bill in Congress are demanding changes. As disturbing and devastating as the proposed cuts would be, the final result could be downright bone chilling,” he said. “New York’s entire delegation – democrats and republicans – need to stand up and they need to fight, stand against this regressive plan, and protect the people they are sworn to represent. There is no going back.”

According to Tom Flanagin, a spokesman, Stefanik is already talking with local stakeholders — including local hospitals and elected officials — regarding the new legislation to hear their thoughts and get feedback.

“There is much more outreach planned as this legislation is amended through the committee process,” Flanagin said. “We encourage everyone to read the plan at and to contact our office with their thoughts.”

Kathleen Phalen-Tomaselli is a features writer at The Post-Star. She can be reached at for comments or story ideas.


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