Guest Blog Post: An Extra ‘H’ Changes A Lot: How the AHCA Can Affect Colorado, With a Spotlight on Rural Counties

This is a guest blog post from the Colorado Consumer Health Initiative. 
It gives a thorough analysis of how the current proposals to repeal and 
replace the Affordable Health Care Act will affect Colorado. Access to 
affordable health care is one of the CCC's public policy priority.

An Extra ‘H’ Changes A Lot: How the AHCA Can Affect Colorado, With a Spotlight on Rural Counties

by Emily Michels, Policy Analyst, Colorado Consumer Health Initiative

Popular things in the ‘90s: Tamagotchies, inflatable furniture, and Britney Spears.

Popular things in the ‘00s: Razor scooters, Fallout Boy, and trucker hats.

Popular things in the ‘10s: Veganism, virtual reality, and…stripping millions of people of their health care?

One of these things is not like the others. 2017 brought us the American Health Care Act (AHCA), a fad that unfortunately will have much longer lasting effects than the rest of these on the list (trucker hats were pretty bad though). The AHCA was introduced to the House of Representatives and passed on May 4thwith a vote of 217 – 213. The bill changes things like the Medicaid funding structure, tax credits for private insurance, protections for people with pre-existing conditions, and gives a big tax cut to millionaires, and according to the Congressional Budget Office (CBO) this bill would cost 23 million people their health care if it becomes law. For more detail on which elements of the Affordable Care Act (ACA) stay or go, check out our brief. 

While the effects of the AHCA could be detrimental to people all over the country, it will affect different states in different ways. What we’ve set out to do here is show Coloradans how it could impact your lives, and the lives of those around you – especially rural Coloradans.

The New Health Care Proposal In General

Almost 600,000 Coloradans gained coverage as a result of the ACA – the current proposal would have disastrous impacts on both Medicaid and private health insurance coverage for these people. Some key components of the AHCA are:

  1. Modify the ACA income and regionally based premium tax credits to a flat tax credit adjusted only for age, and that provides less help to people in high-cost regions (and less help for lower-income people).
  2. Cut federal funding for the Medicaid program through a per capita cap.
  3. Allow states that use Patient Stability Funds for high-risk pools or reinsurance programs to waive the ACA community rating requirements for those applicants who have not maintained continuous coverage. This means insurance companies could again charge people with pre-existing conditions more for health insurance, and likely price most of them out of the market
  4. Phase out the enhanced match for Medicaid expansion beginning in 2020, with rapid funding and coverage losses through 2022 and the expansion ending completely in 2024.

Kaiser Family Foundation estimated that, pre-ACA, 22% of non-elderly Colorado adults, or 753,000 individuals, had a pre-existing condition. In the past, pre-existing conditions have included rheumatoid arthritis, heart disease, and diabetes. Under this proposed plan, states could waive the community rating provision, therefore allowing insurers to charge sicker people higher premiums.

The AHCA would also move Colorado backwards from the huge gains we’ve made in reducing the number of people without insurance. Currently we have an uninsured rate of 6.7% – under this new health care system that is bound to skyrocket back to numbers we haven’t seen in years.

Rural Colorado

Colorado has 17 urban counties, 24 rural counties, and 23 frontier counties (see Figure 1), based on the Colorado Rural Health Center 2014 county designations. These rural and frontier counties have the potential to be disproportionately affected by the implementation of the AHCA – many already have few choices of carriers or expensive health premiums,. Medicaid covers 182,000 individualsin rural Colorado, or approximately 26% of the rural population. According to a recent Center on Budget and Policy Priorities (CBPP) report, roughly 21% of Coloradans who have gained coverage as a result of Medicaid expansion live in rural communities.

We looked at 4 different areas of the state (so far!) – Northeast Colorado, Southeast Colorado, San Luis Valley, and Pueblo County – to get a snapshot of the health care landscape and what may be to come.

Northeast Colorado – Logan, Morgan, Phillips, Sedgwick, Washington and Yuma Counties (full brief attached)

In Phillips County, 30.5% of the population has arthritis; 11.14% of Washington County has heart disease; and 10.5% of Logan County’s population has diabetes, and therefore rely on guaranteed access to coverage and the community ratings protections for their health conditions.

Medicaid enrollment is approximately 26.3%.  On a county specific basis, Medicaid enrollment ranges from 22.3% in Logan County to 30.9% in Sedgwick County.

Private insurance enrollment through the marketplace ranges from 1.7% in Morgan County to 4.8% in Yuma County. Those on private insurance could experience anything from a modest decline of a $47.00 lower monthly premium for a 45-year-old receiving tax credits to a $721.75 monthly increase for a 60-year-old under 150% FPL (less than $18,000/year).

Southeast Colorado – Baca, Bent, Crowley, Huerfano, Kiowa, Las Animas, Otero, and Prowers Counties (full brief attached)

In Huerfano County, 41.9% of the population has arthritis; 12.7% of Bent County has heart disease; and 21.2% of Prowers County’s population has diabetes.

