Helpful Rebuttals to Arguments for ACA Repeal or Medicaid Block Grants/Per Capita Caps

Advocates should be prepared to push back against likely criticisms of the ACA and certain conservative proposals. This is critical so that lawmakers who state such talking points feel the pressure and discomfort with their current proposals from their constituents. We want them to think twice about towing the party line and want to hold them accountable when they state misleading points.

Don’t worry – we will replace the ACA with something terrific

  • Press them on the specifics of the plan – will it cover the same number of people? Will people get the same or more financial support? Will current enrollees keep their coverage? Will it cover the same services?
  • There is much talk about reducing costs, but reducing costs for whom? Will costs for low and moderate income beneficiaries go down? How will that be achieved?
  • Get them to explain how the replacement plan would impact your programs

We will retain the popular parts of the law, like prohibiting pre-existing condition discrimination, prohibition on annual and lifetime caps, and other insurance regulations

  • Press them for how they propose to keep the popular parts without the individual mandate. Other states have tried that and it has not worked. How do they plan to keep these requirements and still keep costs down?
  • They may mention requiring people to have ‘continuous coverage’ in order to qualify for insurance with a pre-existing condition. Continuous coverage means you cannot go without insurance, which is very difficult for low income families or people who experience a crisis like job loss or sudden health needs.

The ACA is collapsing on its own

  • Medicaid expansion is working great for our program and those we serve
  • Over one million people have gotten insurance through the ACA – about 650,000 in Medicaid and 350,000 on the Marketplace
  • More people have signed up on the Marketplace this open enrollment than ever before
  • The ACA needs improvement, but don’t throw the baby out with the bathwater. Why not just improve it? Repair the ACA rather than causing all this chaos.

Costs are spiraling out of control

  • Repealing the ACA will not help rising health care costs, which have been increasing for years – long before the ACA
  • The ACA has actually helped slow the growth of health care costs
  • Most of our program participants and neighbors with ACA coverage are on Medicaid or receive a subsidy, making coverage affordable

Don’t worry – the repeal is delayed

  • A delayed repeal will cause chaos – how can we plan for the future? How will the uncertainty affect the economic growth?
  • The Congressional Budget Office estimates that the non-group insurance market will likely collapse without a replacement, even if the repeal is delayed, leading to 18 million people losing coverage nationwide the very next year and premiums spiking after that

Medicaid expansion is crowding out the ‘truly needy’

  • Access to care for Medicaid enrollees has not diminished since Medicaid expansion – in fact, it has improved as providers have been able to invest in new staff and facilities thanks to Medicaid expansion dollars
  • Many who qualify under Medicaid expansion are truly needy. Most individuals experiencing homelessness and many of those struggling with severe mental illness or addiction qualify under Medicaid expansion.

Medicaid expansion has caused waitlists for seniors and people with disabilities

  • Waitlists have existed for many years and are actually increasing at a slower rate since the ACA was passed than they had the previous decade
  • Waitlists in Illinois are caused by insufficient funding of our home and community based services programs. Without Medicaid, this funding deficit would be much worse.
  • Access to nursing homes and home and community based services for seniors and people with disabilities is not limited by the Medicaid expansion population – it is limited by state funding and eligibility requirements. The infusion of federal dollars from Medicaid expansion has helped the state avoid further waitlists and restrictions.

Block grants will give the state needed flexibility in its Medicaid program and control costs

  • Governor Rauner has so far expressed concern about Medicaid block grants. Aren’t you concerned about how this could impact our state and our precarious budget situation?
  • All Medicaid block grant proposals and similar reforms would dramatically cut federal funding and shift costs to the states. This will harm my program and the state.
  • States need resources in order to be innovative and take advantage of any flexibility –how can we be innovative with significantly less money?
  • There is nowhere to reduce Medicaid spending further in Illinois. Medicaid spending has grown much more slowly that private insurance and Illinois has very low rates.
  • The Illinois behavioral health 1115 Medicaid waiver is very innovative and crafted under the current Medicaid structure. But it needs resources and Medicaid expansion to work!
  • Most of the flexibilities we’ve heard about are work requirements, waiting lists, and higher costs for Medicaid beneficiaries. The people we serve who depend on Medicaid will have a hard time meeting those requirements because of their circumstances. What happens to them? They will likely end up in the ED, a hospital or institution, or jail if they go without care.

Why the ACA is Important to Me

Joyce from Chicago (Congressional District 1):

My mom is currently covered under Medicare. She is going blind in one eye and recently moved back to Illinois. I remembered that a Navigator signed her up last year and called to see if he could assist her again. He was able to help my mom sign up for Medicaid and QMB. He was able to give her a number for a local social security office to assist her in signing her up for disability. I was very grateful that he was able to assist her in a timely manner. We really need individuals like this gentleman who are very knowledgeable and genuine.

Janette from Chicago:

My husband and I are examples of people who are hard working and reasonably healthy, who benefited from Obamacare, and who have paid for full price coverage for ourselves ever since we enrolled. I am a psychotherapist and I treat people with PTSD, anxiety, and depression. My husband Bill has been a musician, singer, and music teacher for almost 30 years. We are both paid by the hour and do not have a salary or benefits. Obamacare was a lifesaver for our family, including Bill’s adult children, who we were able to cover under the new law. I can’t say how amazing it was to know that we could enroll without fear of denial of coverage for preexisting conditions or the age of my step children.

