What Does Repealing Obamacare Mean for New Hampshire?

My Turn: Health insurance in a post-Obamacare world

For the Monitor

Wednesday, January 04, 2017

The Republican-controlled Congress has pledged to repeal the Affordable Care Act, also known as Obamacare. Over the past six years since it became law, the ACA has brought major changes in health insurance laws that ended the worst insurance company abuses.

The effect of this has been important in New Hampshire, so, as we stand on the precipice of the ACA’s potential repeal, it’s a good idea to review the impact of these changes on New Hampshire’s people and consider how we will be affected if the law is repealed.

Perhaps the most important reforms involve the guarantee of insurance coverage. Thanks to the ACA, the 600,000 Granite Staters who have a pre-existing health condition can no longer be denied coverage or charged so much that they can’t afford it. Insurance companies can’t cancel their policies when they get sick or put caps on their coverage. Women can’t be charged more than men simply because of their gender, and young adults can stay covered through their parents until age 26 as they establish their careers. That’s a lot of peace of mind thanks to Obamacare.

The coverage itself is improved as well and has a better overall value. Important preventive services are always covered, such as colonoscopies and mammograms, and insurance companies are regulated on the amount of premium dollars that must go to pay for services, rather than marketing and executive pay. And with mental health services a critical need in New Hampshire, the ACA requires coverage of these services at parity to other medical services.

While the coverage has gotten better, the rate of cost increase for the 850,000 Granite Staters who get insurance through their employer has also slowed by more than a third. And more than 30,000 of us who buy insurance through the individual market qualify for tax subsidies to make the purchase more affordable.

Already more than 20,000 older New Hampshire residents are saving on average more than $1,000 a year on their medications. We must ask ourselves what will happen to this group of Granite Staters when the Donut Hole returns.

The Medicare program itself is also improved by the ACA. An annual exam and essential preventive services are now provided without cost sharing. In 2015, 74 percent of our seniors who are enrolled in Medicare Part B took advantage of this benefit. Medicare also brought payment reforms to hospitals to encourage fewer unnecessary readmissions.

Over the past five years, readmissions dropped 3 percent for New Hampshire’s Medicare beneficiaries, keeping our elders out of the hospital unless really necessary.

Finally, New Hampshire took advantage of the ACA’s Medicaid expansion, bringing health coverage along with mental health and substance abuse treatment access to many Granite Staters for the first time. Over the past two years since the expansion began, 107,000 residents have participated at some point; currently 50,000 people are enrolled. The Medicaid expansion has also brought financial stability to our smaller, rural hospitals since they are now compensated for care they must provide.

Virtually everyone in New Hampshire has felt the impact of the Affordable Care Act, whether they are on Medicare, get insurance through work, through Healthcare.gov or through Medicaid. For the past few years, they have had higher quality, more transparent coverage that treats them more fairly than in the past.

We can only wonder how Granite Staters will react and suffer when the Trump administration and Republican Congress take these benefits away.

(Rep. Cindy Rosenwald of Nashua is the deputy House Democratic leader.)

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