Jackson County residents have good reason to watch carefully as Congress this week begins debating House Republicans' proposed replacement for the Affordable Care Act, also known as Obamacare. The proposed changes would have far-reaching implications for the county's economy, and lower-income residents stand to pay more for health coverage starting in 2020.
After voting more than 50 times to repeal Obamacare outright, knowing President Obama would veto their effort if it ever made it to his desk, congressional Republicans finally have a Republican president poised to sign what they send him. So are they tossing Obamacare in the trash and starting over?
Faced with vocal constituents who have newly obtained health coverage under Obamacare, House Republicans are treading carefully, leaving the basic framework in place and changing the tax credits and the Medicaid expansion that Obamacare put in place. In the process, their plan would generally make things better for younger, higher-income people and leave older, poorer Americans worse off.
The replacement plan would phase out the federally funded expansion of Medicaid — government health care for low-income people — starting in 2020, although extra funding for states such as Oregon that chose to expand the program will continue until then.
This is especially significant in Rep. Greg Walden's 2nd Congressional District. Walden is chairman of the House Energy and Commerce Committee, one of two panels working on the replacement plan.
An analysis by House Democrats in advance of the release of the GOP replacement plan showed 129,000 residents of Walden's district signed up for Medicaid under the ACA — the largest number of any Republican district in the country.
The Medicaid expansion also was a boon to the medical industry in the Rogue Valley, which is a regional hub for health care. One of the more dramatic increases was in mental health care, greatly expanded by the state and funded with federal dollars. Jackson County Mental Health recruited trained specialists from across the country to meet the increased demand for services.
All told, 63,453 Jackson County residents are on the Oregon Health Plan — Oregon's version of Medicaid — 30.1 percent of the total county population of 210,975. In addition, Jackson County residents eligible for subsidies to buy private insurance under the ACA received an average of $432 a month toward their premiums, based on their income.
The Republican proposal would replace the income-determined subsidies with an age-based system of tax credits that also takes income into account.
An analysis by the Kaiser Family Foundation shows Jackson County residents who are younger and more affluent will see a larger tax credit, while older, less well off residents will see their tax credits shrink:
A 60-year-old with $40,000 in income would see his credit cut in half in 2020, from $7,960 under the ACA to $4,000 under the replacement plan. A 40-year-old earning $40,000 would see an 89 percent larger tax credit under the GOP proposal, from $1,590 to $3,000.
The plan also adds tax credits for people earning up to $75,000. A 60-year-old in Jackson County earning $75,000 gets no tax credit under Obamacare, but would see $4,000 in credits under the GOP plan. It's not clear why.
The replacement plan would drop the individual mandate — the Obamacare penalty for staying uninsured. Instead, it would let insurers charge a 30 percent penalty to those who allowed their coverage to lapse for two months or more and then tried to re-enroll.
That's more likely to encourage young, healthy people to stay uninsured, and the financial hit to older people could cause them to drop coverage as well — driving up costs for everyone as the pool shrinks.
It's almost as though House Republicans were determined to change Obamacare just because it is Obamacare. But it's hard to see how the replacement plan improves on the existing system. Instead, it shifts benefits to those who need them less, while putting Medicaid clients — the most vulnerable of all — at risk.