The repeal of the Affordable Care Act could have a profound effect upon many of Roosevelt Island’s residents, particularly those receiving treatment at Coler, the Island’s post-acute care center, as well as thousands of Island Medicaid recipients, according to John Jurenko, vice president of intergovernmental relations and planning at NYC Health and Hospitals Corporation (HHC), the largest public health-care system in the nation.
Jurenko was the keynote speaker at the annual Legislative Forum held March 3 at the Island’s NYC Health and Hospitals/Coler post-acute care center (formerly known as the Coler-Goldwater Specialty Hospital). The 815-bed chronic-care facility, located north of the Octagon, provides rehabilitation and specialty nursing to those on Medicaid and Medicare, and is part of a network of 11 hospitals, trauma centers, neighborhood health centers, nursing homes, and post-acute care centers in New York.
Jurenko’s warning came just days before House Republicans unveiled their plan to repeal the Affordable Care Act (ACA) and replace it with a more conservative vision that replaces federal insurance subsidies with a new form of individual tax credits and grants to help states shape their own policies. According to the proposed terms, the individual mandate for health insurance would be eliminated in favor of tax credits, and the recent Medicaid expansion would be rolled back, among other changes.
According to Jurenko, one of the biggest impacts for his organization would be the rollback of Medicaid coverage.
According to reporting by The New York Times, as of January 2016, 32 states had expanded Medicaid coverage under the ACA or were considering it. The result has been lower premiums for those with health care exchange policies in those states.
“Every state gets a certain amount of funds from the feds. Due to the way [New York] State distributes the funds, we (HHC) would get hit first and worst,” said Jurenko. “If the ACA was repealed in its entirety and nothing were to go in its place, the State has estimated 2.7 million New Yorkers could lose coverage.” According to Jurenko, New York City residents comprise 1.7 million of that number.
Specifically, Jurenko says, 1.1 million New York City Medicaid participants would lose coverage, of which 200,000 are served by HHC. Of those on the Essential Health Plan – lower-income people who don’t qualify for Medicaid or Child Health Plus – 400,000 people in the City would lose coverage. This would also impact 100,000 people who bought their healthcare through the New York State Department of Health.
According to the New York State Department of Health website, in 2014, Roosevelt Island’s zip code (10044) counted 2,472 Medicaid beneficiaries. Of that number, 749 Islanders were eligible for both Medicare and Medicaid and there were 373 child Medicaid beneficiaries. Unique total hospital admissions among Island Medicaid recipients that year numbered 673. Unique emergency room visits totalled 837.
Jurenko estimates that the change could potentially total $500 million in lost revenue for HHC. He says his organization is working with a group of safety-net hospitals, community health care providers, and people who support the child health insurance program because “all of these things expire or need to be reauthorized this year.”
Sizing up the Options
As for options to replace the ACA, Jurenko went through all of the alternatives that have been floated by Republicans, pointing out potential problems.
Of refundable tax credits, Jurenko noted that “they don’t work for very low-income people who may not be filing their taxes.” Regarding placing a cap on the exclusion of employer-sponsored health coverage, Jurenko says, “Most people get their healthcare through their employers. New York has very generous health coverage compared to other states, so they would essentially tax the difference, which would hit us pretty hard. When you hear people talking about the ‘Cadillac Tax,’ that’s what they’re talking about.” The Cadillac Tax is a 40% surcharge on the value of employer-based health premiums above specific thresholds. Under the Republicans plan, the so-called Cadillac Tax, which taxes employers on their most generous health insurance plans, would still kick into effect, but not until 2025.
Jurenko says high deductible plans might work for someone who is willing to pay a little bit each month and is fairly healthy. Yet, if a catastrophic event were to occur, they would have to pay a lot of money. “For our patient population, this wouldn’t work. Because who’s got a couple of thousand dollars in the event that they may need it?” Similarly, he says, with health savings accounts, if you have trouble putting food on the table, and/or making rent, you’re probably not setting aside money for health savings accounts.
As for insurance sold across state lines, Jurenko says, “I don’t know about you, but we have very robust regulatory and administrative oversight over insurance plans in New York State. I’d be a little bit concerned about a product being sold in some other state, because who knows what kind of vetting that company has gone through. Who knows if it would even work here. This is another thing that sounds great but would probably not work at all.”
Medicaid block grants are also on the table. A block grant is a fixed amount of money that the federal government gives to a state for a specific purpose. If Medicaid was turned into a block grant, the federal government would set each state’s Medicaid spending amount in advance. Jurenko says, “This would really hit New York not only on the chin, but would be more like a shot to the head. The way that folks that sell block grants in Washington, or in Albany, for that matter, talk is we’re going to give you a certain amount of mixed funding, and then give you the flexibility to do what you want with it, and therefore you won’t have to meet all of these expensive regulatory requirements and this or that. But they cap and cut your funding and you still have to meet all of these requirements.”
In reality, says Jurenko, “the only way they’re going to save money is to cut benefits, cut services, and require people to take more out of their pocket. That doesn’t work in New York State. New York gets more Medicaid money than any other state and we provide more services to folks than any other state. New York has the most to lose in this case. And therefore HHC would have the most to lose.”
Some have looked to Albany for help mitigating the possible effects of an ACA repeal. In a January press release, Governor Cuomo stated, “The cost of a repeal of the ACA, to state and local budgets and to the New Yorkers who depend on its health care coverage, is simply too high to justify. Since its implementation, the Affordable Care Act has become a powerful tool to lower the cost of health insurance for local governments and New Yorkers, and it is essential that the federal government does not jeopardize the health and livelihoods of millions of working families.”
Yet, Jurenko said, “The governor released his budget in mid-January. There wasn’t a lot in it that hurts us, but there wasn’t a lot that helps us.”
Untangling Health Care
“This may come across as partisan but I am going to tell you how I see it,” said Jurenko. “The Republicans have been running against the Affordable Care Act (ACA) since the day it was signed ... Now, the Republicans control all three branches in Washington and they are finding out how hard it is to actually govern. Those of us who are a part of the hospital safety net that were in Washington [last week] took a lot of amusement at the President’s remarks when he said, ‘Who knew healthcare could be so complicated.’
“Everybody in this room knows how complicated it is. All the staff here know how complicated it is. Those of us trying to access health care for a family know how complicated it is. All the patients know how complicated it is. I guess it takes a billionaire who is totally out of touch to not know how complicated it is.”