RICHMOND, Va. – Despite repeated promises that the replacement for Obamacare would be better, groups digging into the official projections say they show the replacement legislation puts the country back where it was before reform.

According to the Congressional Budget Office, the GOP plan to replace the Affordable Care Act means about 14 million people would lose health coverage next year.

Edwin Park, vice president for health policy at the Center on Budget and Policy Priorities, says eventually, the healthcare system would revert to the crisis situation that the ACA reforms addressed.

"For all promises about replacement, the House bill results in very large coverage losses, and all the progress we made in the number and percentage of people who don't have health coverage, would be lost," he explained.

Republicans point to other CBO projections that the replacement plan would reduce the budget deficit. Park points out that most of the savings comes from shifting Medicaid costs onto the states. He adds the very wealthy and some big healthcare corporations would see huge tax cuts.

Speaker of the House Paul Ryan says many of those who would lose coverage in the first few years would be folks who decide they don't need insurance when the individual mandate is repealed. But Park says what's more likely to happen is premiums would rise, and subsidies that help people pay them would fall. Soon, he predicts, many Americans simply couldn't afford health coverage.

"CBO finds that premiums are going to rise in 2018-2019 by 15 to 20 percent, making coverage unaffordable for some people who'd otherwise get health insurance under the current rules," he added.

Health and Human Services Secretary Tom Price has long argued that under the ACA, the market for individual insurance was in a "death-spiral" that has to be stopped. But Park believes the replacement plan badly undermines those markets long-term.

He says by comparison, CBO found that under current law, those markets are stable and growing.

"Despite the claims the private insurance market is heading to a 'death-spiral,' there's no evidence of that," he said. "In fact, enrollment has continued to grow."

Republicans note that insurers have pulled out of some less-profitable markets. Despite opposition from hospitals, the American Medical Association and AARP, GOP leaders in Congress hope to pass their ACA replacement quickly.


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Until the pandemic, telehealth and telemedicine were still outliers in health care but they have gone mainstream, especially benefiting underserved and rural New Mexico communities.

Heather Dimeris, director of the Office for the Advancement of Telehealth at the Health Resources and Services Administration, the primary federal agency tasked with improving access to health care services for people who are uninsured, isolated or medically vulnerable, said a national conference being held today will bring public- and private-sector leaders together to discuss topics related to best practices.

"Telehealth licensure, agreements between states to help practitioners practice across state lines, as well as access to broadband," Dimeris outlined. "This is free and virtual and it's open for the public."

Dimeris explained government data show patients who get telehealth services have the same, and in some cases better, outcomes as in-person visits.

Dimeris noted underserved communities often see benefits and improvements in their quality of life through behavioral-health services via telehealth. And those who qualify can leverage the federal Lifeline program, a free government phone service through the Federal Communications Commission.

"Internet is really a foundation of good telehealth services and we can do audio-only appointments, or appointments over the phone, but it's always nice to at least have the video chat," Dimeris pointed out. "That connectivity can be really hard in remote areas of New Mexico."

She added expanding virtual visits could cut down lengthy waitlists for urgent appointments. And she acknowledged many people seeking mental health services prefer to talk with a doctor in order to bypass stigma sometimes experienced with office visits in small communities.

A new analysis from Washington state shows passing an initiative making a long-term care benefit program optional could cost taxpayers millions.

Initiative 2124 would make optional the WA Cares program, in which workers contribute a little more than 0.5% of their paychecks for access to long-term care benefits. The Office of Financial Management estimates passage of the initiative would cost the state between $12 million and $31 million within three years.

Kristin Hyde, press secretary for the group No on 2124, said other analyses have found even greater consequences.

"This initiative would effectively actually end the program, it would shutter it, it would bankrupt the program," Hyde contended. "By 2027, in effect benefits would not be able to be paid out for the nearly 4 million workers who have been vesting in the program."

Supporters of the initiative, including Rep. Jim Walsh, R-Aberdeen, said the program provides little practical effect and people should have choice on whether to contribute to the program. Under the program, Washingtonians will have access to up to $36,500 in benefits from the WA Cares Fund starting in 2026.

Hyde noted the program can be used to pay home aides, for instance, which could help more than 800,000 family caregivers in the state. She added many caregivers are women who sometimes have to choose between work and taking care of family members.

"Long-term care is not covered by regular health insurance and it's also not covered by Medicare," Hyde pointed out. "It's this gap and so we're really in a rock and a hard place here. We don't have anywhere to turn."

Hyde explained it is why state lawmakers approved the WA Cares Fund. She stressed the benefits are flexible and available for use on expenses like home modifications as well.


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Kentucky has made some changes to expand access to free transportation for people who need help getting to medical, dental and mental health appointments, picking up prescriptions and more.

Medicaid's nonemergency medical transportation benefit will now include individuals who own a working vehicle but cannot drive due to a medical condition.

Emily Beauregard, executive director of Kentucky Voices for Health, noted it also applies when using the vehicle conflicts with another household member's need to drive to work, school or their own health care appointment.

"It's going to mean that a lot more Medicaid members will be able to schedule these appointments, make it to the doctor, and not have to schedule everything around when a car or a ride is available to them," Beauregard explained.

If the vehicle is unusable or is unsafe, Medicaid members will need a note from a clinician, employer, school, mechanic, or transportation authority stating the vehicle isn't operable. Nearly 60% of Kentucky Medicaid beneficiaries report lack of reliable and affordable transportation as a barrier to receiving health care services, according to data from the University of Kentucky.

Amber Sparks, a Corbin resident, said she relied on nonemergency medical transportation when her son experienced a mental health crisis requiring hospitalization. She recalled not until she needed nonemergency medical transportation did she realize it was available.

"Another instance that I had to deal with it is that my dad was diabetic, and he wasn't homebound, but he did need daily care and daily back-and-forth to appointments," Sparks recounted.

Beauregard outlined how Kentuckians can find out if they quality for transportation assistance.

"They can call the regional broker in their area," Beauregard pointed out. "If they don't have a car in their name -- or if there is a car, but it's in use for work or for school by another adult in the household -- they should be able to get approved for nonemergency medical transportation."

She added rides can be scheduled with those regional brokers by appointment, Monday through Friday, 8 a.m. to 4:30 p.m., or Saturday from 8 a.m. to 1 p.m., at least three business days before their trip. A list of brokers is online at kyloop.org or by calling Kentucky Medicaid at 800-635-2570. For medical emergencies, call 911.