CHARLESTON, W.Va. — Health and Human Services Secretary Sylvia Mathews Burwell returned to her native West Virginia to extol the virtues of several aspects of the Affordable Care Act just ahead of an incoming administration that has vowed to repeal it.
Burwell, a Hinton native, spoke before a crowd at The University of Charleston’s Erma Byrd Gallery. She sat alongside fellow West Virginians who told stories of how the Affordable Care Act has affected their lives — because they have pre-existing conditions, because they were students able to stay on their parents insurance or because they are medical professionals seeing a shift from emergency room care to preventative treatment.
“This isn’t a conversation about a word — Obamacare — it’s a conversation about people’s lives,” Burwell said in her introductory remarks.
She urged people to use the hashtag #CoverageMatters on social media, saying that would be a place where people could come and tell their stories of being insured “so that when this conversation starts in January about what to do that the conversation is informed by reality.”
Throughout election season, President-elect Donald Trump vowed to repeal the Affordable Care Act. Republican majorities in both houses of Congress will make that easier. Vice President-elect Mike Pence went on Sunday news shows and said doing so would be a priority right “out of the gate.”
A repeal could be a challenge, though, because the system is complicated. Popular aspects like continued coverage for pre-existing conditions or allowing people under the age of 26 to stay on their parents’ health insurance depend on enough relatively healthy people being in the insurance pool to keep costs relatively level.
Those were some of the aspects of Affordable Health Care that Burwell and her guests spoke about Tuesday in Charleston:
Pre-existing conditions
Kelly Allen, who lives in Morgantown, has her health insurance through her employer. She said she has an immunodeficiency disorder and has been on medication since 2005.
“The Affordable Care Act affects me very much,” Allen said. “I don’t want to go back to the way it was before the Affordable Care Act.”
Burwell said federal health officials are happy to hear people value that part of the law. But she said it only works if there are enough healthy people in the insurance pool to spread the cost.
“We share risk,” she said. “We pool risk.”
She said now is the time for a realistic conversation about that.
“You have everybody in or create a very heavy penalty,” Burwell said.
Staying on parents’ insurance
Another speaker, Nicole Green of Charleston, was a college student who wanted to take some time off to pursue a few challenges. She wound up competing and winning the Miss West Virginia pageant.
Taking chances was easier because she was able to stay on her parents’ health insurance, Green said.
“I was able to pursue my dreams without worrying about health insurance,” she said.
“A 23-, 24-, 25-year-old kid doesn’t need to have fear of what am I going to do if I don’t have health insurance.”
Burwell said parents and their children across the country have considered this piece of the Affordable Care Act important. But she said it pulls an important group out of the risk pool. Burwell compared that to a game of Jenga.
“When you pull out a key piece the whole thing is going to tumble.”
Medicaid expansion
Allen Kennedy, who described himself as a small business owner who does home repair and remodel projects, said he went for years without health insurance and just avoided going to the doctor. But when he turned 60, he thought he should finally be insured and discovered he qualified for Medicaid.
Soon after that, he was diagnosed with cataracts and had surgery.
“If I didn’t have insurance I wouldn’t have gotten anything done,” Kennedy said.
Burwell said Medicaid expansion is likely to be a hot topic for states that opted in. “We’re probably going to have a big conversation about Medicaid.”
Preventative medicine
Sarah Chouinard, medical director of Community Care of West Virginia, said everyone on the panel was someone who could be a patient at her organization. She said the medical system until now has been based on a pay-for-service model without much attention being paid to outcomes.
That’s changing, she said, as health providers are better able to track patients.
“How do we improve the quality of care and also keep the costs down,” she said. “It’s hard to improve the quality of care if patients don’t come in the first place. It’s about getting a handle on our population.”
Rocco Massey, community chief executive officer at Beckley Appalachian Regional Hospital, said the hospital is experiencing fewer patients who are uninsured, which is keeping people out of emergency rooms and driving costs of care down.
“The cost of health care is coming down because of the Affordable Care Act,” Massey said. “Our emergency room visits are declining. People are being taken care of in the clinic rather than emergency rooms.”
Burwell said such stories should be valuable to the incoming presidential administration, Congress and the public as changes to the Affordable Care Act are debated.
“This isn’t a slogan,” she said. “This is real people’s lives. What will changes do to access? We should know what it will do in terms of quality and affordability. If there’s a plan or an approach, let’s take a look at it.”