As a Tulsa emergency room physician, Eric Brown’s job is to save lives.
His wife, Sabine Brown, worries that plans by Congress to repeal the Affordable Care Act could put his own life at risk some day. She was among a group of protesters who gathered at U.S. Sen. James Lankford’s Tulsa office Thursday to share their stories.
Brown, a Bixby resident, and about 20 others spent an hour in Lankford’s office detailing how their families would be affected if the Affordable Care Act is repealed without a replacement.
She organized demonstrations at Lankford’s offices in Tulsa and Oklahoma City after she felt her concerns weren’t being heard. Brown said she had been calling Lankford’s office to tell her story prior to the demonstrations but felt she needed to go a step further.
Eric Brown was diagnosed with Burkitt’s Lymphoma when he was five years old. As a childhood cancer survivor, he was denied health insurance during adulthood before the Affordable Care Act because of his medical history.
“He was actually in medical school without healthcare coverage himself,” she said.
“Eventually, we found one plan that would cover him. It was really expensive, it had a really high deductible and it really didn’t cover much. It was mostly just worst case scenarios. And it certainly wouldn’t have helped us if for some reason his cancer returned.”
Eric and his family currently have health insurance through his employer. However, Brown worries if her husband lost his job for some reason and insurance companies were once again allowed to deny coverage to people with pre-existing conditions, it would be difficult for him to find health insurance elsewhere.
“If the ACA were to be repealed and for some reason he lost his job, we would be in a really unique situation of having a doctor in our family who couldn’t get health insurance for himself,” she said.
The Affordable Care Act prohibits insurance companies from denying coverage because of pre-existing conditions.
Brown posted her story on Facebook and within a few days demonstration groups in Oklahoma City and Tulsa had formed. Those who journeyed to Lankford’s offices told personal stories of what the ACA, also known as Obamacare, means to them as well as what the legislation has done for them.
“I felt like these stories, the real-world stories of the effects this repeal would have on people was being lost in the conversation,” Brown said. “A lot of these stories were way worse than our family was facing.”
A new study by the Pew Research Center shows Americans’ opinions on the issue are shifting.
Last year, 51 percent of those surveyed said the government had a duty to ensure health coverage for all Americans. That figure is now at 60 percent, the highest point in a decade.
Notably, a demographic that voted heavily for Trump — working class Republicans — followed the same trend.
The survey found that 52 percent of Republicans with family incomes below $30,000 believed the government should be responsible for ensuring all Americans have health coverage, up from 31 percent last year.
Carly Putnam, a policy analyst at OK Policy, said about 130,000 Oklahomans receive healthcare coverage through the act. Putnam said there is uncertainty surrounding the future of the ACA and the timeline in which government officials will act.
The Senate voted to approve a budget measure Thursday that will allow both houses of Congress to begin working on the bill to repeal the ACA.
The bill only applies to the federal budget but could have an impact on funding medicaid expansion, stopping tax credits and ending the tax penalty for the uninsured, Putnam said.
“What we’re hearing now is that members are getting nervous because even if ending federal funding and subsidies was delayed two years that would still end them now because of how the market would react,” Putnam told The Frontier.
In a blog post for OK Policy, Putnam outlines potential market behavior following a partial repeal of the ACA. She writes that ending the individual mandate would cause healthier enrollees to get rid of their insurance, leaving a less-healthy population to endure higher premiums.
Because any sort of repeal and delay would also inflict heavy damage on the individual marketplace, Putnam said, it’s likely about 300,000 Oklahomans would become uninsured.
“That would increase (Oklahoma’s) uninsured rate by 59 percent, we’d go from about 500,000 uninsured to well over 800,000 uninsured,” she said.
An increase in the number of uninsured wouldn’t be the only issue to arise from a partial repeal, Putnam said.
Oklahoma has the third-highest uninsured rate in the country, meaning a significant strain has already been put on healthcare safety net systems such as community health centers and hospitals, she said.
“I don’t want to say they are at their breaking point, but some of them are,” Putnam said. “And then if we dump a whole lot more uninsured people onto them, I think that’s when we begin to see the state’s entire health system struggle.”
Rick Snyder, Oklahoma Hospital Association’s vice president of finance and information systems, said hospitals aren’t doing as well as they were a few years ago.
