Frederick County health insurance coverage

A federal Republican bill to repeal and replace Obamacare was introduced on Monday, but the future of health care remains unclear, local doctors and medical experts say.

“The fight starts now,” said Dr. John Vitarello, a cardiologist in Frederick. “And I hope there’s some maturity in this, because at the end of the day, it’s the patients that will suffer.”

The new bill, titled the American Health Care Act, fulfills a Republican promise to repeal the Affordable Care Act, known as Obamacare.

Since the ACA was signed in 2010, Democratic and Republican lawmakers have clashed. The law has weathered filibusters, Supreme Court challenges, and more than 50 repeal efforts in the U.S. House and Senate.

The American Health Care Act differs from the ACA in several key ways. Most significantly, it removes the individual mandate — a requirement that people who can afford it have health insurance, or pay a monthly tax as penalty.

It also changes how subsidies are distributed to health care purchasers. Under the ACA, tax credits are distributed based on income and the cost of health care plans where an individual lives.

Under the proposed Republican plan, tax credits would be fixed and based on age. A buyer younger than 30 would get a $2,000 tax credit, with increases per decade of age. Buyers older than 60 would get $4,000.

Some Frederick County doctors support removing the individual mandate, citing higher insurance prices some consumers experienced under the ACA.

“What’s happening with the individual mandate is, the deductible is so high, individuals avoid going to the doctor for anything,” said Dr. Julio Menocal, a family medicine doctor in west Frederick.

Vitarello agreed that rising prices hurt private-sector consumers whose insurance costs weren’t offset by subsidies, largely based on income. He said Obamacare became more problematic after three major health care companies pulled out of the government exchange, limiting options.

“Our prices doubled, but now these three major carriers are gone,” he said. “So, Obamacare is like having an airline ticket while there’s no plane, and the airline no longer exists.”

At the same time, he said, removing the individual mandate could cause problems later.

“I don’t think that’s wise because to keep costs down, you need healthy, young people to be in it,” Vitarello said. “They’re not going to be contributing a lot to the cost of health care because they’re not going to get a bypass, they’re not going to get a pacemaker and they’re going to be pretty much low spenders.”

The proposed bill includes a “continuous coverage incentive,” letting insurers charge customers a 30 percent surcharge if coverage lapsed for 63 days or more.

Critics say that’s not enough to pressure younger, healthier people to buy insurance. Otherwise, premiums will rise for older or sicker individuals.

“I’m not quite sure how that formula is going to work for them,” said Dr. Barbara Brookmyer, the health officer for Frederick County. “I would expect many who are healthy would choose not to have insurance, because we can’t predict today whether we’ll get in a car crash or be diagnosed with cancer.”

Impact on
Frederick County

Under ACA rules, providers cannot charge older customers more than three times what they charge young adults. But under the American Health Care Act, insurers could charge up to five times as much.

According to Brookmyer, that change could have a big impact on Frederick County residents, a large number of whom are senior citizens.

“Even when people qualify for Medicare, sometimes they only get entitlements for the hospitalization part of care,” Brookmyer said. “So, whatever care they get out of the hospital, they have to pay for that. And if it’s up to five times [as much], it’s going to make it really unaffordable.”

Rich McQuarrie, a physical therapist who co-owns a Braddock Heights outpatient physical therapy clinic, called the change an unfair punishment for older consumers.

“To get penalized for living is a problem,” he said.

Brookmyer expressed concern that higher premiums — which she expects under the Republican health care proposal — would exacerbate the high cost of living in Frederick County. A 2014 report from the United Way of Central Maryland found that a single adult in the county needs to make $31,536 a year to afford bare necessities.

Data from the Maryland Health Care Commission suggest that government tax credits under the GOP plan might not fully cover health care costs for Frederick County residents, or Marylanders in general.

In 2012, Maryland residents spent an average of $8,397 per capita on personal health care, including hospital stays, prescription drugs and doctor’s visits.

The ACA’s sliding scale sometimes offset those costs for lower earners. Under Obamacare, a 60-year-old in Frederick earning $20,000 annually would get an $8,800 tax credit, according to an analysis published Tuesday by Kaiser Health News. The same 60-year-old would be capped at $4,000 under the GOP plan.

However, unlike the ACA, the new proposal would let higher earners qualify for tax credits.

A 27-year-old in Frederick making $50,000 could get a $2,000 tax credit under the Republican plan, but not under Obamacare.

What’s fair?

Most doctors didn’t expect their patients to be affected by the new plan, based on Monday’s draft.

McQuarrie, who primarily treats middle-aged and older adults, said most of his patients are middle class and might benefit from reduced costs or higher tax credits under the GOP proposal.

