After an unusually sickly childhood filled with doctor appointments, chronic ear infections, and seemingly untreatable allergies, Baylee Gregory of Lompoc finally discovered why she, unlike her five siblings, was always so unhealthy. Baylee was 14 when she was diagnosed with common variable immunodeficiency, a disease that severely weakens the immune system.
Baylee’s mother, Annette, explains the disease by mentioning David Vetter, an immunodeficiency patient famous for spending most of his short life in an isolated and sterile “plastic bubble” that protected him from common germs his immune system couldn’t combat the way a healthy person’s would.
But Baylee has yet to live alone in a plastic bubble, and for that, Annette thanks the Affordable Care Act (ACA). That’s why Congressional Republicans’ continuous attempts to repeal the ACA have felt so personal to Baylee and her mother.
“They sent us [to Washington, D.C.] as advocates and we met congressmen and senators who told us the repeal wouldn’t happen,” Annette said. “So when the repeal went over to the Senate, it was really scary. You know, Obamacare wasn’t great and it needs to be tweaked, but it doesn’t need to be repealed.”
In an effort to halt a repeal and promote ACA improvements, Congressman Salud Carbajal (D-Santa Barbara) announced in a July 18 press release his plan to co-sponsor the Marketplace Certainty Act. The legislation would permanently fund and expand access to cost-sharing reduction subsidies, insurance discounts offered to low-income individuals and families through the ACA.
Carbajal’s decision to co-sponsor the Marketplace Certainty Act came after Senate Republicans’ recent effort to repeal and replace the ACA failed, resulting in a supposed plan to repeal without a replacement. This, Carbajal told the Sun, would return America to the “dark ages” of health care, when millions of Americans were uninsured and unable to afford medical treatment.
A full repeal would mean the loss of health insurance coverage for many Californians like Baylee, Carbajal said, who would have to pay $27,000 a month for the specialty medication she takes every two weeks, Hizentra. Specialty drugs were only recently made more accessible through the ACA, Annette explained.
Annette said an ACA repeal would also mean little to no protection for patients with pre-existing conditions like Baylee’s, which would likely leave her without any coverage at all. Annette has no answer to how her family would handle a financial blow like that.
“Well,” she said, pausing for several seconds, “we don’t know. I don’t know what we’re going to do.”
Her family is not alone. More than 3 million Californians enrolled in Medicaid expansion in 2015. Nearly 1.5 million, including 27,500 in Santa Barbara and San Luis Obispo counties, were enrolled in ACA marketplaces in 2016, according to data compiled by the Henry J. Kaiser Family Foundation. More than 700,000 of those ACA enrollees have plans with cost-sharing reductions.
Cost-sharing reductions are subsidized with federal payments made to insurers that lower out-of-pocket expenses, including deductibles, copayments, and coinsurance, for low-income enrollees in the ACA’s marketplaces. While the ACA currently requires insurers to offer cost-sharing plans to marketplace enrollees with yearly incomes of 250 percent above the poverty level only, Carbajal said the Marketplace Certainty Act would extend cost-sharing reductions to all enrollees with incomes up to 400 percent above the poverty level. The 2017 federal poverty level is a yearly income of $24,600 for a family of four. A family of four 400 percent above the poverty level would have an income of $98,400.
Carbajal said that because the Trump administration has “refused to commit to funding” cost-sharing reductions, the bill would also require that money be permanently appropriated for the cost-sharing subsidies, ensuring that current and future presidents and members of Congress would be forced to carry out the program.
Although the Congressional Budget Office estimates the cost of funding the cost-sharing reduction subsidies will rise from $7 billion in fiscal year 2017 to $16 billion by 2027, Carbajal said continuing to fund the payments would actually save the government $2.3 billion in spending per year by “stabilizing” the marketplace.
This sentiment was echoed by a 2017 Kaiser Family Foundation report, which estimated that insurers would react to the end of cost-sharing reduction subsidies, the discounts offered through the ACA, by drastically increasing premiums or leaving the ACA marketplace altogether. That would in turn increase tax credits for low-income families, the report said.
“We estimate that the increased cost to the federal government of higher premium tax credits would actually be 23 percent more than the savings from eliminating cost-sharing reduction payments,” the Kaiser Family Foundation report states. “For fiscal year 2018, that would result in a net increase in federal costs of $2.3 billion. Extrapolating to the 10-year budget window (2018-2027) using Congressional Budget Office’s projection of cost-sharing reduction payments, the federal government would end up spending $31 billion more if the payments end.”
Carbajal said that although it’s unlikely the Marketplace Certainty Act will pass by the House majority, it’s vital that representatives continue pushing against a full ACA repeal and for bipartisan collaboration to change and improve the ACA in all necessary ways.
Some Republicans and Democrats in Congress have come together to form the “Problem Solvers Coalition,” Carbajal said, a group focusing on ways to work together on bipartisan issues.
“We have the responsibility to continue to put legislation forward in the hopes that someone, somewhere is willing to work with us,” Carbajal said. “In addition to being dismayed, I stand ready to work.”
Staff Writer Kasey Bubnash can be reached at kbubnash@santamariasun.com.
This article appears in Jul 27 – Aug 3, 2017.