How repealing Obamacare would affect the Lower Shore

Few states have as much to lose as Maryland if President Donald Trump and the Republican Congress make good on his campaign promise to repeal the 2010 health-care reform law.

The federal repeal of the law, known as the Affordable Care Act, could cost the state $1.4 billion in the 2018 fiscal year, state budget analysts warned last week. Most of the money — about $1.2 billion — would come from the federal government's enhanced funding to cover the Medicaid expansion that took place under the law.

As congressional leaders discuss dismantling the law a few miles away in Washington, Maryland health care advocates and state officials have been continuing to urge Marylanders to enroll in the exchange. The law, also known as Obamacare, has reduced the number of uninsured state residents by about 50 percent, they say.

Enrollment in the Maryland Health Exchange thus far has been climbing at faster rates than in previous years. More than 465,500 Marylanders had enrolled in the Maryland Health Connection since it opened on Nov. 1, surpassing the 457,862 who had enrolled by the same date last year. The enrollment period ends on Jan. 31.

As in most of the country, a full repeal of the exchanges and Medicaid expansion would have far-reaching consequences on the Lower Shore.

In Wicomico County, the uninsured rate has plunged to 6 percent, down from 13 percent in 2010, according to Census Bureau estimates. Worcester and Somerset counties have experienced similar boosts in coverage.

People are continuing to sign up for plans right up to the deadline to get coverage for 2017, said Brooke Hughes, a patient "navigator" for the Lower Shore Health Insurance Assistance Program.

"Things are still going business pretty much as usual," she said Monday. "Everyone I've had come in here to get insurance and get coverage is pretty thankful for it."

People who come to sign up are asking what will become of their plans if Congress repeals the Affordable Care Act, but Hughes doesn't have an answer for them.

READ MORE: Harris backs Trump on temporary immigration ban

"We are unsure of any of the changes that are going to be made as much as they are," she said.

Of those 465,500 who have acquired coverage, about 150,000 have enrolled in private health insurance and about 315,500 have enrolled in Medicaid. About 73,500 additional Marylanders have passively re-enrolled, meaning they will retain their same coverage if they do nothing to change their plans, according to data provided by Andrew Ratner, director of marketing and strategic initiatives at the Maryland Health Benefit Exchange.

Whatever Washington's new power structure does, it is unlikely to roll back such gains in health insurance coverage, said Michael Franklin, president and CEO of Atlantic General Hospital in Berlin. In 2015, nearly 10,000 people on the Lower Shore received insurance through state's health exchange or Medicaid expansion, according to the Maryland Health Benefit Exchange.

“The whole dynamic has shifted in the industry that has supported these people," Franklin said. "I don’t think it’s that easy to say the exchanges and the individual insurance market will be gone. I don’t see that as a reality.”

Other reforms would be nearly impossible to undo, including the Affordable Care Act's incentive program to get hospitals and physician offices to convert to electronic medical records. That money has been spent, and the new systems are up and running, including at AGH, Franklin said.

The main problem under the current law, he added, is that the health insurance mandate isn't backed by a strong enough financial penalty. Those who decided to forego coverage in 2016 faced a nearly $700 tax penalty.

With relatively few younger and healthier people to offset the costs of the sicker people who joined, the exchanges raised their deductibles and monthly premiums for the rest.

In Michael Pyles' case, the exchange premium surged 68 percent to more than $1,000 a month.

READ MORE Trump orders two-for-one repeal for all new regulations

He couldn't afford to go without coverage this year because he planned to have surgery to repair a torn rotator cuff in his right shoulder. He easily reached his $6,500 annual deductible on Jan. 13, when he went under the knife. The total bill: $96,000.

“I was happy with the way things were" before the reform law went into effect, said Pyles, a property and life insurance agent who lives in Princess Anne. His previous insurance plan automatically converted into an exchange plan, he said.

He would like to see the federal government allow insurance companies to sell plans across state lines to inject more competition into the market.

Several Republicans, including Trump, have backed such an idea.

The Obama-era reform law has changed the way doctors practice medicine and not necessarily for the better, said Dr. Joe Inzerillo. With more people gaining access to health-care services, many physicians were forced to compress how much time they could spend on individual cases.

Inzerillo, who lives near Princess Anne and works for a network of urgent care clinics in Delaware, planted a Donald Trump sign in his yard before the election. He describes himself as someone who support's the president's policies, if not the man.

He hopes that one key part of the Affordable Care Act remains, though: the coverage mandate for people with pre-existing conditions.

“This has always been something the insurance companies have gotten away with and it’s been devastating to people who need insurance but are sick," Inzerillo said.

An executive order Trump signed on his first day in office gives federal agencies the power to eliminate or loosen some regulations created by the health care law. The move came after the Senate passed a budget resolution that would make it easier to begin rolling back portions of the law.

To continue insuring the thousands of Marylanders who benefit from the Medicaid expansion alone, Maryland, which is already operating on a “lean budget,” would likely have to cut from other programs and services, said Del. Clarence Lam, D-Howard and Baltimore counties.

If the Affordable Care Act is repealed soon, the Maryland General Assembly may need to call a special session later in the year to address the budgetary concerns, Lam added.

“There’s no place to get billions of dollars within the state of Maryland,” said Vincent DeMarco, president of Maryland Citizen’s Health Initiative. “We need to prevent the Affordable Care Act from being repealed and we’re going to work very hard to do that.”

The Capital News Service contributed to this report.