In Focus: Impact of the Affordable Care Act in Appalachia

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The Affordable Care Act could be a saving grace for those in Southeast Ohio who are uninsured or underinsured. It helps cover those who have pre-existing conditions, and provides preventive care to those who could usually not afford it, plus it expands Medicaid and Medicare coverage.

“The uninsured is about 12.5 percent. It’s pretty common, actually in Ohio. In this part of the state, 12 to 15 percent are going to be uninsured.” said LaMar Wyse, head administrator at Doctors Hospital in Nelsonville.

Although the law may appeal to many people in poverty, others in Ohio remain skeptical.

Those worried about the law are concerned about how the government will pay to properly insure the 16% of Americans who don’t have insurance, and who will be footing most of the bill, especially while the country is still in a debt crisis.

Sticker Shock

The Affordable Care Act will cost upwards of $490 billion dollars over the next ten years, according to the Congressional Budget Office. There are about ten different ways that the federal government plans to help pay for this coverage.

Approximately three of these options are taxes on some of the public, while others are taxes on various health care industries.

According to the law, states also have the option of whether they want to implement insurance exchanges to offer a competitive market place for the people who need to find affordable individual insurance, as required by the law.  

In November of 2012, Ohio Gov. John Kasich rejected the option of creating an exchange for Ohio, which means the federal government will run the exchange in the state.

However, State Rep. Debbie Phillips believes this was not a smart decision.

“I personally think that we would have the capability to tailor things more effectively towards the need of Ohioans if we set up the exchanges internally. In general, as government is closer to the people, they have the ability for it to be more responsive,”  Phillips said.

The real question, though, is what provisions will affect those in the Appalachian region the most?

Will the residents of Southeast Ohio actually be paying a high price for the care that they will receive through the new law? That question is a concern for Wyse.

“I think everybody having coverage will help people seek care at the appropriate level. If people are not denied access to care at certain levels because they don’t have the ability to pay for it and aren’t covered, that will help a lot. But the flip side of that is, can we afford it as a society? Or can they afford it as individuals?” he said.

Breaking it Down

Here are some of the major provisions that Southeast Ohioans may be seeing in the next few years to help pay for the law (provided by the Congressional Budget Office):

  • Individuals making more than $200,000 a year and married couples making more than $205,000 a year will see a tax rate increase increase of 0.9 percent to 2.35 percent on Medicare Part A (hospital insurance).
  • Those in the same income bracket will also pay a new 3.8 percent tax on unearned income (dividends, interest, etc.).
  • Only 2% of people/couples in the area fall into the tax bracket and will be affected by the tax, which began in January of this year, and goes through 2019.
  • Drug manufacturers will pay the federal government 16 billion dollars between 2011 and 2019.
  • Those who choose to opt into the Medicare Advantage plan (plans run by private insurers as an alternative to traditional government-run Medicare) will see a reduction in the plans by $132 billion over a ten-year period.


A Private Matter

When the law was initially passed in 2010, there was much speculation about how the government would pay for it, and whether or not the public would be taxed heavily for public health care.

As the research shows, most of the funding for the law will come from those in the highest tax bracket, and the private sector.

It appears that those who cannot afford proper care in the area may receive the coverage that they need without receiving a major hit to their wallets when March rolls around.

To see what taxes and fees could affect you and your family, taxfoundation.org has an interactive calculator to show individualized costs.

Affordable Appalachia

While the costs of these changes are yet to be determined, many believe something needs to be done.

Regarding those in Southeastern Ohio, these healthcare enhancements will help aid the problem that continues to affect so many in the region.  

“I think both access and affordability are real challenges in terms of healthcare for people in my district and throughout Southeastern Ohio. There are currently two counties in the district that I represent that do not have hospitals with 24-hour emergency rooms for example,” Phillips said. “So just that basic access and having somewhere that you can go can be critical.”

Athen's resident, Don Finley Jr., faces the burden of access first hand.   

"There’s no free clinics. I mean you’d having to go around to the other towns." Finley goes on to explain that, "To the best of my knowledge, they’re on their own."

As the various elements of the Affordable Care Act go into effect over the next three years, people in Southeast Ohio, such as Don Finley, will find out how much they are on their own for health care.