U.S. Rep. Liz Cheney, the state’s only member of the House, voted to repeal the Affordable Care Act on Thursday, saying it would deliver on a promise to protect people with pre-existing conditions. But some Wyoming health care officials said the bill could be “devastating” and “catastrophic” for the state.
“The House of Representatives has taken an important and necessary first step in rescuing the American health care system from the destruction caused by Obamacare,” Cheney said in a statement, which described Wyoming as the state that has struggled most under the ACA.
Reached by phone after the vote, the Republican from Wilson said she also successfully co-sponsored a measure that prohibits members of Congress from being exempted from the provisions of the new health care law.
Cheney and Wyomingites involved in health care had varied opinions on the new legislation, which was narrowly adopted.
While Cheney praised its passage, Wyoming health care officials said it will hike costs for the sickest Americans while increasing the number of insured people here and across the country, which in turn will cost hospitals millions.
In a January interview with Star-Tribune journalists, Cheney said she supported a replacement to Obamacare that requires insurance companies to cover people with pre-existing conditions. Provisions around pre-existing conditions would change under the Republican law.
“Some of the things we need to make sure we still have for people are insurance for pre-existing conditions and making sure people can get access to care regardless of that,” she said at the time.
On Thursday, Cheney said that Republicans kept their promise to keep pre-existing conditions intact.
But Republicans and Democrats have opposing talking points on the pre-existing conditions portion of the bill.
Democrats say the pre-existing conditions mandate in Obamacare has been eroded in the American Health Care Act.
She said the bill was amended to provide $8 billion for federal and state high-risk insurance pools for people who wouldn’t be able to get insurance. She said that money was in addition to $138 billion that had previously been in the bill.
She said she believes the money for the high-risk pools will be sufficient. Others disagree.
Eric Boley, the executive director of the Wyoming Hospital Association, called high-risk pools “expensive and problematic.” He said there was a similar situation for sick Wyomingites before the ACA passed and that it was “unsustainable.”
Sam Shumway, the Wyoming director for AARP, said the bill would allow insurance companies to charge sicker people higher premiums, a sentiment echoed by both Boley and Vickie Diamond, the president and CEO of Wyoming Medical Center.
Shumway said older Wyomingites would be hit particularly hard by the bill. A provision in the AHCA allows insurance companies to assess premiums for older Americans that are five times higher than younger patients. That could change in the Senate, he cautioned, but it could also be “devastating.”
For people on a fixed income, he said, a premium increase could mean older people are choosing between health care and food.
“I think it’s a terrible bill,” Diamond said bluntly. “I think it’s going to increase the number of uninsured. I think it’s going to increase the cost of care for the pre-existing (condition) people and the elderly people up to 64.”
She and Boley said it’s difficult to determine the full impact of the bill because the Congressional Budget Office had not finished its assessment by the time House lawmakers voted to pass it.
Diamond said it was difficult to keep track of what was in the bill because it was amended so often to help appease different legislative factions, such as the conservative House Freedom Caucus.
“For what purpose? To say you got rid of Obamacare? Great,” she said. “But you’re not replacing it with anything better.”
According to the Washington Post, people may have a 30 percent increase in insurance rates under the American Health Care Act if they have a lapse in coverage. Also under the bill, states may allow insurance companies to consider for a year people’s health status when writing some policies.
The idea, the Post said, is that overall premiums for healthier people will lower.
Diamond agreed, saying that would the bill would likely benefit younger, healthier people.
Wyoming hospitals could be affected by the AHCA in two primary ways, Boley said. For one, if fewer people, particularly those with histories of illness, have insurance, then they may put off care until they’re seriously ill. At that point, their need may be so serious that they cannot pay their medical bills, meaning hospitals would absorb the costs.
Diamond said that “uncompensated care,” or treatment that patients cannot or will not pay for, could rise by $7 million in the next fiscal year if Trumpcare becomes law in its current form. “That’s more than our bottom line.”
Boley said that the other way the bill will affect hospitals goes back to a bargain struck between the American Hospital Association and the creators of the Affordable Care Act, Boley said. Hospitals agreed to give up $150 billion in annual Medicare and Medicaid reimbursements under the assumption that more people would be insured by the ACA. Under Trumpcare, millions could lose health insurance, so hospitals want back the money they gave up years ago.
But restoring that money was “taken off the table” in negotiations with lawmakers, he said.
“In Wyoming, that can have some catastrophic effects,” he said.
The Wyoming Medical Society declined to comment until its board could come to a consensus on the bill. Anne Ladd, the executive director of the Wyoming Business Coalition on Health, also declined to comment because she didn’t believe the bill would affect the employers she represents.