Locals await impact from pledged repeal of health care law

By Marilyn Meyer
The Ledger

While campaigning, President-elect Donald Trump pledged to repeal the Affordable Care Act on Day 1 of his presidency. He has not released detailed plans and leaders in the Polk County health care industry seem to be taking a wait-and-see attitude.

As in the rest of the country, health care was only one of the myriad of issues as the Republicans' Trump and Mike Pence ticket carried Polk County with 49 percent of the vote. The Democrats' Hillary Clinton and Tim Kaine, who had pledged to tweak and improve the ACA, garnered 47.8 percent of the vote.

“I am reading different things about what to expect,” under the Trump administration, said Ann Clausen, chief executive officer of a Central Florida Health Care, a federally qualified community health clinic with a dozen clinics in Polk, Highlands and Hardee counties. “There is just so much we don’t know; my feeling is it is best to wait and see, and not speculate.”

President Barack Obama’s signature piece of legislation, often called "Obamacare," aimed to rein in the spiraling cost of health care and bring medical coverage to the uninsured — which numbered 49.9 million Americans in 2010, according to the Bureau of Census. Post-election, Trump has pulled back a bit on his pledge to repeal the health care law, saying he may keep the parts that he thinks work. The federal Department of Health and Human Services estimates that more than 20 million people have gained health insurance since the ACA passed in 2010, including health insurance Marketplace coverage that provides premium subsidies and tax breaks to low- and moderate-income people, expansion of Medicaid in 32 states — although not Florida — and changes in private insurance that lets young adults stay on their parents’ health plans until age 26 instead of 22 if in college and requires insurance companies to cover pre-existing conditions. When the ACA was passed by a Democratic-controlled Congress in 2010, 21.3 percent of Floridians had no health insurance. By 2015, the percentage had dropped to 13.3.

In terms of how many people are directly impacted in Polk County, during the signup period last year, 34,156 health plans were sold through the ACA’s Marketplace.“I truly believe he (Trump) is going to try to surround himself with experts and try to improve access to health care,” said Claussen, whose agency has benefited from increased funding the ACA has filtered toward qualified community health clinics that treat low-income, underserved people.

Ann Barnhart, chief executive officer of Heart of Florida Regional Medical Center in Haines City, said, “Many in our community count on the health insurance coverage made available through the ACA for care.“While the details of President-elect Trump’s plans have not been released, we are hopeful that our elected officials will ensure continued access to covered care for those who wouldn’t otherwise have it,” Barnhart said. “We remain committed to caring for our patients to help them access the services they need.”

The unraveling

“The dismantling and removal of the ACA will have to be done on a timely basis,” said Bill Gardam, executive director of the nonprofit Peace River Center, which provides mental health and behavioral health services throughout Polk County. “There are contracts with insurance companies and providers," he said. "In spite of what was stated during the campaign of either party, it will happen over time, tied to the expiration of contracts.”


Gardam said Peace River Center did not see a surge of patients with benefits after adoption of the ACA. “Many of our clients would be Medicaid eligible rather than insurance eligible,” Gardam said. Expansion of services to the mental health field has been slow under the ACA, he said. “Four years after enactment, we were finally contacted by an insurance company asking if we would be a provider.” “We did not contract with the company,” he said.

It’s complicated

The Trump administration and the Republican-controlled House and Senate are expected to enact their own law in place of the ACA.

In the highly politicized world of health care, most local officials are guarded about commenting.

Elaine Thompson, president and CEO of Lakeland Regional Health, issued this statement: “It is our practice to be constantly vigilant about changes on the healthcare horizon and look for ways to achieve safe and exceptional quality care while maximizing efficiency. As we learn more in the coming weeks about potential Affordable Care Act changes, we will respond as needed.”

The ACA is complicated and has much more than the extensive insurance regulations. It touches on the entire healthcare infrastructure with measures aimed at controlling costs, improving quality and promoting wellness.

Among its many aspects, the law:

— Emphasizes primary care.