After the election, we were afraid we would lose our benefits. At the last minute we were offered health care benefits through my husband’s job. When I found out, I cried with relief to know we will have something more stable that cannot be used as a political tool. We are talking about life or death situations here. I have epilepsy and my husband has hypertension. Both are well managed. What would we do without the security of health care? It strikes me as horribly ironic that I could spend my work week in service to those among us who are traumatized, suicidal, depressed and anxious, and yet have my own ability to receive health care be threatened constantly and even taken away. What kind of people would do this to a whole population, knowing how disastrous the results will be?

Emily from Chicago:

Right after finishing my masters in 2010, I had to move back home to live with my parents because I couldn’t find a job in my field. Working part time in retail, I would never have been able to afford a good healthcare plan and make my student loan payments, car payments, car insurance payments, and pay for my other living expenses without the ACA. And even after I got a full time job in my field–a two year fellowship at a liberal arts college–the pay was not great, so with all my other expenses, I still would have had to drop health insurance so I could eat, pay rent, and get to work. The ACA allowed me to stay on my parents’ insurance policy until I was 26, and because of that I could afford to eat and go to the doctor and get my prescriptions filled. Moreover, because of the mandated coverage of birth control, I was able to get an IUD. My previous birth control medication had given me high blood pressure, and after the ACA I was able to get to an IUD, which is not only long lasting and less expensive long-term but also is most effective form of birth control you can be prescribed. The device and procedure costs at least $600 up front, and without mandated insurance coverage, I could not have afforded to get an IUD. With the insurance mandate, getting an IUD was completely covered. I owe my normal blood pressure, my ability to choose when and if to have children, and my ability to continue to work in the humanities to the ACA. Without it, I wouldn’t be where I am today–in a PhD program, pursuing my dream.

Gregory from Chicago:

My father was a teacher in New York City, and my family had group health insurance through the NYC Board of Education. After my brother and I finished college, we were on our own. I worked in a print shop and then the restaurant industry, but received no insurance. Eventually, a friend of mine convinced me to buy private insurance through the open market, which I did until I went to law school, got married, had kids and was on my wife’s health insurance through her job. After law school, I got a full time job which provided insurance. It was good insurance, but we had to pay more than $1000/month for it. By then, my wife was running a preschool, which was too small to provide insurance. When I lost my job, we lived without insurance for a few months, and then bought private insurance. But since I had had a gap for the first time in more than 20 years, the coverage was minimal and very expensive, and I was accused of having a pre-existing condition and denied future coverage permanently for a very minor ailment for which I had received treatment only twice. When the ACA began, we signed up immediately. If the ACA was eliminated, even though my wife works full time and I run a nonprofit organization, we would have to go back to buying insurance on the private market. We would be subject to unregulated pricing and reduced care. Our children would not have near the same quality of health care that we had when we were children. The costs would be outrageous. It is a national disgrace that health coverage is tied to employment in this country rather than living citizenship. And it is a national shame that we allow the insurance industry — which posts record profits with executives bringing home 8-and-9 digit annual salaries — to dictate our healthcare system.

David from Chicago:

I’m in the field of higher education- I work hard but have faced worsening job quality and increased job instability. Although I have taught a lot as a writing instructor and lecturer at the University of Chicago and the School of the Art Institute of Chicago, neither has provided me with health insurance. The Affordable Care Act has not only provided me with quality, affordable care, but also given me peace of mind in this difficult time as I look to transition careers. I don’t know what I’d do without this safety net, especially if I ever face rocky employment again. If the ACA and my Marketplace plan were taken away and I got sick without insurance, I don’t know if I could ever get coverage again. I thought we were past those days for good.

Laura from Chicago:

In 2008, while I was living in Japan for work, I had a blood sugar test done that showed abnormal sugar levels. When I came back to the U.S. for grad school, I got an Aetna insurance policy as a student. I wanted to get a diagnosis for my high blood sugar, but before I even received one from a doctor, Aetna had already declared that I had a pre-existing diabetic condition. Because my previous insurer had been the Japanese health care system, I did not meet the minimum continuous coverage requirements and was prevented from getting the care I needed for a year- I couldn’t get my blood tests, test strips, or medication covered for 12 months even though I had insurance and paid my premiums every month. I was so relieved when the ACA passed because I thought no American, including me and my family members, would have to face this situation again. My sense of security has only lasted a few years, though, because of threats to repeal the ACA. I’ve seen the kind of care another country can provide for an affordable price. Repealing the ACA will take us backwards in so many ways. If every other first world country can figure it out, so can America.

Abisola from Chicago:

I am pregnant and on a Visa. I was able to apply for a Medicaid at a Federally Qualified Health Center to help pay for doctor visits and with the delivery of my baby.

Joslyn from Chicago:

I had coverage for myself through an employer, but my daughter did not. I was told by the doctor that she had been going to for years that they no longer accepted Medicaid. I went to see a navigator and they assisted me in signing my daughter up for AllKids. The navigator called the doctor and found out they started accepting Medicaid again. I was very relieved and thankful for the assistance of the Navigator- now I know that my daughter will still be able to go to the doctor that she has been seeing she was born.