SYRACUSE, N.Y. – Nearly 110,000 Central New Yorkers, enough people to fill more than two Carrier Domes to the rafters, would lose their health insurance if the federal Affordable Care Act, also known as Obamacare, was scrapped.
The Trump administration told a federal appeals court last week the entire law should be thrown out.
If that happened and the law was not replaced “ …it would have undeniable dramatic effects in New York,” said Bill Hammond, a health policy expert with the Empire Center, an Albany think tank.
While enrollment in Obamacare has declined in many states amid legal and political uncertainty about the law’s future, it increased 10 percent in New York during the open enrollment period that ended Jan. 31.
The Trump administration’s Department of Justice had been pushing to remove the law’s protections for people with pre-existing conditions, but had not argued in court that the entire law should be struck down.
But the administration changed its position last week when it said a December ruling by a district court judge in Texas which declared the Affordable Care Act unconstitutional should be affirmed. The district court ruled that a 2017 change in federal tax law eliminating a penalty on uninsured people invalidated the entire health law.
White House counselor Kellyanne Conway said Sunday Republicans are working on a plan to replace the Affordable Care Act, but did not provide any specifics. Trump tweeted Monday that Congressional Republicans won’t vote on a GOP replacement for Obamacare until after the 2020 election.
Mick Mulvaney, Trump’s chief of staff, said in an interview no one will lose their coverage if the Trump administration succeeds in getting the Affordable Care Act invalidated. He also said Republicans support preserving coverage of pre-existing conditions.
Hammond said he thinks it is unlikely the Texas judge’s ruling will be upheld.
The Texas judge’s decision had no effect on 2019 Obamacare coverage. Experts say the fate of the Affordable Care Act may ultimately be determined by the U.S. Supreme Court.
Here’s a look some of the potential consequences for New York if the law is scrapped:
*Nearly 3 million people statewide would lose their insurance. That includes about 1.9 million people on Medicaid, the federal-state health insurance program for the poor and disabled.
The federal Affordable Care Act gave states the option of changing Medicaid eligibility rules so more people can qualify. New York was one of the states that did that by offering Medicaid to residents with income up to 138 percent of the federal poverty level. The federal government pays most of the additional cost for newly eligible enrollees. If the ACA were struck down and the old eligibility rules reinstated, the state estimates those 1.9 million New Yorkers newly enrolled in Medicaid would fall off the program’s rolls.
*In Cayuga, Cortland, Madison, Oneida, Onondaga and Oswego counties, 109,869 people would lose coverage.
- 77,535 people in the state’s expanded Medicaid program;
- 21,165 people enrolled in the Essential Plan which provides low-cost coverage to people with income up to 200 percent of the federal poverty level;
- And 11,169 people enrolled in private health plans, many of whom receive federal tax credits to lower their insurance costs.
Here’s a breakdown by county of the number of people who would lose coverage:
- Cayuga: 8,262
- Cortland: 4,980
- Madison: 6,431
- Oneida: 27,144
- Onondaga: 49,372
- Oswego: 13,677
*Killing the Affordable Care Act could hurt hospitals, health insurers and other businesses. The Affordable Care Act “has been a multibillion dollar source of money for the New York health care industry,” Hammond said.
A recent analysis by the Empire Center shows most Central New York hospitals saw big increases in Medicaid revenues after the Affordable Care Act allowed the state to expand Medicaid eligibility.
Here’s how much Medicaid revenues increased between 2012 and 2016 at Central New York hospitals:
- Community Memorial, Hamilton: 55 percent
- St. Joseph’s, Syracuse: 46 percent
- Auburn Community, Auburn: 41 percent
- Cayuga Medical Center, Ithaca: 29 percent
- Oneida Health Care Center, Oneida: 25 percent
- Upstate University, Syracuse: 18 percent
- Crouse, Syracuse: 8 percent
The Affordable Care Act also has been a boon for insurance companies that sell Obamacare plans through New York’s health insurance exchange.
Excellus BlueCross BlueShield, for example, collected more than $87 million in 2018 selling private Obamacare plans to individuals through the exchange.
*Health insurance could become unaffordable for people with costly pre-existing conditions like cancer, according to Hammond.
People with pre-existing conditions cannot be denied coverage or charged more by insurers under the Affordable Care Act. New York has prohibited insurers from doing this since 1993 and that protection would stay in place if the Affordable Care Act was jettisoned.
But if federal premium subsidies that make insurance more affordable disappear, the pre-existing condition protection could backfire by driving up costs for younger, healthier consumers, prompting them to leave the market, according to Hammond.
That would leave the market with a preponderance of older, sicker people with pre-existing conditions who require costly care. That in turn would prompt insurers to raise premium rates, setting off the same kind of insurance “death spiral” New York experienced before the Affordable Care Act.
In 2013, the year before the Affordable Care Act took effect, New York had the nation’s highest insurance rates. New Yorkers were paying $1,000 or more a month for individual coverage.
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