— Pushes programs that establish medical homes for patients and routine care for chronic conditions.

— Streamlines and avoids duplications and medical errors by requiring such things as electronic record-keeping.

— Provides for monitoring hospitals and others that accept Medicare and other government payments on a wide array of quality issues.

— Moves payment from fee-for-service toward payment based on quality of service.

— Sets up programs to improve workforce training.

— Expands funding for community health centers.

Its economic impacts are widespread and not just for the insurance industry. For example, the stock of Community Health Systems — the Franklin, Tenn.-based company that owns Heart of Florida and Lake Wales Medical Center — stock plummeted by 21.9 percent the day after Trump’s surprising win, according to stock adviser Motley Fool.The day after Trump announced he would like to keep parts of the ACA that work, CHS stock rose by 11 percent, Motley Fool said. Motley Fool’s analysis of Community Health Systems, published Nov. 10, said, that among other factors facing the heavily in-debt hospital chain, it will be impacted financially when customers covered under the ACA lose their insurance.

Locally, Heart of Florida and Lake Wales hospitals have gone beyond the much larger not-for-profit Lakeland Regional Health in helping people sign up for medical coverage under the ACA. At those for-profit hospitals, certified counselors and navigators guide consumers through the complicated process. If the consumer does not make enough money to qualify for a subsidy, they are guided through how to sign their children up for Medicaid and how to sign up for health care through agencies that receive funds through Polk County's half-cent sales tax for indigent health care.

In a news release promoting an upcoming information session about the Marketplace, Rebecca Brewer, CEO of Lake Wales Medical Center, said, “We have helped hundreds of individuals enroll on the Marketplace since it first launched four years ago. It’s very gratifying to help individuals enroll knowing that they will be able to access healthcare they need it. It’s a relief to so many people.” (The Marketplace information session will be at 6 p.m. Tuesday at Lake Wales Care Center’s community room, 140 E. Park Ave.)

BayCare, the affiliation of nonprofit hospitals that includes Winter Haven Hospital and Bartow Regional Medical Center, also has taken steps to help people sign up for Marketplace coverage — providing a Navigator line (855-404-3334, option 1) to set up appointments for personal help working through the maze of options and filling out the electronic paperwork.

Who Marketplace reaches

While critics have maintained the coverage is too expensive and restrictive, the federal Department of Health and Human Services says that after the government pays sliding-scale subsidies the vast majority of people have affordable health insurance: in 2017, 80 percent of Florida Marketplace consumers are expected to be able to find a plan with a premium of less than $75 per month, and 84 percent to find plans with premiums below $100.

A key element of the ACA was providing health care to the poor by extending federal-state funded Medicaid benefits to able-bodied adults whose incomes are under the federal poverty level. In spite of federal penalties, some Republican-dominated states balked at the increased price and refused to expand Medicaid.

Florida is among the 18 states that have not expanded Medicaid. In Polk County, about 40,000 very-low income adults have no form of health insurance.

Since these Polk Countians are not eligible for benefits under the ACA, repeal should not impact them, said Lea Ann Thomas, the assistant county manager who oversees administration of the half-cent sales tax for indigent health care.

The county devised the Polk Healthcare Plan to pay for health care for the working poor whose incomes are below the poverty level, which is $11,800 for a single person, and set up a network of community partners to provide services to them and Polk County residents whose incomes are up to 200 percent of the federal poverty level, which is $23,760 for a single person.“For people who are at between 100 (percent) and 200 percent of the federal poverty level, our information is they could not afford the insurance anyway. What we have been told is even with subsidizes they still could not afford it,” she said.

“Under a Trump administration, we are hopeful and believe the intent is not to cause harm but to find a low-cost option to provide access to mental health services,” Peace River's Gardam said. “The Republican Party is not happy with some of the tenets, costs and bureaucracy of a government-run program.”

— Marilyn Meyer can be reached at marilyn.meyer@theledger.com or 863-802-7558. Follow her on Twitter @marilyn_ledger.