|The Health Care Plan Pennsylvanians Want
This month President Trump and Republicans in Congress began their effort to repeal and potentially replace the Affordable Care Act. Although many Pennsylvanians support Donald Trump — people who are enrolled in marketplace coverage or Medicaid coverage created by the law— the repeal fervor in Washington seems disconnected from the concerns of working people.
This disconnect was reinforced for me when I read a summary
of the Kaiser Family Foundation’s two focus groups in Pennsylvania: one with Trump voters enrolled in the Affordable Care Act marketplaces, and one with Trump voters receiving Medicaid. The sessions, with 8 to 10 men and women each, were held in late December 2016 in Cumberland County PA. Though the participants did not agree on everything, they expressed remarkably similar opinions on many health care questions:
- They were not, by and large, angry about their health care; they were simply afraid they would be unable to afford coverage for themselves and their families. They trusted Mr. Trump to do the right thing but were quick to say that they didn’t really know what he would do, and were worried about what would come next.
- They spoke anxiously about rising premiums, deductibles, copays and drug costs. They were especially upset by surprise bills for services they believed were covered. They said their coverage was hopelessly complex. Those with marketplace insurance — for which they were eligible for subsidies — saw Medicaid as a much better deal than their insurance and were resentful that people with incomes lower than theirs could get it. They expressed animosity for drug and insurance companies, and sounded as much like Bernie Sanders supporters as Trump voters.
When asked about policies found in several Republican plans to replace the Affordable Care Act — including a tax credit to help defray the cost of premiums, a tax-preferred savings account and a large deductible typical of catastrophic coverage — several of these Trump voters recoiled, calling such proposals “not insurance at all.” One of those plans has been proposed by Representative Tom Price, Mr. Trump’s nominee to be secretary of Health and Human Services. These voters said they did not understand health savings accounts and displayed skepticism about the concept.
Obamacare has disappointed some of these voters — people of modest means — but they could be even more disappointed by Republican alternatives to replace it. They have no strong ideological views about repealing and replacing the Affordable Care Act, or future directions for health policy. What they want are pragmatic solutions to their insurance problems.
People’s health is at stake. Lives are on the line. The 1.1 million Pennsylvanians who gained health insurance through the ACA — 400,000 with Marketplace coverage and 700,000 through Medicaid — will lose without a comparable replacement.
In the weeks and months ahead PHLP will keep readers informed as repeal and replacement plans become real. We’ll highlight disconnects such as HHS nominee Price’s who repeatedly (and falsely
) stated during his confirmation hearing this month that Medicaid beneficiaries have health care coverage on paper only, and lack access to quality care. And PHLP will identify opportunities for readers to contact federal policymakers and influence their decisions.