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You Visit Tour. Webb Lion Fountain. June 1 2017. Photo David B. Hollingsworth

ODU Health Care Experts Fear Repeal of Obamacare

By Irvin B. Harrell

The Patient Protection and Affordable Care Act (ACA) - which is frequently referred to as Obamacare and designed to dramatically expand health care coverage for most Americans - has been trumpeted as a historic regulatory triumph but also vilified and targeted for repeal.

Since the law's enactment in 2010, millions of previously un-insured Americans have signed up for health care coverage under ACA provisions that mandate participation through tax penalties for non-compliance. It is projected that up to 30 million people will lose coverage if the law is repealed.

Many Republicans oppose the Democrat-sponsored ACA for a variety of reasons, including its mandated and subsidized nature funded in large part from tax increases targeted at higher income brackets.

President Donald Trump promised during his campaign to dismantle the act and pulled advertisements for healthcare.gov, a website where individuals and families can sign up for ACA plans, soon after taking office in January. He also forbade efforts by the Department of Health and Human Services to encourage coverage. More recently, he signed an executive order directing federal agencies to waive enforcement of significant portions of the law.

Congressional Republicans have also began efforts to dismantle the ACA, including the introduction, in January, of H.R. 370, a bill in the House of Representatives that would repeal the law.

Health care experts at Old Dominion University are concerned that scrapping the ACA will result in a number of public health problems.

Some of the key provisions of the ACA include:

  • A Medicaid expansion to 138 percent of the federal poverty level ($15,415 for an individual and $31,809 for a family of four in 2012) for individuals under age 65;
  • The creation of health insurance exchanges where individuals who do not have access to public coverage or affordable employer coverage are able to purchase insurance with premium and cost-sharing credits available to make coverage more affordable;
  • Regulations that prevent health insurers from denying coverage to people for reasons such as health status;
  • A requirement that most individuals have health insurance, beginning in 2014;
  • Establishment of penalties for employers that do not offer affordable coverage to their employees, with exceptions for small employers.

Strategically, the ACA has been a step in the right direction, said Kimberly Adams Tufts, professor and interim associate dean for inter-professional education and evaluation at ODU. She notes that many countries have national health insurance programs, including Canada, Austria, the United Arab Emirates, Scotland, Great Britain, Wales and the Netherlands.

"One of the major issues with repealing the ACA is that there is a chance that any replacement would not mandate that all seek and obtain insurance coverage, she said. "Such a mandate is very important because it requires young adults, healthy persons, and those without chronic conditions to spread the risk across the insurance pool. This decreases costs for insurers and for the insured."

Robert Cramer, an associate professor in the School of Community and Environmental Health, has an expertise in LGBT health, mental health and interpersonal/community violence. He says the repercussions for the mentally ill could be disastrous with the repeal of the ACA.

"One very practical issue is that access to and funding for mental health care will decline," he said. "This raises the potential for increased rates of untreated mental health conditions. Practically speaking, this means entities and professionals, such as emergency departments and law enforcement having to be the first to interface with those in a mental health crisis even more so than they already do."

Another surging health care issue that could potentially worsen without the ACA is the opioid epidemic, which claims three lives each day from overdoses in Virginia. ODU's Center for Global Health is responding to the problem by doing early intervention projects at schools in Hampton Roads.

While there are many theories on what will happen if, or when, the ACA is repealed, there doesn't appear to be a clear replacement to a plan that has provided insurance for millions of Americans since its implementation.