In early May, the Republicans in Congress and the White House achieved a slim victory when the U.S. House of Representatives voted 217-213 to repeal the Affordable Care Act (ACA) — commonly known as Obamacare — and replaced it with the American Health Care Act (AHCA), nicknamed Trumpcare.
Aptly named after the president who vouched for it, Republicans in Congress, specifically Speaker Paul Ryan, have been eyeing like a hawk to end the Obamacare. With step one done in that process, the Republicans celebrated their victory in the Rose Garden, drinking craft beer and foreseeing the Trumpcare’s passage in the GOP-controlled Senate. In its current form, Trumpcare has found political and public opposition from people of all walks of life, the question at hand though is, how will it affect Guam if it does pass?
“I think it is good if they keep the pre-existing conditions intact and the benefits,” Dr. Thomas Shieh said. “But the mandate is the main issue. For Guam, I don't think it will affect us very much. Guam is a very independent insurance captive island. Selectcare, Staywell, Netcare, Takecare all will survive. For patients and doctors alike, we still have to wait for the main details to transpire.”
Repealing Obamacare
Obamacare was signed into law on March 23, 2010. The intent was to provide accessible health insurance at fair rates for Americans, offering incentives to the companies by providing government subsidiaries to help backbone the related costs. The law was not implemented perfectly nor did it solve every problem in healthcare system. Nevertheless, it did give coverage to millions of Americans, who otherwise would not have been able to get access to health insurance before the law.
For Guam and other U.S. territories, however, it was a different story. Insurance premiums increased from 33 percent to 53 percent during this period. In “Hate Obamacare? You Should Move to Guam,” the author Sarah Kliff sums up the problem with Obamacare. “Health plans in the territories had to accept all customers, for example, but didn't have any individual mandate or insurance subsidies to lure the healthy people into signing up. This is pretty much a recipe for a death spiral: when the insurance market is open to everyone, but there are no incentives to sign up, it’s usually only the sick people who buy coverage.”
On July 16, 2014, the Obama administration announced insurance companies operating in U.S. territories did not have to abide by the ACA. It was of course a relief for the local providers because, compared to the states, Guam did not get those subsidiaries. However, the insurance markets had destabilized by then and Guam still had to pay a large amount of money for healthcare. Guam opted out of the individual mandate.
“Obamacare didn’t really have any impact on Guam, in my opinion, on insurance or at least for now. There is no mandate on Guam. Obamacare mandates every one buys health insurance. Guam opted out,” Shieh said.
While the repeal of Obamacare that does not affect the U.S. territories might seem like a non-issue, there are two things to consider. First is the federal related backlash of the AHCA that will affect the territories. In 10 years, $880 billion will be cut from Medicaid. “Reduction on Medicaid money— that’s just about all it does,” said Frank Campillo, Selectcare’s plan administrator.
The Guam Department of Public Health and Social Services 2015 statistics show that 44,000 people were enrolled as Medicaid beneficiaries. The number accounts for 26 percent of the population. Guam was allotted $268, 343,113 from the ACA, from 2011-2019. Losing this money further weakens Guam’s healthcare system. This is a trend with the Trump administration, which has been trying to find ways to fund the budget for the border wall between the United States and Mexico, increasing the defense budget, and hiring more border patrol agents. They have been trying to free up money through cutting federal social, educational, health and art programs.
The second thing to consider is that the bill does nothing to fix the known problems Guam has in its health care industry. Take the price of prescription medicine, Guam has to get USDA approved products due to the U.S. Jones act, and the financially accessibility of insurance.
“Despite the President’s and the House Republican Leadership’s efforts appease members of their own party, the bill passed by House Republicans today will cripple health care around the country and force millions of Americans to lose coverage,” Guam’s Delegate to Congress, Madeleine Bordallo said in a statement following the passage of Trumpcare. “It is particularly concerning to Guam because the bill does nothing to address the unique health challenges in the territories and does not include important provisions that would make health care more affordable and accessible.”
While Obamacare may not be a cure-all, it was the closest safety net —next to nothing— that Guam could get from the feds. “The Affordable Care Act was not perfect but we should work to improve it in a way that advances health care for all Americans,” Bordallo said.
Trumpcare seems to be moving the U.S. down a direction where less people will be covered and premiums will be higher. At least 28 million Americans are projected to lose their health insurance. In a modern world where Universal Health Care is a first world right, the U.S. is regressing in coverage. Guam will suffer with the implementation of the American Health Care Act, the federal government will cut programs like Medicaid. Segments of the population, like the poor, sick, and old, will be devastated with health and financially problems that could have been avoided or handled better.
While the version of this bill may eventually be revised, if Trumpcare passes in the Senate in its current form, many of the weakened budgets of these federal social branches will mean less financial aid to Guam.
“I believe that we must find ways to remove the disparity between the 50 states and the territories in Medicaid and bring down insurance costs. I continue to advocate for the elimination of our Medicaid cap, providing Medicaid eligibility to Compact migrants, improving the FMAP to give state-like treatment to the territories, and extending eligibility for the territories to participate in high risk pools extended to the states and D.C.,” Bordallo said.
In the end, Guam and the other U.S. territories will be in a stage of uncertainty when it comes to any federal attempts to solve health care due to our undefined relationship with the US government.