Menocal didn’t anticipate major changes. While Medicaid patients make up about 70 percent of his practice, he said, the proposal likely wouldn’t affect them, even though it will gradually roll back expansion to the Medicaid program.

Under the new plan, states that expand Medicaid would get the same levels of federal funding until 2020. Funding would be reduced for people who left the program, then re-enrolled, or who became eligible in 2020.

The proposed bill would place new limits on Medicaid. The plan suggests capping federal funding levels based on how much each state spent per enrollee in 2016.

About 25.8 percent of Frederick County residents, or 62,715 people, were insured through public coverage, including Medicare and Medicaid, as of 2015, according to U.S. Census Bureau estimates. In 2010, 18.8 percent of the county’s residents were insured through public coverage.

While Brookmyer said there was a reasonable basis for the federal government to limit Medicaid spending, it could hurt states later, especially if health care costs rise past 2016 levels.

“It’s saying, ‘Well, we’ll give you so much per person and you’ll have to make it work,’” she said. “The concern is that the per-capita rate they select is not the one that will cover both preventive care and more critical conditions.”

Vitarello was concerned that Medicaid benefits could gradually decrease if state lawmakers do not prioritize the program. But overall, he supported the new GOP plan, citing aspects of the ACA that he felt placed an unjust burden on patients.

He and Menocal opposed the individual mandate, which forced health care buyers to subsidize services they didn’t need.

“You can’t require a 60-year-old man to be paying for coverage for a well woman exam,” Menocal said.

“Under Obamacare, you had people who were 62 years years old and they had to pay for maternity care or contraception. Meanwhile, well, my wife’s been dead for four years," Vitarello said, referring to a hypothetical situation. "I don’t have any need for maternity care or contraception. Why am I paying this? Well, it’s being done to offset the costs for young females.”

Critics argue that the new plan will push up premiums and hurt lower income consumers. But Vitarello said he would rather have tax subsidies that let patients pay for an affordable product, rather than a health care plan that forces heavily subsidized insurance.

Premiums under Obamacare rose substantially from 2014 to 2017, though 84 percent of consumers received financial subsidies to offset those costs, according to the Department of Health and Human Services.

The increases largely affected remaining consumers and those who bought insurance directly, rather than getting it through employers or the government.

Under the proposed GOP plan, insurers can’t reject or charge more to people with existing medical problems. It also lets young adults stay on their parents’ insurance plans until they turn 26.

Despite those assurances, the Maryland Hospital Association and several national health groups oppose the bill.

“Without estimates from the Congressional Budget Office of the impact on the federal budget or, more important, the impact on the number of Marylanders with health care coverage, we, along with the rest of the nation’s hospitals, must oppose the bill,” MHA President Carmela Coyle wrote in an email.”

The Associated Press contributed to this story.

Follow Kate Masters on Twitter @kamamasters.

Kate Masters is the features and food reporter for The Frederick News-Post. She can be reached at kmasters@newspost.com.

Nancy Lavin covers social services, demographics and religion for The Frederick News-Post.

(23) comments

tonyc51

There is little doubt that more people had insurance (cards) after the ACA, but the truth is that when you consider the high deductible (as well as the continuing escalation in premiums), many had coverage not much different than a catastrophic policy before the ACA. Whether the republican plan will be better or worse time will tell, but the ACA was not the panacea that too many people think it was.

DickD

Most of us are not affected whether they pass the bill or not. But there are 20 million that would be affected and most of them voted for Trump. West Virginia is probably the best example of this. "Ignorance is bliss."

Brookhawk

Wait a minute, Dr. V. Many people paying into the money pool is what insurance is. I pay into an auto insurance even though I have no accidents so that the people who have accidents will pay into it so money will be there for me IF I have an accident. Similarly, I pay into the pool for a young woman's wellness care (even though I am not of childbearing age) so that she will pay into the pool for my bypass surgery. What's wrong with our healthcare insurance industry is that people don't remember what insurance really is about.

hayduke2

Yes, which is why I have never understood the outrage over the mandate to have coverage. It works with other insurance plans ( auto, homeowners, etc. ) so what makes healthcare different?

mrnatural1

Very good point hayduke.

I've never heard an explanation for why gubmint mandated auto insurance is A-OK, but requiring people to have health insurance is not.

The idea behind both is the same -- and one that conservatives like: personal responsibility. Everyone should pay their own way. If they are wealthy enough to post a bond for millions of dollars to cover worst case auto accident liability as well as any conceivable medical procedure they might require, then they do not need to purchase insurance. The rest of us however do need insurance coverage.

A person who intentionally does not buy health insurance is freeloading -- knowingly forcing others to pay their medical bills.

That's why it is critical that we have a mandate to have coverage.

elymus43

It would go over better if the Congress and Senate members would into the plan??

gary4books

I think we will have to wait for the final law to see what they have hidden in the fine print. Then we will know.

