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With proposed ACA repeal plan, NYS lawmakers could face ‘very hard choices’

One of the biggest proposed changes in the ACA repeal bill is about Medicaid. Medicaid now functions on a per person basis. If you qualify, you get it. But in the bill released earlier this week, lawmakers have proposed changing over to a block grant program. That means each state gets a fixed amount of money. If the population that needs Medicaid grows or shrinks, that amount of money remains the same.

“The impact on New York state, who has had significant commitments to providing insurance for everyone that they can in the state, will force some very hard choices,” says Dr. Thomas Mahoney, chief medical officer for Common Ground Health in Rochester.

The majority of people insured through the NY State of Health, the state’s insurance marketplace, receive Medicaid or other heavily subsidized insurance.

“The choices would be to decrease the access to coverage to people who have gotten it at this point from the Affordable Care Act. Or to continue to spend that money to keep people insured and have resulted impact on spending for state infrastructure, schools, other things that are important to people in the state,” Mahoney says.

Another major change in the ACA repeal bill is about the requirement to have insurance. Now people are required to have insurance or they get fined. In the bill, lawmakers say that requirement should go away. Instead, they’re proposing that any break in coverage would mean insurance companies could charge you a higher premium once you’re ready to get insurance again. Mahoney says that makes him nervous.

“I’m really scared by what impact it would have to have people who lose insurance - because of job loss or financial difficulties -  to face a 30 percent increase in their premiums to enter back into the insurance market,” Mahoney says.

Lawmakers are expected to revise the bill and vote in the coming weeks. 

Karen Shakerdge covers health for WXXI News. She has spent the past decade asking people questions about their lives, as a documentary film producer, oral historian and now radio reporter.