When David Hayes’s then-girlfriend came home to find him passed out in a bathtub last August, he had only had health insurance for a few months.
Hayes couldn’t figure out what had happened. He wasn’t in any physical pain. He figured he must have fainted, but seemed to be feeling fine. Still, his girlfriend insisted he go to the emergency room, and Hayes agreed — a decision that may have saved his life.
Within 24 hours, he was on an operating table.
Turns out, Hayes’s appendix was on the verge of bursting. A CT scan revealed it was wrapped around his intestine, which is why he couldn’t feel any pain. And which is why Hayes is certain that if he hadn’t been able to purchase health insurance at an affordable rate, thanks to the Affordable Care Act, he would have just stayed home instead.
“Not to hyperbolize it too much, but I’d probably be dead,” he said, “just because I wouldn’t have gone in to see the doctor because it’s expensive, and I just wouldn’t have bothered.”
Hayes, 30, is a self-employed, professional working musician, performing at his church, at weddings, parties — anywhere he can make music and money. He brings in about $28,000 after taxes “on a good year,” he said. And so before last year, he had never been able to afford health insurance in his life. He was also raised in the small, conservative city of Abilene, Texas, and for years, he and most of his conservative friends simply preferred to pay the tax penalty for failing to get a health insurance plan rather than hop on the much-despised Obamacare bandwagon. He changed his mind last year after his girlfriend prodded him about it, asking, what if something bad happened?
But even after he now admits that Obamacare likely saved his life, Hayes, who now identifies as a moderate, never shed his skepticism about its flaws. And as Congress considers the new American Health Care Act — which the Congressional Budget Office projects will cause 24 million people to lose access to health insurance by 2026 — Hayes says he isn’t feeling too hopeful. For him, it's the possibility of having to pay more for less care that has him wishing "some of the less horrible people in Congress will get a hold of it" to make changes.
“It seems like a bad deal for everybody,” he said.
The AHCA revolves around four key changes: People who choose not to buy health insurance — like Hayes until last year — would no longer face tax penalties. States would phase out and ultimately halt Medicaid expansions for low-income Americans. The bill would provide tax credits based on age instead of income, disadvantaging people the older they get. And insurers will be allowed to sell plans covering a smaller share of people's medical costs — putting coverage of the 10 essential benefits under Obamacare, such as mental health care and emergency care, up in the air and likely increasing out-of-pocket expenses.
“What will happen is people will be able to come to the doctor’s office — but their medications won’t be covered,” said Katy Caldwell, CEO of Legacy Community Health. “I think we’ll see people forgoing medications or taking half of what they’re supposed to. We'll end up with people who are sicker, especially people with chronic illnesses. And then they’ll end up in the emergency room — which affects costs for all of us.”
The nonpartisan Congressional Budget Office released its projections for the American Health Care Act Monday, presenting a bleak picture for access to care, a semi-OK one for the effect on premiums, and a superb one for the federal budget.
The CBO estimates that the federal government would save about $337 billion — but at the same time, 14 million more people would be uninsured by next year under the new law compared to the current one, rising to 24 million over the next decade. By 2026, Medicaid spending would have been reduced 25 percent under the new bill, and 17 percent fewer people would be covered by Medicaid, largely due to the halt on Medicaid expansion. For those purchasing insurance, premium rates are expected to rise 10 to 15 percent by 2018 and 2019, but expected to be 10 percent lower than they are now by 2026.
In the meantime, however, Caldwell said people over the age of 50 and under 65 (the year people qualify for Medicare), who will have to pay more for health insurance in the marketplace, are most at risk for losing access to care.
“It's great that the rates will come down in 10 years, but what happens tomorrow, next year, the year after? What does somebody who's 55 years old do for the next 10 years?” she said. “They forgo their health insurance, because they can't afford it.”
The future of Medicaid in Texas under the new bill is uncertain. Texas is already one of the 19 states that hasn't accepted the Medicaid expansion anyhow, but future changes in eligibility requirements could present a blockade for the poor and disabled who need it, Caldwell said. According to Legacy Community Health, Harris County is home to about 740,000 uninsured people, and according to Harris Health System — which operates Ben Taub Hospital, Houston's largest public medical facility — about 64 percent of patients it treats are uninsured.
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Overnight, the Medicaid expansion would result in 60,000 more insured people in Harris County and $85 million more in revenue, according to Harris Health, and would insure more than one million people statewide and earn Texas $6 billion in revenue. But for now the county's public hospital system, and many others across the state, relies on a federal waiver to help pick up the tab for uncompensated care, one that expires at the end of this year.
How the expiration of that waiver and the rescinded Medicaid expansion under the new bill would affect the costs to taxpayers is unclear for now. But Caldwell is almost certain it will result in more uninsured poor people, hoping they don't get sick or hurt.
Hayes, for one, knows too well what remaining uninsured could have meant for him last August. Well enough that it almost scares him.
“I try not to think about it,” he said.