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Dayton Health Care Organizations Brace For Obamacare Repeal

Donald Trump
Michael Vadon
Flickr/Creative Commons

More than six million people across the country signed up by the end of 2016 for health plans beginning in January through the Affordable Care Act, President Barack Obama’s signature health care law. That’s a record high. Enrollment was also up in Ohio, one of three dozen states nationwide that expanded Medicaid under the federal health law.  

But President-elect Donald Trump and congressional Republicans have called for repealing at least part of the Affordable Care Act, also known as Obamacare. With just weeks to go before Trump takes office, many in Dayton’s health care community are wondering what those changes could mean for providers and patients -- and the future of economic development in downtown Dayton.

Repeal of the Affordable Care Act could hit certain patients especially hard. Low-income people with coverage through the state’s expanded Medicaid program. And people with preexisting or chronic health conditions. Conditions that are often the most expensive to treat.

Take diabetes, for example.

“Because there are so many other complications. You have the vision, the kidney, the diabetic foot and then they can have the strokes, the heart attacks,” says Dr. Tanisha Richmond, a surgically trained podiatrist on Dayton’s west side.

About half of Dr. Richmond’s patients are diabetic. That makes them high-risk for foot problems.

“So, how are you today?” Dr. Richmond greets one of her regular patients, who has had type 2 diabetes since 2010. “Today you wanted to get your nails cut. And you were having some problems with your prescription,” she says. 

Credit Jess Mador/WYSO
In an exam room, podiatrist Dr. Richmond pulls up a low stool for a closer look at a diabetic patient’s feet. She says it’s important to watch diabetics for signs of potential health trouble. “I'm looking at her skin, I'm looking at her nails, I'm looking for signs of infection,” she says.

In the exam room, Dr. Richmond pulls up a low stool for a closer look at the patient’s feet. She says it’s important to watch diabetics for signs of trouble.

“I'm looking at her skin, I'm looking at her nails, I'm looking for signs of infection,” she says. “I see some scrapes but they are healing.“

The patient tells the doctor she’s worried about a dark spot on her foot.

“Dark like right in there, where you just touched,” the patient says. “My toes are dark.”

Dr. Richmond is concerned about the discoloration. She says she wants to run some tests.

“Would you have time today to get your blood flow checked?” she asks. The patient agrees, and Dr. Richmond orders the diagnostic test.

For diabetics, tests like these could mean avoiding serious and deadly complications such as amputations, blindness and kidney failure. But lab tests can be expensive.

In the past, Dr. Richmond says, many of her low-income, uninsured patients just couldn’t afford to pay.

She says a lot of that has changed since the Affordable Care Act took effect. She’s able to run more necessary tests and provide more comprehensive care because more of her patients have insurance coverage through Ohio’s expanded Medicaid program.

“So the continuity of care just keeps going because they have health care, and it does not stop, and it does not hit roadblocks or walls, where there's just nothing that can be done.”

It’s an improvement from when patients with relatively minor conditions went without needed treatment only to face bigger, more expensive problems down the road.

Credit Office of Governor John Kasich

Gov. John Kasich administration officials say Medicaid expansion through the Affordable Care Act has worked for many Ohioans. A recent report found Medicaid expansion has helped more than 700,000 people across the state -- most of whom were previously uninsured.

That’s because since the state expanded Medicaid in 2014, more people who used to fall into a gap -- where they didn’t earn enough to buy private health insurance, but earned too much to qualify for Medicaid --- are now covered. Ohio’s uninsured rate has been cut in half.  

Amy Rohling McGee, who directs the nonprofit Health Policy Institute of Ohio, says it’s too soon to know exactly when or how the Affordable Care Act could change under the incoming Trump administration. States could get more flexibility to restrict who qualifies for Medicaid. They could reduce doctor reimbursements. Greater flexibility, she says, could also benefit the state’s outcome-driven patient-care model.

“Ohio was one of the states that has made great strides in aligning payment with value. More flexibility from the federal government could accelerate those efforts as well,” she says.

Credit Kaiser Family Foundation

Northwest Dayton’s Five Rivers Health Centers CEO Gina McFarlane-El says patient outcomes have improved dramatically. Compared to before the Affordable Care Act, she says, it’s also been good for the bottom line.

“That self-pay patient that was uninsured, the visit may have cost $125 and our sliding fee scale was to pay at least $20. We had to write off that balance of $105,” she says. “With the Affordable Care Act, now that patient has Medicaid. And so instead of having to write off that amount we're now getting reimbursed.”

But, critics charge, many people’s monthly insurance premiums have also gotten more expensive. A recent analysis by the nonpartisan Center for Health and Economy estimates the hikes could cost taxpayers nearly $10 billion more next year in subsidies.

McFarlane-El acknowledges the federal health law is not without its problems. But it’s been a success for many of her patients. She urges lawmakers debating the future of the Affordable Care Act not to take the country back to a time, before the law took effect, when high numbers of uninsured patients flooded into the health care system.

“The impact that had on the emergency rooms the impact that it had on patients who basically could not get insurance and waited until the last minute,” she says. “We're hoping that there will be some common sense on looking at how well patients have been able to improve their health over the past three years.”

But it’s not just providers and patients whose futures are riding on the outcome of changes to the Affordable Care Act. So are many health care organizations that have invested millions of dollars of new business into the Miami Valley, including Dayton-based health insurance company CareSource.

Credit vistavision / Flickr

CareSource Executive Vice President for Business Development Jon Allison takes the long view. He says any uncertainty around potential changes to the Affordable Care Act won’t stop the company from continuing to expand in the region.

“That is that is absolutely our pathway. Look, we know that there will be changes to our health care system going forward. We're going to be actively engaged to make sure that we are, number one, focused on our mission and focused on health care options for our members, but also doing so in a way that will make CareSource an even stronger citizen for downtown Dayton and for the Miami Valley going forward,” he says.  

CareSource is planning to open a big new building, bringing hundreds of new jobs to downtown Dayton. The facility is expected to open in the next few years.