Republican led efforts to repeal ACA will have local, national impacts
May 6, 2017

Justina Ligori with her parents when she graduated from DePaul University with
a Master’s in Public Health. A manageable illness ended up costing her father, Santo, his home and nearly his life before the Affordable Care Act was in place.

By Dan Kolen

Despite Congressional Republicans’ failure in their attempt to repeal the Affordable Care Act (ACA, or “Obamacare”) in March, many of the protections in the ACA remain on the chopping block, as both the Trump Administration and Congress still have options allowing them to weaken the law and in April ramped up another attempt at repeal.

The potential impact on Chicagoans has some local people concerned, while others point out the pitfalls and high costs of the ACA.

“It looks quite catastrophic to me,” said State Senator Mattie Hunter (D-3rd) of possible repeal. “We would have tremendous amounts of loss, and the previously uninsured then would probably come back out uninsured again.”

One item being discussed is rolling back on coverage for individuals with pre-existing conditions.

“Pre-existing conditions are still in play,” said Dick Simpson, political science professor at the University of Illinois at Chicago. As Republicans threatened to repeal protections for people with pre-existing conditions, Republican members of Congress faced angry constituents at town hall meetings in April. “Even Republicans are concerned about covering pre-existing conditions,”
Simpson said.

If lawmakers repeal the ACA, 1.2 million Illinois residents would lose their insurance in two years, and Illinois would face a $49.9 billion Federal funding loss, according to the Urban Institute. UI found 29.8 million people would lose their insurance nationwide.

One of the biggest items directly on the chopping block is Medicaid expansion, which saw more than 17 million new recipients of Medicaid nationwide and more than 400,000 people added in Illinois since the ACA took effect, according to the Henry J. Kaiser Family Foundation.

“We should continue the program that allowed us to grow Medicaid,” Simpson said. “County taxpayers are paying hundreds of millions less,” Simpson said. In Cook County alone, 350,000 residents are now covered under Medicaid expansion that were not previously, according to the county, and around $200 million in federal dollars have come in thanks to the expansion. This has removed the burden from local hospitals and taxpayers to cover these expenses.

Problems with Obamacare

Even before Donald Trump became president, private insurance policy holders already saw a major change in the cost of premiums— one of the reasons opponents of the ACA are so strongly against it.

In 2008, the total average premium cost was $12,680, and by 2016 the number jumped to $18,142, according to Kaiser.

“Insuring people doesn’t give] people access to care,” said Brian Miller, DC, chiropractor and coowner of University Village Chiropractic.

“Prices have skyrocketed so much so much that many people don’t get the care they need because they can’t afford their own insurance.”

Meanwhile some of Chicago’s major hospitals opted out of being in network for any individual Obamacare marketplace plans in 2017.

“You can give everyone great coverage, but you may not have a doctor that takes it,” Miller said. “I have lost three physicians myself because they don’t want to take my insurance. Our health insurance has tripled over several years.”

Miller used to be on an individual plan, but due to changes in the law, his office had to form a group plan to get costs in line and still be able to stay in network with some of the city’s major hospitals. His family is covered, and his business partner’s family is also covered. After adjusted for taxes, they will pay a whopping $72,000 this year for their insurance policy.

Medical students from Rush University Medical Center, the University of Illinois at Chicago, the University of Chicago, and Northwestern University as well as patient advocates gathered earlier this year at Federal Plaza to oppose the American Health Care Act, the Trump Administration alternative to the Obama
Administration’s Affordable Care Act.

Besides increasing costs for some individuals, the ACA has increased costs for caregivers such as University Village Chiropractic. Coordinating with insurance companies in Miller’s office to cover claims often results in loss of dollars when his office is left with covering the costs of procedures, and a large amount of his office’s time is spent dealing with of insurance and insurance companies.

“I would say 70% of my time is spent on paperwork, insurance verification, getting people approved the processed,” Miller said. “So 70% of my time is spent dealing with insurance companies.”

Meanwhile, the insurance exchanges set up by the ACA saw a decrease in the use of the widercoverage PPO policies over the more restrictive HMO policies and similarly restrictive “exclusive provider organization products.” The more restrictive policies rose from 41% of those offered in 2015 to 52% in 2016, according to the Blue Cross and Blue Shield Association. Across the country, the ACA saw higher coverage rates. The Illinois 1st Congressional District saw the uninsured rate drop from 13.5% in 2013 to 6.8% in 2015; the 7th District saw a fall from 16.9% to 8.1%; the 4th saw a drop from 27.2% to 18.2%; while the 5th saw a reduction from 13.5% to 6.5%, according to FiveThirtyEight, a statistical analysis service headed by Nate Silver.

Cover a majority

“Our whole thing is to cover as many people as you can cover,” Hunter said. “If we can cover a vast majority of people, we need to cover them, because that’s the best thing to do.”

Despite the Republicans’ failure to repeal the ACA on their first attempt, many Chicagoans remain wary of considering that a victory.

“I do not trust this administration to not attempt some other measure of a similar nature,” said Justina Ligori, a nursing student at Rush University Medical Center. “It’s just heartbreaking to think of so many individuals without healthcare, and I feel like the fight certainly isn’t over.”

Ligori nearly lost her father Santo to a form of heart disease that, had it been treated early, would not have brought him so close to losing his life. He started developing symptoms in 2003 but could not get proper treatment because he could not afford medicine and regular doctor visits.

‘Can’t afford doctor’

“I remember he said, ‘I can’t afford to go to the doctor.’ Why does someone have to say that? Why does someone have to compromise their life?” Ligori said. By 2007, fluid had backed up into his lungs because his heart did not work properly. His condition deteriorated further when the left side of his heart failed, followed by the right side failing, too. What started as a manageable heart condition turned to complete heart failure.

Ligori rushed her father to a hospital emergency room, a visit that would cost Santo his home. He was $185,000 in debt. The only way he could pay off his medical debt was by giving up his home. The doctors gave him five years to live, but ten years later Santo is still alive. Ligori said the ACA helped him pay for his medication and medical professionals to monitor his condition and avoid another $185,000 ER visit.

“My dad is my whole motivation” for becoming a nurse, Ligori said. “I don’t care about my student loans. I wake up every day knowing that I have a passion every day. The reason I’m doing what I’m doing; the reason I’m becoming a nurse, is because of what I went through with my dad.”

Community impact

Chicago saw an outpouring of community support for the ACA, as thousands took to the streets to support Obamacare in the face of the Republicans’ plan to dismantle it in March.

“It’s important for people with privilege and power to speak out for those who don’t,” said Sydney Doe, a first year medical student at Northwestern University and West Side native. Doe helped organize Keep America Covered: ChicagoHealth Advocates Die-In, a protest held in Federal Plaza in mid-March. The event brought in medical professionals and students from across the city to show their dissatisfaction with proposals coming out of the U.S. House of Representatives.

“We got into medicine to help people,” Doe said. “That’s why we’re spending all of our time, all of our 20s sitting in libraries working. And it’s really frustrating there’s bureaucracy and corporate greed getting in the way of us being able to help people. “We can’t help patients if they can’t make it to the hospitals to see us.”

Organizations throughout Chicago have concerns about what the future means to the health of the people they serve. “As we were just adjusting to the new health care system, the rules change,” said Byron Sigcho, director of the Pilsen Alliance, a grassroots social justice organization in
Pilsen. “It usually affects the most vulnerable, those who don’t have access to information.

These changes and proposed changes put a lot of pressure on organizations that are small like us.”