ACA repeal and replace — redux

by Joyce Jackson, Northwest Kidney Centers president and CEO


The effort to gut the Affordable Care Act (ACA), signed into law March 23, 2010, gained traction recently. The U.S. House of Representatives voted to repeal the ACA and replace it with a bill that substantially changes Medicaid coverage. That measure has now moved to the Senate.

Northwest Kidney Centers opposes this bill. We have data that shows that expanded Medicaid improved kidney health care in our region, and the new bill takes that away. We are not alone in our opposition to the proposed replacement.

Most if not all major medical organizations are on record as opposed, including the American Medical Association, American Hospital Association, American Academy of Family Physicians, American College of Physicians and locally the Washington State Hospital Association.

Northwest Kidney Centers supports maintaining Medicaid expansion provided by the ACA and opposes its repeal without a workable health insurance replacement for low-income people with kidney disease.

Besides the cuts to Medicaid, a major problem with “repeal and replace” is that it gives insurance companies the right to discriminate against people with pre-existing conditions. Under the new bill, an insurance company may deny coverage or may charge exorbitant premiums (another way of denying coverage) to people with pre-existing conditions. The rationale for this measure is that it would allow healthy people to pay less for their health insurance.

Here’s the reality

A person under the age of 65 (not yet eligible for Medicare or Medicaid) with a pre-existing condition such as diabetes is likely to find it extremely hard to find or pay for health insurance.

Millions of people will fall into this category and face constraints in changing jobs, being self-employed, retiring early or going without employment-based coverage—because they are likely to find themselves without any health insurance options.

The Kaiser Family Foundation estimates that 27 percent of adult Americans under age 65 have health conditions that would leave them uninsurable for individual market coverage under pre-ACA underwriting practices. Here in Washington, 25 percent of the population under age 65—one million people—have a pre-existing condition and could be declined for insurance coverage.

These are reasons for insurance denials before the passage of the ACA, and would again result in denials under the House-passed health bill:

AIDS/HIV; alcohol or drug abuse; Alzheimer’s or dementia; arthritis (rheumatoid), fibromyalgia or other inflammatory joint disease; cancer; cerebral palsy; chronic obstructive pulmonary disease or emphysema; congestive heart failure, coronary artery or heart disease, bypass surgery; Crohn’s disease or ulcerative colitis; diabetes; epilepsy; hemophilia; hepatitis C; chronic kidney disease or renal failure; lupus; mental disorders such as bipolar or eating disorder; multiple sclerosis; muscular dystrophy; severe obesity; organ transplant; paralysis; paraplegia; Parkinson’s disease; pending surgery or hospitalization; pneumocystis pneumonia; pregnancy; sleep apnea; stroke.

Because the repeal and replace legislation that passed the House of Representatives does not promote the optimal health of people with kidney disease, Northwest Kidney Centers opposes the bill as it currently stands. We support significant improvements to the bill or to current law in order to truly enhance kidney health specifically and overall health generally in the United States.