NORTHAMPTON — A lively crowd of around two dozen, donning pink hats and pink signs, rallied Tuesday in front of Congressman James McGovern’s Northampton office in opposition to a plan by House Republicans to defund Planned Parenthood.
The rally was just part of a wave of opposition from across the political spectrum that Republican lawmakers have faced after introducing the American Healthcare Act, their plan to repeal and replace the Affordable Care Act.
Undoing what has come to be known as “Obamacare” has been a priority for Republicans since the law passed in 2010. But for Pioneer Valley residents, the uncertainty over the future of health care in America has left many deeply concerned and confused.Health care providers
“In some ways I’ve been anticipating this ever since the election, hoping it would not happen,” Joanne Marqusee, president and chief executive officer of Cooley Dickinson Health Care, said of the proposed legislation.
Marqusee is one of a number of local health care providers troubled by the plan’s potential effects, both in terms of the care the industry is able to provide and the effect on their business. She said the bill is likely to decrease overall coverage and the money available for health care, and that those cuts hurt patients and providers alike.
“We have a fundamental belief that when people don’t have health insurance, they don’t seek care in a timely way for preventative and wellness visits,” she said.
That means less of the early-stage interventions that keep patients healthy and lower health care costs, and more intensive treatment when a neglected condition becomes serious.
To make matters worse for hospitals, Marqusee said, the new Republican proposal would change Medicaid payments to a per-capita formula, meaning states would get a certain amount of money per enrollee instead of an amount based on how much health care each patient needs.
“To have the sort of discussions about capping Medicaid payments and turning it into block grants are very concerning,” she said, adding that those cuts would also affect the hospital’s finances. “We are not operating with a large margin right now. We barely break even.”
That sentiment was echoed by Baystate Health President and CEO Mark Keroack, who said his hospital’s margins are far too small to deal with a significant decrease in payments.
“There’s not an awful lot of give in our financials for us to absorb some big hit in the tens of millions of dollars,” he said. “We don’t have a lot of give in our budget.”
And it’s not just the region’s largest health care providers who are anxious about the Republicans’ agenda.
“This is a proposal by Congress that’s going to throw people back onto the safety net. And the safety net includes us,” said Cheryl Zoll, CEO of the community organization Tapestry Health.
Under the Affordable Care Act, the federal government provides subsidies to Americans making up to four times the poverty-level income. With the newly floated Republican plan, however, that money would be replaced by tax credits, based not on income, but on age.
Zoll said that just won’t work for Tapestry’s clients.
“The cost of insurance is going to rise and the tax credits aren’t going to be sufficient, especially for the low-income people we serve,” Zoll said. “About half the people we see, we’re the only care they get.”
Zoll is also concerned that providing a capped amount of Medicaid funding could leave the state unable to deal with a major health crisis should it arise.
But Zoll, Keroack and Marqusee all noted that the plan has a long way to go before it becomes law, and that many things could change before then. Zoll herself was on her way to Washington to lobby for a separate issue, but said she would now also be pushing back against the American Healthcare Act.The elderly
Sitting in the common area at the Northampton Senior Center on Wednesday was 66-year-old John Riley of Florence, a flat cap covering his head and a newspaper occupying both his hands.
“I think seniors are generally on a fixed income,” he said, taking a break from his reading to express his disappointments with the new Republican proposal. “We don’t have room to have new expenses thrown in there. We’re budgeting pretty tightly already.”
In the center’s games room, 74-year-old Fred Shea put it another way.
“It sucks!” he said during a relaxed game of pool with friends. “It’s just too expensive.”
It’s for that reason that the American Healthcare Act has drawn condemnation from the AARP over the potential effects it would have on the country’s seniors.
“This bill would weaken Medicare’s fiscal sustainability, dramatically increase health care costs for Americans aged 50-64, and put at risk the health care of millions of children and adults with disabilities, and poor seniors who depend on the Medicaid program for long-term services and supports and other benefits,” the advocacy group for seniors said in a statement signed by Senior Vice President Joyce Rogers.
University of Massachusetts Amherst economics professor Gerald Friedman agrees, especially considering the fact that the new law would allow insurers to charge older Americans five times more than they charge younger customers.
“The tax credits are too low for low- and middle-income people, especially the elderly, to buy insurance,” he said.
It’s those issues that had some at the Northampton Senior Center uneasy. For John Chmura, 65, the tax credits create confusion and uncertainty.
“I don’t know how that tax credit is going to work,” he said before heading into the center’s workout room. “We don’t know what the hell we’re going to do.”
Chmura said he liked when Massachusetts established its own health care reform law under then-Gov. Mitt Romney, which provided coverage to almost all of the state’s residents. But that law has not been folded into the Affordable Care Act in many ways, and it is unclear to what extent the state would be able to return to the system it had pre-Obamacare.Businesses
Another aspect of the Affordable Care Act that would be changed under the new health care plan is the federal “employer mandate,” which requires companies with more than 50 full-time employees to provide them with health coverage.
Republicans and other critics of the ACA have denounced the employer mandate as an undue burden on small businesses struggling to make a profit. White House Press Secretary Sean Spicer said Monday that the Affordable Care Act has lead to “skyrocketing costs that are crushing small business.”
Repeal of the employer mandate “is going to lead to lots of companies dropping health insurance coverage for their employees,” said Friedman, the UMass Amherst economics professor.
But some even smaller Pioneer Valley employers, who began covering their employees when Massachusetts mandated they do so in 2006, said they have no intention of dropping their employees’ health coverage. That is despite the fact that the state’s employer mandate was repealed in 2013 to make way for the federal mandate.
“I won’t kick off anybody,” said Jim Greco, owner of Northampton’s Bluebonnet Diner, who said he has around 25 full-time employees. But covering half of his employees’ insurance premiums is expensive, and he said any plan that would lower both his and his employees’ costs would be welcome.
“I’m cautiously optimistic,” the 57-year-old said of the new plan. “If it does reduce the cost of health insurance, I would like that, but that remains to be seen.”
Joe Ryan, 64, owns Ryan Imported Car Repair in Northampton, and said he has long provided health care for his employees. Standing behind his desk, the smell of oil thick in the air, he said not helping to pay for employees’ health care is something big businesses are more likely to do.
“I provide health insurance for my employees as a benefit because everybody’s got to have health insurance,” he said. “I’m a little business guy.”
“It’s more of a moral mandate that people have coverage for me,” he said.
Dusty Christensen can be reached at email@example.com.