During his election campaign, President-elect Donald Trump promised a complete repeal of the Affordable Care Act. With his election last Tuesday, the future of health care for Connecticut residents remains uncertain.
Connecticut’s health exchange marketplace, Access Health CT, provides private and public insurance options for the state’s residents. Just this past year, it provided more than 116,000 residents with coverage through private health plans and helped the state Department of Social Services enroll or renew more than 750,000 through Medicaid. Now, despite the potential repeal of the ACA, state politicians are encouraging residents to enroll in Access Health CT before the current registration period closes on Jan. 31, 2017. The hope, according to interviews with multiple health care professionals, is that state health care programs will remain steadfast despite potential cuts at the federal level.
“Access Health CT will continue to be a vital link, connecting them to high-quality, affordable health insurance,” said Lt. Gov. Nancy Wyman in a Nov. 9 statement. “If there are any changes in the federal ACA, we will address them — and, as always, the priority will continue to be ensuring affordable, accessible, high-quality health care for our residents.”
Sen. Richard Blumenthal LAW ’73, D-Conn., echoed this in a statement to the News on Thursday afternoon. He said the ACA has already provided many in Connecticut with the quality health care residents both need and deserve, and added that he is confident that 2017 “will be no different.” And as open enrollment continues, Blumenthal urged anyone seeking coverage to reach out to Access Health CT.
Gov. Dannel Malloy was similarly encouraging last week. According to NBC Connecticut, Malloy said no one should miss the opportunity to have coverage or to continue to have coverage because of Trump’s election.
But with Trump assuming the presidency in two months alongside a Republican majority on Capitol Hill, the future of the ACA and Access Health CT could be a concern for Connecticut residents.
Ellen Andrews, executive director of the Connecticut Health Policy Project, said Trump’s plans to repeal Obamacare will be slow to come to fruition, as any proposed changes to the ACA must pass the Senate with 60 votes — a number that Andrews argued “simply does not exist at this point.” The Republicans currently hold a one-seat majority in the Senate.
Yale professor of radiology and economics Howard Forman also said such a move is improbable, arguing that the pervasiveness of Obamacare will move Republicans to give a second thought to a measure that drastic; over 20 million Americans are currently insured under the ACA.
However, in a report drafted by the health care consulting firm Leavitt Partners, Congress plans to enact ACA reforms between next April and July.
Though the Republican majority in the House and Senate have put forth proposals to repeal Obamacare in the past — all of which were vetoed by President Barack Obama — Forman does not find such a history indicative of what Republicans will do under a Trump administration.
“They must be running scared right now,” Forman said. “They’ve had multiple votes to repeal ACA in past. Symbolic votes, basically. They get all the political attention and the rewards for voting against the ACA, but they don’t suffer any of the consequences. Now, if they do something that creates an unfixable problem, the voters will hold them responsible for it.”
Professor of health policy Mark Schlesinger similarly believed that a blanket repeal of the ACA will not be a move Republicans take lightly, noting that the federal subsidies granted by the ACA to alleviate enrollment costs are extremely important to enrolled low-income households. He predicts that Republicans will need to formulate a way to keep such subsidies in place, as “they will realize the hardship they will inflict and will need to find a way to buffer that.” And if federal subsidies were to dissipate alongside the ACA, states could take on the burden for their residents, Schlesinger said.
But Connecticut’s ability to do so is questionable, given its current $1.3 billion budget deficit — one of the worst in the country, according to Forman.
According to a spokesman from the Connecticut Department of Social Services, the state’s administering agency for Medicaid, federal subsidies are currently paying for 100 percent of the state’s Medicaid expansion — a federal program in which Connecticut enrolled in 2010 to expand coverage of its services. Schlesinger is unsure if states can sustain the expansion program, which now counts 206,000 enrollees in Connecticut.
Andrews adds that Medicaid currently accounts for 25 percent of the state budget, a fraction that could spell major issues for the state if it were removed.
“If that gets tightened at the federal level, there’s even more pressure on the state,” Andrews said. “The state pays for a lot of hospital subsidies, public health programs, needle exchanges. Those programs would all be at risk.”
Schlesinger, however, said though Connecticut’s federally funded health care programs could suffer greatly if Obamacare were repealed, the state is relatively poised to sustain many of its programs.Most state health exchange programs — including Connecticut’s — operate by offering private insurance for their consumers, and Schlesinger said it is likely that the private sector “will provide protective cover” should Washington withdraw federal funding for them.
Additionally, Schlesinger said Access Health CT’s status as a state-run health exchange helps buffer the organization against any policy changes on the federal level.
“You don’t actually need to have federal support to make markets work,” Schlesinger said. “Connecticut runs its own exchange, it will continue running its own exchange, and things will probably change little.”
Though Access Health CT was jump-started with federal funding in 2010, it has gradually transitioned toward “self-sustaining architecture and infrastructure,” said Patricia Baker, president and chief executive officer of the Connecticut Health Foundation.
A major threat to Access Health CT’s self-sufficiency, however, is the withdrawal of insurance providers from the exchange. According to Baker, ConnectiCare, the exchange’s single largest insurer, spoke with Access Health CT this past summer about pulling out from the program, a move that would leave the exchange with only a single provider: Anthem. ConnectiCare eventually decided to stay in the exchange through 2017.
Vin Candelora, Connecticut’s House deputy Republican leader, said ConnectiCare’s decision does not necessarily guarantee continued involvement past 2017.
“[Access Health CT] should be concerned that ConnectiCare is going to pull out of the exchange in a year. The exchange is going to eventually fall apart at this rate,” Candelora said. “We need reform to get more insurance companies going into the exchange and more healthy people purchasing.”
When asked about ConnectiCare’s plans beyond next year, Baker, who recently spoke with company representatives, said though “any discussion of withdrawal is resolved” the issue is “always a changing process.”
Despite the immediate health care policy changes that could come under a Trump presidency, Baker highlighted that many prior challenges continue to persist. The problems that led to the ACA, she said, have not gone away.
Ken Ferrucci, senior vice president of government affairs at Connecticut State Medical Society, voiced a similar sentiment.
“The election’s impact doesn’t change the issues that Connecticut is facing,” he said. “Regardless of what happens, we still have issues in Connecticut like the need to recruit and retain physicians. All the issues remain.”
Just under 44 percent of New Haven’s residents are enrolled in Medicaid.