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The Eagle: Flores votes in favor of American Health Care Act to replace 'Obamacare'

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BRYAN, May 5, 2017 | comments
By Kelan Lyons 

Calling it a "remarkable day," U.S. Rep. Bill Flores was among the Texas delegation to the U.S. House who voted along party lines Thursday to narrowly pass the American Health Care Act.

Flores said he and other legislators from the Lone Star State were brought one step closer to "relieving hardworking Texas families from the failures of Obamacare."

U.S. Rep. Will Hurd, a Texas A&M graduate who once served as student body president, was the only Texan Republican to break ranks and vote against the plan.


The bill now heads to the U.S. Senate, where it could be substantially changed before being sent back to the House. Republicans pulled the core of the bill in March before a scheduled vote, lacking the numbers to begin the fulfillment of their seven-year goal of repealing the Affordable Care Act, commonly known as Obamacare. Since then, legislators added three amendments designed to better protect those with pre-existing conditions from facing extraordinary costs for healthcare coverage and allow states the opportunity to apply for waivers for covering essential health benefits, provided they set up invisible risk pools.

Among the provisions added to the AHCA was a nationwide $8 billion-pledge over five years to fund high-risk pools and help those with pre-existing conditions, an amount the Center on Budget and Policy Priorities called "nowhere close" to meeting the needs of people across America with pre-existing conditions; according to the U.S. Department of Health and Human Services, there are 10.7 million such people in Texas.

Flores said the $8 billion would be "enough money" to cover those with these conditions.

"This only applies to a really small part of the population," he said, since so many people had left the insurance marketplace already.

One of the primary changes to the March legislation that helped the new bill pick up steam was a provision that would allow states to apply for waivers allowing insurers to charge higher premiums based on an individual's "health status," pre-existing conditions, in order to predict an individual's future medical costs.

Gov. Greg Abbott's office did not immediately respond to requests from The Texas Tribune for comment on whether Texas would seek such a waiver. But U.S. Rep. Lloyd Doggett, D-Austin, predicted Texas would pursue that option.

"I think it's almost certain," he told The Texas Tribune.

Flores said he felt "pretty good" about the AHCA's possibility of passing through the Senate, "as long as our senators know what's happening to the American people."

Once the bill moves to the Senate, U.S. Sen. Ted Cruz will likely take center stage as a player. As the House tangled with division, Cruz spent most of the winter and spring avoiding alienating major GOP constituencies.

Now, with the House passing the bill on to the Senate, he will likely emerge a counter to moderating forces in the upper chamber.

Ruth Helpert-Nunez, a 61-year-old diabetic clinical social worker, said she has personal and professional reasons to be a "little concerned" about the passing of the bill.

"It's going to put me in a crisis," said Helpert-Nunez, who owns her own practice in Bryan. As she sees it, she has two options: work more hours and potentially exacerbate her diabetes because of stress due to the longer workday, or be priced out of the market and go without health insurance.

"I'm stable, but will I continue to be stable if I don't have access to proper medical care?" Helpert-Nunez asked of the second dilemma.

Framing the first, Helpert-Nunez wondered aloud whether working more hours, to the detriment of her health, would make her seem hypocritical in the eyes of those she dedicates her professional life to helping.

"What kind of role model am I to take care of people with mental health issues if I'm not working to take care of myself?" she asked.

Medica -- a health insurance provider -- suggested recently it would pull out of Iowa in January 2018, leaving tens of thousands of Iowans without options for individual health coverage. This comes on the heels of Maryland health insurance providers selling through ACA exchanges posting requests for rate hikes between nine and 54.3 percent. Despite the nationwide hikes in premiums over the years, few Americans pay the full cost of their coverage purchased through the exchange; the White House said in 2015 that 86 percent of people on marketplace plans received financial assistance from the federal government to pay for their premiums.

Flores said insurance options in Texas could go the way of Maryland or Iowa: high insurance premiums and deductibles, or no coverage options whatsoever.

Under the ACA plans, said Flores, Texans would lose coverage, but "we're giving them the ability to have coverage options, which they're going to lose under the Obamacare system."

House Republicans voted on this version of the bill without an assessment from the Congressional Budget Office, but the CBO did analyze the previous version: The office projected that version would lower the federal deficit by $337 billion over a decade, but at the cost of causing 24 million to lose their insurance over the same time frame. Premiums would rise until 2020 -- ballooning up to 20 percent higher for single policyholders in 2018 and 2019 -- before falling, according to the CBO analysis. The same report predicted that young policyholders would benefit the most from the bill, while older enrollees would see substantially higher premiums, since the AHCA would scale tax breaks based on age, not income, like the ACA does for subsidies. So, older Americans close-but-not-quite-Medicare-age could face substantially higher premiums. People like Helpert-Nunez.

Currently on a plan purchased through the ACA marketplace, Helpert-Nunez pays a $230 monthly premium. Her medications add up to under $100 per month.

"It's very likely I'll have to go without insurance. I'm concerned about having to pay for my medications," she said.


Flores is adamant that "no one will lose their coverage" because "everyone on the exchange will have a choice of coverage" that will let them "choose whether they want to buy coverage or not," and if they do, they'll have premiums that are "more affordable than they are now."

When Bryan small business owner Jane Gherardi registered for a plan on the health insurance marketplace on Wednesday, all she had to do was click "enroll."

But by Thursday, she wasn't sure if the plan would still be available. (It will -- ACA plans will remain in place until 2020.)

Gherardi and her husband, 56 and 57, respectively, will lose coverage by the end of the week, since her husband recently quit his job. The plan she intended to enroll in would have left her paying a $121 monthly premium. If she exits the insurance marketplace, she estimates she could pay around $1,600 in monthly premiums.

"I suppose I could just not have insurance, but how does that work? I'm 56. Things happen at my age," she said.

Gherardi said the AHCA worried her, since, being in the not-quite-Medicare-age-range, she could face steep premiums, based on the the CBO analysis of the previous bill.

"Should we eat up our retirement?" Gherardi asked, or should she risk high medical bills -- or her health -- and forgo coverage?

"At some point, one way or the other, I will be a burden on my children, which is what I'm striving not to be," she said.

To be clear, Helpert-Nunez, who has been on an ACA plan since January, has been frustrated by her new coverage: she had to change her doctor and, to see a dermatologist, had to drive to Georgetown, taking time away from her patients to travel around 90 miles to see a specialist, which "impacts my income."

But, Helpert-Nunez said, she has a network of people to support her in navigating the healthcare world, being a provider herself.

"I keep looking through the eyes of my clients," she said. "I have a network of people I can turn to, but some people just don't."

The Texas Tribune contributed to this report.

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