If the Supreme Court declares the Affordable Care Act unconstitutional, thousands of Tri-Citians could suddenly find themselves without health insurance when the program’s total enrollment has grown.
About 31,000 Benton and Franklin county residents had no health insurance in 2014, according to the Washington State Office of Financial Management. By 2018, that number had fallen to about 21,000.
Many of the newly insured obtained coverage through the ACA’s expansion of Medicaid, which includes people with incomes below 138 percent of the federal poverty line.
The ACA also gave people like small business owners and others who were not covered by an employer an option for insurance.
The U.S. Supreme Court heard arguments last November about the ACA’s constitutionality. The court will decide by the end of June 2021.
If the law is scrapped, more families will find it impossible to pay for insurance coverage. Others may have to pay budget-busting premiums.
Some people with no insurance may put off preventative care if they cannot afford to visit a doctor. Not treating problems like high blood pressure and diabetes will result in unnecessary suffering and more expensive care as the conditions worsen. Neglect could also be life threatening.
“They make you beg for it”
According to one local woman I call Jane to protect her privacy, “The Affordable Care Act has been a real blessing.”
Jane said that before the ACA, she had to apply for high-risk insurance because of her blood cancer. Since this type of coverage does not usually transfer from state to state, she had to reapply when she moved to Washington.
“Over the years,” she said, “based on my income, insurance premiums have gone down because of the ACA.”
Without the ACA, more patients will be forced to apply for charity to cover their hospital bills. Washington requires hospitals to offer charity care for anyone below 200 percent of the federal poverty level — about $24,000 for a single person, and around $52,000 a year for a family of four.
Two indigent patients described the difficult process.
“Dolores,” who is disabled and on assistance, said that at Walla Walla St. Mary’s Hospital, “They make you beg for it.”
“I’m on disability and have no secondary insurance and I get food assistance and housing assistance,” Dolores said. “It should be pretty clear that I am an indigent patient, and they know well ahead of the game what Medicare agrees to pay and what I will be left owing.
“I told them from the beginning that I couldn’t pay,” she said. “They let me flounder and go to collections instead of trying to work with me from the beginning.”
The state requires that the availability of payment relief be publicly displayed throughout the hospital including the places that patients check in.
Dolores said she didn’t believe that the hospital’s efforts to publicize the availability of the charity care were adequate.
It took her a year to settle her bill, about $8,000.
Another patient, “Cynthia,” had a different experience. She arrived at Kadlec after being hit by an SUV. She received $25,000, the minimum amount of liability insurance that a driver must have, so she could hire an attorney to help her negotiate the system. He worked with the surgeons and hospital to reduce the bills. To prove that she was truly indigent, her lawyer gave Kadlec a picture of his client working at her low-wage job.
“I received bills after I thought I’d received all of the charity I applied for,” Cynthia said. “My attorney’s final (donated) assistance was to successfully pressure them to reconsider.”
Even with legal assistance, it took Cynthia over a year to settle her hospital bills, about $78,000.
State has limited protections
Washington passed a law to protect several popular consumer protections if the ACA is repealed. Insurers in Washington cannot impose life-time caps or exclusions for pre-existing conditions and adult children under 26 must be allowed insurance on their family’s plan.
However, in an Oct. 15 letter, Gov. Jay Inslee and state health officials told U.S. Sens. Patty Murray and Maria Cantwell that state law “provides no protection for Washingtonians who simply cannot afford the coverage.”
Inslee and the officials also pointed out that since the COVID-19 pandemic, 80,000 more people statewide have enrolled in Medicaid expansion. Based on the Tri-Cities population, that could mean as many as 3,200 more people here are covered under Medicaid.
Inslee and state health officials predicted “a total loss of $4.2 billion annually in federal funds for residents across the state who currently receive free or low-cost coverage under the ACA” if the federal law is struck down.