The four Republicans in West Virginia’s Congressional delegation (Senator Shelley Moore Capito and Congressmen David McKinley, Alex Mooney and Evan Jenkins) have all pushed for repealing Obamacare.
House Republicans fulfilled that campaign promise last week by narrowly passing (217-213) The American Health Care Act. However, for some Republicans, the action feels like the barking dog has finally caught the car it was chasing.
For example, 3rd District Representative Jenkins clearly has reservations. “This was a tough call,” he told me on Talkline last week. “Is it a perfect solution? No,” he said. “It goes to the Senate. Work will continue. Doing nothing wasn’t an option.”
It sounds like Jenkins and a number of his fellow Republicans can scratch “Repeal Obamacare” off their To Do lists, but they are also hoping the Senate will save them from themselves. The issues are particularly sensitive in West Virginia, where the population is older, sicker and poorer.
The Medicaid Expansion program has over 170,000 West Virginians enrolled, with the federal government picking up a larger share of the cost than the typical reimbursement. However, under the Republican plan the federal government will reduce funding for expanded coverage after 2019, leading to an expected decline in coverage.
When supporters of the replacement say no one on Medicaid will lose their coverage they are technically correct. However, the system has a certain amount of churn, so as the Washington Post Fact Checker reported, “If they try to get back into the system, however, the planned reductions in funding may mean they no longer find themselves eligible for the program, or that their benefits have been scaled back.”
Also, the Kaiser Family Foundation says the AHCA allows for higher out-of-pocket costs for older people. “Generally, people who are older, lower-income, or live in high-premium areas (like Alaska and Arizona) receive less financial assistance under the AHCA,” Kaiser reports. “Additionally, older people would have higher starting premiums.”
Congressman Jenkins is correct that doing nothing was not an option because the exchanges are flawed. There simply are not enough young healthy people willing to pay skyrocketing premiums and out-of-pocket expenses to subsidize the sickest people or those with pre-existing conditions.
The alternative high-risk pool makes sense, as long as it’s fully funded. As columnist Holman Jenkins wrote in the Wall Street Journal, “By giving new options to the states, the House bill would make subsidizing pre-existing conditions a general obligation of the taxpayer as it always should have been.”
Republicans banked for years on “Repeal and replace Obamacare” as an instant applause line, but West Virginia has quickly become dependent on Obamacare to provide coverage for a large chunk of the population, and many providers prefer the known of existing law to the unknown of the legislative process.
Controlling Medicaid costs and making premiums more actuarially sound make fiscal sense, but they are going to be a hard sell in West Virginia and elsewhere. Government benefits build constituencies and expand government power. Those trends are not easily reversed.