For East Hampton resident Maude Muto, living with chronic Lyme disease has taken both a physical and a financial toll.
Each month, she spends about $1,000 out of pocket on doctor visits, tests, acupuncture, supplements and other treatments that are typically not covered by her health insurance. She is quick to note, however, that without coverage provided through the Affordable Care Act, or ACA, her expenses would be much higher.
“I was out of work for six months—I couldn’t work,” said Ms. Muto, who is now employed at a local nonprofit that she declined to identify. “I can’t tell you how many blood tests I’ve had. I can’t imagine what it would have been like the past year and a half to not have any coverage.”
Ms. Muto and her family—which includes her husband, Richard Cangiolosi, an independent contractor, and their two daughters, Molly, 14, and Christina, 20—are among the roughly 939,000 New Yorkers who have gained health insurance coverage with the 2010 passage of the ACA, according to the U.S. Department of Health and Human Services. Additionally, millions more New Yorkers with employer, Medicaid, individual market or Medicare coverage have also benefited from new protections as a result of the law.
Now they also are among those who are worried about what will happen if President-elect Donald Trump, and the Republicans in Congress who have targeted the national healthcare program since its inception, follow through on a promise to repeal the ACA, commonly referred to as “Obamacare,” as it was the brainchild of President Barack Obama.
The more than 1,000-page package of legislation was intended to reform the country’s health insurance and health care systems, with the goal of providing affordable coverage to millions of uninsured Americans. But opponents of the law dislike the mandated coverage, explaining that it often means higher insurance costs for business owners and elevated premiums for those who have coverage on their own.
Earlier this month, Governor Andrew Cuomo shared the potential effects of an outright repeal of Obamacare, estimating that some 2.7 million New Yorkers would no longer have coverage in such a scenario. He also estimated that the state would lose almost $600 million in federal funding if the ACA is gutted, while also noting that the program accounts for some $3.7 billion of the annual state budget.
Locally, Mr. Cuomo said that 152,631 people living in Suffolk County would be at risk of losing their health insurance, while the county government would lose more than $18.3 million in annual funding.
Republican U.S. Representative Lee Zeldin, a vocal opponent of the ACA who supports a Republican plan to “repeal and replace,” in a prepared statement took issue with the Democratic governor’s words, calling his figures “half-baked” and designed to “scare people about a particular course of action that is divorced from reality.”
He continued: “The governor’s press release fails to state absolutely any acknowledgment whatsoever that the Affordable Care Act, otherwise known as Obamacare, is flawed. Nothing at all is included about any of the lost doctors, canceled policies, higher premiums or higher deductibles that New Yorkers are now facing.”
Wednesday morning, Mr. Zeldin expanded on those thoughts, noting that while Long Islanders have ranging opinions on Obamacare, high deductibles and premiums, as well as high levels of Medicaid spending and instances of malpractice, have made for a unique local situation.
“I’m very well aware of the range that exists out there, but many of the promises that were made—to keep your plan, your doctor, to have relief in the cost of premiums—just aren’t true,” Mr. Zeldin said.
He noted that he believes it is important to have a smooth transition to replace the ACA to mitigate any possible negative impacts on patients—but it’s a transition, he said, that the country should expect sooner rather than later.
“The policy is going to be finalized, in many respects, very soon, over the course of literally the first 100 days or so of the president’s new administration,” he said. “We’ll start to see new legislation passed and regulations start to be modified.
“There’s certainly a reality of immediate action coming over the course of the next few weeks and months,” the congressman continued. “But no matter what gets done, there’ll always be room for conversation on how to improve health care in America.”
Mr. Zeldin noted that popular elements of Obamacare, such as guaranteeing coverage for Americans with pre-existing conditions and allowing children to stay on a parent’s policy till age 26, have strong bipartisan support. He added that he supports new additions to replaced health care legislation, such as allowing insurers to sell policies across state lines and reevaluating the scope of Medicaid costs in New York.
Southampton Hospital President and CEO Robert Chaloner predicted that if the ACA is ultimately repealed, the result will be a sharp increase in the number of uninsured people on the East End, and even more no longer qualifying for Medicaid coverage. That scenario, in turn, would most likely result in increased operational costs for the hospital, he added, as Southampton Hospital and other medical centers would most likely stop being reimbursed by the federal government for some of the services they are now providing. He also predicted increased wait times and more crowded emergency rooms, a result of projected budget restraints.
Despite the controversy surrounding Obamacare, many agree with parts of the legislation that they view as positive, such as a requirement that patients like Ms. Muto cannot be denied coverage due to preexisting medical conditions. Additionally, under the ACA, both of her daughters can stay on her plan until they turn 26.
“We are on it, and I think it’s been fantastic,” Ms. Muto said. “I don’t know what I would do if I didn’t have it. In my mind, I’m thinking that it’s not going to come to a screeching halt. I’m hoping that by ‘repeal’ they mean that within several months it’s going to taper off and they’re going to have something else in its place.”
Mr. Chaloner said he has observed a notable expansion of Medicaid offerings on the East End—namely, for those who were not previously covered—since the inception of the ACA. If a repeal does happen, he said he remains hopeful that whatever replaces it still offers coverage to those with preexisting conditions, and will provide some sort of insurance to those who are unable to secure policies through the normal channels.
Kevin Luss, founder and president of the Southampton-based Luss Group, an insurance and financial services brokerage firm, said this week that an outright repeal would have far-reaching effects on the East End, especially Southampton Town.
“I think the changes will have an impact on everybody, especially on a town like this, because we have a hospital,” he said. “I think the first thing they’re going to do is take away the individual mandate. I think that will lead to an increase in the uninsured.”
At the same time, he also points out that the ACA has resulted in higher deductibles for those who have their own medical insurance, a situation that has prompted many to support the push to repeal. “The legislation made people sicker and poorer,” he said. “People avoided seeking care even though they had insurance, because they had a high deductible.”
Even if the ACA’s days could be numbered, Mr. Luss said one of the main benefits of Obamacare is that it helped spark a national dialogue about a serious problem: ever-escalating insurance costs.
On a personal note, he said he would prefer that the program be amended rather than repealed and replaced, explaining that the latter would most likely result in mass confusion among ACA policy holders.
Others are worried about the potential economic impacts of repeal and replacement. According to a January Commonwealth Fund state-by-state breakdown focusing on a repeal of premium tax credits and medical field employment, New York State could lose 131,000 jobs in both the private and public sectors by 2019 if it happens.
At the same time, Mr. Luss said a repeal could potentially benefit those East End businesses that have seen their health insurance costs climb by double-digit percentages annually, mostly due to the fact that they must now offer coverage to their employees. “The employers around here will tell you that health insurance is their highest budget item,” he said. “To any extent we can help that cost, it’s going to help that economy. I just don’t know if savings get passed onto insurers. I do think there may be more competition, which may bring the price down.”
Locally, Mr. Chaloner said he does not anticipate having to stop any large projects, including the potential relocation of Southampton Hospital from Southampton Village to the Stony Brook Southampton campus, if the ACA is repealed and replaced. “I think that we would continue to move forward with what we’re doing,” he said. “One way or another, the system will keep going.”