As Senate mulls a health care overhaul, area patients take stock of what coverage changes could mean | St. Louis Public Radio

As Senate mulls a health care overhaul, area patients take stock of what coverage changes could mean

May 31, 2017

A Republican proposal to gut the Affordable Care Act narrowly passed the U.S. House of Representatives and now the U.S. Senate is crafting its own bill to reshape the nation’s health care system. Elected officials have held few town halls to hear from constituents in the St. Louis area about what they want in a health care bill, sparking demonstrations outside representatives’ offices.

Meanwhile, patients in St. Louis are taking stock of how the proposed changes in the House plan could affect their coverage.

What’s in store:

The measure that passed the U.S. House would reduce the deficit by $119 billion over nine years, according to the Congressional Budget Office. It would also leave 23 million more people uninsured, compared to current projections for the Affordable Care Act. Major components of the bill include a rapid phase-out of expanded state Medicaid programs, a retroactive repeal of the rule known as the "individual mandate" which requires individuals to have health coverage or face a penalty, and a series of waivers that allow states to repeal some rules that govern insurance plans.

Proposals from the Senate are still being ironed out in committee, so whether these changes occur depends on what the Senate crafts. Passing a bill in the Senate will take 50 votes, which means Republicans can only afford to lose just two from their party.

St. Louis Public Radio checked in with three people to gauge their hopes and fears of changes to the current health care law.

'To take it away would be a full rejection of her life.'

On the day House Republicans passed their proposal to repeal major parts of the Affordable Care Act, David Mueller drove through a rainstorm to pick up his three-year-old daughter, Marjorie, from daycare.

“I cannot imagine having to explain to my daughter that somebody in Washington, D.C. voted today, to defund her life,” Mueller said quietly, as he sat in the car. “I am so happy to carry that for her.”

Marjorie lives with a rare form of cystic fibrosis. The family had no idea anything was wrong with their infant daughter until she began throwing up a green fluid just hours after her birth. What happened next was harrowing.

After a frantic series of tests, doctors said they couldn’t tell what was wrong, but Marjorie had to have an emergency operation. As hospital staff prepared her for surgery, a nurse asked the new parents if they were Catholic.

“The entire crew stops, and … she asks for some sterilized water and she baptized our daughter — right there,” Mueller remembered. “Because they told us she had a 50-50 shot.”

Marjorie’s medical bills during her first year of life were more than $2 million, well over many lifetime limits imposed by insurance companies before the Affordable Care Act was enacted. Although the Republican plan that passed the House keeps the ACA’s ban on lifetime limits, the proposal allows states to redefine “essential health benefits” – the types of care that must be covered by all health plans. Care not covered under essential health benefits could, potentially, be capped.  

Mueller says Republicans’ plans to dismantle the ACA could be devastating for his family.

“To take it away would be a full rejection of her life. And a full rejection of her life’s value,” Mueller said.

'How do you come up with $400 a month without an income?'

For others, the Affordable Care Act has not lived up to its promises.

Teresa Douglas of south St. Louis County lost her health insurance a few years ago, when she developed back problems and had to stop working. Because Missouri’s legislature voted not to expand Medicaid, Douglas doesn’t qualify for public insurance for low income people. At the same time, she can’t get subsidies to buy insurance on the marketplaces set up by the Affordable Care Act. 

In a screenshot of a video shot of a January 2014 St. Louis County Council meeting, Teresa Douglas speaks in opposition to the Great Streets Initiative.
Credit Gateway TV Network

“How do you come up with $400 a month without an income?” Douglas said. "I hit right in that gap when they cut you off of Medicaid, and when you can qualify for Social Security and Medicare." 

Still, Douglas said the Republican plan is a step in the right direction, even though she doesn't agree with some of the elements. 

“I think that the problems with Obamacare are going to get worse and worse,” Douglas said. “I think it’s a solution to be able to provide insurance for the maximum number of people that we can.”

Douglas also serves as secretary for the St. Louis County Republican Central Committee. What would she want her senators to know as they weigh in on the federal health care proposal?

“I applaud the fact that it gets rid of the individual mandate,” she said. “It puts people in the position where it forces people to purchase something they do not want, do not need or can’t afford.”

'They need more care than I do, so that makes more sense.'

Tajee Watkins, a 22-year-old student at the University of Missouri-St. Louis, falls somewhere in the middle.

She works behind the front desk of a small nonprofit that supports victims of domestic violence for 35 hours a week. That’s just under the threshold to qualify for insurance through her employer. 

Tajee Watkins, 22, in the student center at the University of Missouri-St. Louis.
Credit Durrie Bouscaren | St. Louis Public Radio

Last year, her father decided she should sign up for her own coverage, even though the Affordable Care Act allows her to stay on his plan until she turns 26.  

“He felt it was important that I learn how to be an adult and be independent,” Watkins said. “I could stay on his coverage, but he thought it would be better for me, being a very healthy person to go ahead and get my own insurance.”

She pays a $100 a month for a plan she buys on Healthcare.gov—right on the cusp of what she could afford.  

Under the plan by House Republicans, young people like Watkins could pay less for individual insurance —and insurance companies would be able to charge more to older people. But she doesn’t think that’s right:

“I don’t like to watch older people struggle. They shouldn’t have to, and it makes it much harder on them,” Watkins said. “They need more care than I do, so that makes more sense.”

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Follow Durrie on Twitter: @durrieB.