Medicaid covers approximately 39.4% of the population.  On a county specific basis, Medicaid enrollment ranges from 26.8% in Crowley County to 44.1% in Huerfano County.

Private insurance enrollment through the marketplace ranges from 1.2% in Crowley County to 4.6% in Baca County. Those on private insurance could experience anything from a 26% ($1,070) decline in annual premiums after tax credits for a 40-year-old making $40,000/year to a 1273% ($12,200) increase in yearly premiums for a 60-year-old making $20,000/year.

San Luis Valley – Alamosa, Conejos, Costilla, Rio Grande, and Saguache Counties (full brief attached)

In Costilla County, 41.0% of the population has arthritis; 3.1% of Rio Grande County has heart disease, and 18.4% of Saguache County’s population has diabetes.

Medicaid covers approximately 45% of the population.  On a county specific basis, Medicaid enrollment ranges from 42.6% in Rio Grande County to a whopping 56.2% in Costilla County.

Private insurance enrollment ranges from 2.0% in Alamosa County to 3.8% in Saguache County. Those on private insurance could experience the same changes in premiums as people who live in the Northeast corner of Colorado.

Pueblo County – Pueblo    (full brief attached)     

In Pueblo County, 32.6% of the population has arthritis; 4.8% have heart disease; and 13.6% of the population has diabetes.

The percentage of the population covered by Medicaid is 41.4%. Private insurance enrollment is 1.5%. Those on private insurance could experience anything from a 46% ($1,860) decrease in yearly premiums for a 40-year-old making $40,000/year to a 1038% ($9,940) increase for a 60-year-old making $20,000/year.

Changes to Health Care and the Colorado Economy

Colorado’s economy has its ups and downs – literally – but the changes proposed at the federal level would be like attaching an anchor to a rubber ducky. Aside from affecting Coloradans’ personal finances by driving up premium prices and cutting Medicaid benefits, it would impact the workforce, large health systems, and small businesses, to name a few.

  • Community Health Centers (CHCs) would close. The AHCA, in combination with other budget changes, would mean a significant reduction in CHC funding and could result in a loss of 1,530 jobs and 67 clinic closures, leaving 62,000 patients without access to care.
  • Hospitals, especially rural ones, would experience cuts, which would trickle down to employees. 1 in 16 jobs in all of Colorado is in the health care sector, and hospitals employ over 75,500 people, generating 183,961 jobs around Colorado. 33,500 jobs have been created in rural Colorado for health care and social services and rural hospitals contribute $2.9 billion to local economic activity.
  • Home health services would be cut and affect Colorado families. The Center for Consumer Engagement in Health Innovation and LeadingAge project from 4,529 to 10,567 home health and personal aide jobs lost in Colorado due to Medicaid home and community based services recipient cuts. Families with elderly or disabled relatives may have to leave the workforce to care for these people, or pay out of pocket for expensive private home care.
  • Small businesses would suffer. John Arensmeyer, the CEO of Small Business Majority, noted that “the AHCA would be a disaster for small businesses because it would destabilize the health insurance market, cause premiums to skyrocket and leave millions of people with pre-existing conditions unable to afford coverage.”

When we look at a rural area like Northeast Colorado, we see the real implications of a repeal of the Affordable Care Act. Health and wellness is the 3rd key employment industry in the area, providing 3,200 jobs. There are 3 hospitals, 6 critical access facilities, and 140 health and wellness establishments that contribute to this job count. In Northeast Colorado alone, a financial model by the Colorado Fiscal Institute that looks at a full (and immediate) repeal of the ACA predicts a loss of 277 jobs, over $10 million in wages, over $12 million in GDP, and over $14 million in production. That’s huge.

Bottom Line

Colorado, and the rest of the country, will suffer if the American Health Care Act passes through Congress. Not only will consumers be at risk for higher premiums, denials based on pre-existing conditions, and a loss of public coverage, the state’s economy and workforce would be slashed. We’re calling on you to take action:

  • Call Senator Gardner! We need everyone that can to be calling his offices on a daily basis. The call volume has died off since the House passed the American Health Care Act, and if we have any hope of stopping this bill, we need that to change and fast! Denver: (303) 391-5777                DC: (202) 224-5941
  • Help us line up spokespeople for these “line up” events at Gardner’s offices. We are organizing a “walk in” action at Senator Cory Gardner’s offices throughout the state on June 22nd. We are asking people to sign up for a designated time-slot on that day to come and walk into Sen. Cory Gardner’s office and deliver a letter or statement opposing the repeal of the Affordable Care Act. Sign up for events here! 
  • Speak up and out. Educate your friends, family, and neighbors about how the AHCA could affect all of them and the rest of Colorado. Keep the conversation alive!

The introduction of the Senate’s version of the AHCA, and a vote on this bill, is expected to happen during the week of June 26th, so this destructive action is on the fast track. We’re counting on consumers and advocates around the country to help us stop it.

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