He said hospitals around the country agreed to steep medicare payment cuts to increase the number of insured, securing a new revenue source. However, hospitals in Oklahoma aren’t faring as well as those in other states partially as a result of the state not expanding Medicaid, a federal program that provides healthcare to the poor.
Snyder said some of Oklahoma’s rural hospitals have closed, reduced services or are considering bankruptcy.
“Those are big changes for a community, where the hospital is usually in the top three employers,” Snyder said. “A number of them are barely hanging on. When a hospital closes down, that affects everybody.”
Oklahoma’s urban hospitals are larger and offer a variety of services, so they haven’t been as hard hit financially as those in rural areas, he said.
Snyder said the extent to which a repeal of the ACA affects Oklahoma hospitals depends on what replaces the act. He said OHA believes if the ACA is repealed, it needs to be replaced simultaneously to avoid a chaotic marketplace.
“We would rather not see it repealed, but elections have consequences and that seems to be where we are going,” he said.
Signals on this issue have been mixed, with Republicans in congress providing few details about their plan to replace the ACA. The law’s popular features include prohibiting insurers from denying coverage due to pre-existing conditions and allowing young adults to stay on their parents’ plans until age 26.
During an interview with The Washington Post Friday, President-elect Donald Trump said he was putting the finishing touches on his own plan to replace Obamacare.
However, his plan sounded a lot like universal, single-payer healthcare, likely to be opposed by his own party as a far more extensive government-controlled system than the ACA.
“We’re going to have insurance for everybody,” Trump told the Post. “There was a philosophy in some circles that if you can’t pay for it, you don’t get it. That’s not going to happen with us.”
People covered under the law “can expect to have great healthcare. It will be in a much-simplified form. Much less expensive and much better,” he said.
By Monday, however, that bold promise was being walked back by a spokesman for the president-elect.
During an interview on NBC’s “Today” show, incoming White House Press Secretary Sean Spicer said Trump’s goal will be accomplished with market forces.
Trump’s plan will “get insurance for everybody through marketplace solutions, through bringing costs down, through negotiating with pharmaceutical companies, allowing competition over state lines.”
How will that happen? Spicer said Trump “knows how to negotiate great deals.”
If the ACA is repealed without a replacement, Snyder said he hopes the medicare payments to hospitals would be restored.
“That doesn’t help people get access to healthcare, but it does help stop the bleeding for hospitals somewhat,” he said.
Hospitals agreed to a medicare cut in exchange for the ACA’s promise of a wave of newly insured patients. In Oklahoma and other states that rejected the law’s Medicaid expansion money, reality didn’t live up to that promise.
Additionally, some younger, healthier patients opted to pay the law’s annual fine on their taxes rather than buying health insurance.
Susan Savage, CEO of Morton Comprehensive Health Services in Tulsa, said 50 percent of the center’s patients are uninsured. They’re among the 127,000 Oklahomans who fall into a coverage gap created when Gov. Mary Fallin rejected an expansion of the Medicaid program.
“We have to pick up that gap, and if that increases, it’s just more of a gap and that requires us to make business decisions,” Savage said.
The center offers a variety of services and focuses on primary care, especially for Oklahoma’s underserved population. There are six Morton clinics in northeastern Oklahoma, serving about 20,000 patients collectively each year, Savage said.
Savage said if the act is repealed, the state’s uninsured population will grow and more people are likely to defer their healthcare.
“That’s a workforce issue, that’s a community issue, it’s an economic issue — I don’t know how you expect people to be a productive workforce if they’re unhealthy,” she said.
After the demonstrations Thursday, Brown said she felt the group was able to put a face on a highly political issue. Brown said she hopes Lankford, R-Okla., understands how his constituents could be affected by the actions of Congress.
In response to the demonstrations, Lankford released a statement in favor of repealing Obamacare while doing no harm to current enrollees.
“In the past five years, the Affordable Care Act resulted in skyrocketing costs and limited provider options for families all across Oklahoma,” Lankford said in a statement.
“It’s important that this new Congress fulfill the promise to repeal the law, and replace it with a better model. We must craft a health care replacement plan that provides a smooth transition from the current Obamacare exchange to a much stronger, more sustainable system that gives patients more control over their coverage. We do this with the goal in mind of doing no harm to current enrollees as the transition occurs.”
Brown said overall she hopes members of Congress will think of how their actions could affect the people they were elected to represent.
“I would ask that our legislators put politics aside and think of their constituents and the affect these decisions have on them,” Brown said.