After months of anticipation, the Republican plan to replace the Affordable Care Act drew a reaction in North Carolina Tuesday ranging from caution to criticism.
Mostly, health care customers, industry trade groups, analysts and even some Republican politicians said they hope it will get better.
Few who were willing to comment expressed much enthusiasm for a bill that creates uncertainty over the future of health insurance costs and access.
The bill faces a lengthy debate, is expected to go through multiple congressional committees, and will undergo many changes in the coming weeks and possibly months.
North Carolina U.S. Sen. Thom Tillis, while criticizing Obamacare as a failure, said in a statement, “I look forward to closely reviewing the House plan to reform our nation’s health care system.”
The state’s other Republican U.S senator, Richard Burr, called the plan “a good first step.”
The ACA, originally passed in 2010, was a sweeping piece of legislation that included employer mandates and hospital penalties along with a host of fees and taxes, in addition to its signature legacy: a health insurance marketplace with federally subsidized coverage. The Republican plan dumps key elements of the ACA – eliminating financial penalties for failing to buy insurance and reducing federal subsidies to offset costs – making insurance coverage optional.
But the Republican alternative does preserve two key features of the ACA: It would bar insurers from turning away customers with pre-existing conditions, and it would allow parents to keep their children on their plans through age 26.
Some health industry organizations in the Triangle said it was too early to comment on the legislation, which would undergo revision in the coming weeks. However, the goals they said are necessary to create a workable system in North Carolina are not guaranteed by the GOP’s American Healthcare Act.
Most significantly, industry trade groups in health care and business agreed on one point: The half-million-plus state residents currently insured through Obamacare should not lose their coverage.
“We need to make sure that coverage that North Carolinians currently have is maintained or improved,” said Gary Salamido, vice president for government affairs for the N.C. Chamber, the statewide business lobby. The N.C. Chamber, medical and hospital groups and Blue Cross and Blue Shield, the state’s largest health insurer, outlined this goal, among others, in a joint letter to the N.C. congressional delegation in January.
Advocates for the poor predict that many will lose coverage if the Republicans pass their plan.
“It’s sort-of Robin Hood in reverse,” said Brendan Riley, a health policy analyst for the N.C. Justice Center in Raleigh. “The plan would reallocate resources away from the needy and give them to the rich, the young and the healthy.”
The Republican plan would replace income-based subsidies with age-based subsidies ranging from $2,000 to $4,000 a year. In some North Carolina counties, the Republican subsidies would be as much as three times smaller than the ACA subsidies, according to an analysis by the independent Kaiser Family Foundation.
For example, a 60-year-old Durham resident with a salary of $30,000 would qualify for $4,000 in subsidies under the proposal, but $12,690 in annual subsidies in 2020 under the existing law.
However, ACA health plans may not be identical to insurance in the Republican model, because the ACA requires coverage that would no longer be required by law.
The Republican plan will help those who have been neglected by the ACA: individuals and families with household income above 400 percent of the federal poverty level. People in this category don’t qualify for ACA subsidies but will qualify under the Republican plan.
Hospitals, insurers and advocates for the poor have also wanted to expand Medicaid to provide a safety net for people who can’t afford health insurance even if it’s subsidized.
Gov. Roy Cooper has tried to expand Medicaid in North Carolina despite Republican opposition. The effort is now in court. The Republican plan would create a new funding system capping the amount each state receives annually, making any expansion unlikely.
Mike Molitoris, an Air Force veteran and financial adviser in Cary, pays a monthly premium of $510 thanks to ACA subsidies, down from the list price of $1,438 a month if he weren’t receiving subsidies. Still, with an annual out-of-pocket maximum of $13,100 and more than $6,000 in annual premiums this year, his family’s health care is not cheap.
“The biggest thing is: Don’t rush to erase it,” Molitoris said. “Whenever Washington is involved, I’m always worried that things will end up worse.”