DickD

For me this boils down to what you consider right and how you choose to view it. First, look at money as a rationing system, the more money the more goods and services you can obtain. So, whether you consider the current Republican Obama Care replacement good or bad, it is a rationing system and it will lower the amount of medical allowances for those that need it.

Now, look at it from an ethical and moral perspective. Do we owe others medical care and what do our religious beliefs teach us. Even if you are not religious, how much compassion do you have for your fellowman? The answer to that is up to you, for me, I think we do owe some treatment; how can you stand by and let someone die, when treatment would save them. The choice is yours.

Cost is another consideration and Obama Care has driven up costs. The problem is the new plan will also drive up costs, even though it will not cover all medical cost. So, hospitals and doctors will try to recover costs that the uninsured incur by charging those with medical care more, (There are hidden costs to this plan.)

What is the answer to get good medical care? The obvious answer seems to be a one payer system where all are covered and costs are contained. Contained for doctors, hospitals and drug companies (throw in ambulance service too.) Negotiating nationally it should be possible to drive down prices for all, but it is no panacea because there are always ways to skirt rules, regulations and laws.

mrnatural1

Well said Dick. [thumbup][thumbup]

DickD

It just bothers me that Obama Care will be scuttled, even though it would cut taxes for some and I do not personally use it. And the ones that it would cut taxes for are the wealthy.

jth7100

Insurance works by dividing the risk in a population over the greatest number of potential claims in that population. Whether you like that or not, it is math. Granted, it would be convenient to know that you will never have a heart attack or a brain tumor and then you could simply decline those benefits. So men must pay into insurance for Pap smears and women have to pay for testicular cancer and thin people have to help cover overweight people. Don't ask doctors how insurance works beyond how it affects their bottom line.

mrnatural1

Testify jth!

Absolutely correct. For a man (a medical doctor no less) to complain that he must pay -- indirectly, through his insurance coverage -- for services specific to a young woman is just, well, stupid.

As you pointed out, the reason insurance exists is to spread the risk and costs among a large group of people. So we all end up paying for some procedures & services we'll never need -- and others pay for something that benefits us and not them.

There are some cases where it is appropriate for people to be 'singled out' for higher or lower insurance rates -- auto insurance comes to mind -- but those are almost all situations where the insured has control over the risk factors.

elymus43

The House and Senate needs to start from the beginning and make a total new health plan. Let people who smoke, drink, take drugs, and are over weight pay more money for their insurance. Put a TAX on fast food and all unhealthy snacks. People need to write or contact their senators and congressmen, then things will change.

DickD

What you state will hasten the inevitable end, but all humans have an end. Actually, the ones that pass on sooner might cost those left less money.

mrnatural1


The justification for the "sin taxes" on tobacco and alcohol is that there is a large cost to society from the use of those (legal) products.

Fair enough, assuming the additional taxes are just enough to cover those related expenses, and not excessive and used for other purposes.

However, obesity-related illness and disease is the leading cause of death -- above tobacco and alcohol related causes.

We know that soft drinks, 'junk food', and most fast food causes obesity. Therefore, it is logical and appropriate to tax those "food" items.

Dwasserba

"Under ACA rules, providers cannot charge older customers more than three times what they charge young adults. But under the American Health Care Act, insurers could charge up to five times as much." And no comments here yet.

N928J

Congrats "45" supporters, you played yourself.

hayduke2

This proposed health care plan would do nothing to improve health care and would, it appears, punish those who are older and on fixed incomes. The real problem is the health insurance industry who looks to always increase the bottom line and has greed as their sole goal. Make a reasonable profit, sure but do not take advantage of your clients.

wind chaser

[thumbup]

mrnatural1

Exactly. In fact, I would go further and say that there are some things -- like health insurance -- that should not be "for profit".

I do not want to have to worry whether my insurance company is more concerned about their share price than my wife's health.

Education; parks; roads/tunnels/bridges; libraries; emergency services; water & sewer; and health care are things that we need as a society. They are all best provided by the government -- which of course is already the case with Medicare; Medicaid; and VA benefits.

Regulated capitalism works well for almost everything else.

DickD

"Medicare; Medicaid; and VA benefits." Medicare and Medicaid are insurance plans, VA benefits are more as they include actual health care with doctors and nurses, besides all of the other aspects, such as mortgages.

DickD

The problem we always have, Hay, is what is a reasonable profit. Can you define reasonable, other than say what most people would expect to pay for it? Would that be 10%, 20%, 30%, etc.? And if you did, there are ways to cheat on that too, just look at the old Bell System monopoly. Not that the government is any panacea either, as they will find ways to make kingdoms for their management teams.

DickD

Define older, Debbie. Not many older people would be interested, as after 65 you are on Medicare.

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