Rich Sutphin

Sutphin

One key to maintaining good health is having good health insurance at an affordable level.

The Affordable Care Act, which became law more than a decade ago, was designed to provide more Americans with good and affordable health insurance. In many cases, that was done by providing subsidies to defray the costs for some people. But skyrocketing consumer costs and increased insurance rates have caught up to working families across West Virginia and the country – enough to reduce access to primary care for some of them.

Fortunately for them, Congress decided to implement expanded ACA subsidies early last year as part of the American Rescue Plan Act during the depths of the pandemic. But those expanded subsidies are in jeopardy and scheduled to expire this year unless Congress acts to extend them. In West Virginia, a failure to extend these subsidies would result in an estimated 5,000 people being kicked off their coverage altogether, with another 18,000 seeing increased rates.

That couldn’t come at a worse time. The pandemic, supply-chain problems and strife overseas have left us with the highest level of inflation in four decades. The West Virginians who depend on the care enabled by the ACA subsidies are already struggling to make ends meet every day. Loss of the subsidies would mean that thousands of them – and millions of other working Americans – would be in danger of not being able to afford their coverage.

What would that mean? Having health care coverage allows many people to stay employed and on the job, so not having the subsidies could increase unemployment. Many of those who might drop coverage then would seek uncompensated care, such as ending up in emergency rooms late at night. As we know, that’s the most expensive form of care, and it increases health care costs for all of us. As bad as this situation might be in urban areas, it would be worse in rural areas – and West Virginia is one of the most rural states.

That effect has been known well for years. Back in 2009, about the time Congress was working to pass the Affordable Care Act, a study by J. Michael McWilliams reported in the Milbank Quarterly that “the health consequences of uninsurance are real.”

More recently, in 2019, the Kaiser Family Foundation reported: “Health insurance makes a difference in whether and when people get necessary medical care, where they get their care, and ultimately, how healthy they are. Uninsured people are far more likely than those with insurance to postpone health care or forgo it altogether. The consequences can be severe, particularly when preventable conditions or chronic diseases go undetected.”

Likewise, the Annals of Internal Medicine reported in 2017: “In several specific conditions, the uninsured have worse survival, and the lack of coverage is associated with lower use of recommended preventive services.”

The Affordable Care Act decreased the number of uninsured Americans from 48 million in 2010 to 28 million in 2016, but the number had risen again to 30 million by the first half of 2020, when the pandemic hit, according to a report from the U.S. Department of Health and Human Services’ Office of the Assistant Secretary for Planning and Evaluation in February 2021.

The increased subsidies in the American Rescue Plan Act helped reverse that climb in the number of uninsured people and proved a critical lifeline for West Virginians – particularly those in rural areas.

But again, that gain is only temporary unless Congress acts to preserve the subsidies. Right now, there’s movement to extend the subsidies this summer, and we need our leaders in Washington to do just that. Congress needs to act and do so quickly. We cannot afford to see the subsidies expire this year, as rural West Virginians are budgeting for a prolonged economic downturn.

Rich Sutphin, Ph.D., is executive director of the West Virginia Rural Health Association, based in Barboursville, W.Va.

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