Las Vegas Sun

November 20, 2018

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Analysis: Advocates look to 2018 midterms to restore, protect ACA

With a voice that was nearly taken from him by a rare form of cancer in his larynx, Joe Merlino makes a powerful argument in favor of the Affordable Care Act and Medicaid expansion.

In 2014, Merlino was hospitalized after suffering an infection and complications from surgery to remove the cancer, including a condition in which his trachea shrank to just a couple of millimeters wide.

“It was like breathing through one of those little straws you stir coffee with,” he said. “Try it sometime. I guarantee it’s a terrible feeling.”

Merlino had enrolled in Medicaid just two months before the infection, after losing his employer-sponsored health insurance due to the length of his leave of absence after his surgery. Medicaid paid for a subsequent surgery to deal with the infection and reopen his trachea, and Merlino later purchased a plan on the ACA exchange that covered subsequent doctor’s visits, scans and surgeries.

Finally, in January 2016, he was able to return to his job in customer service for a major airline.

“Medicaid and the ACA took this 40-something-year-old, in his prime working years, who was shaken down by a devastating diagnosis, and brought him back from near death to a 50-something-year-old, functioning, working and taxpaying American again,” Merlino said during a news conference Friday to commemorate the eighth anniversary of the ACA’s passage.

Merlino, of Las Vegas, was one of many Americans who told stories last week of how they benefited from Obamacare and expanded Medicaid. Their messages were generally aimed at two audiences: Republican lawmakers who are trying to dismantle the ACA, and people without health care who need to know that they can still receive coverage under the law.

Some messages were directed at voters, too. After being weakened by the Trump administration and Republican leadership in Congress, the ACA’s fate now hinges on this November’s midterm elections.

Already, the GOP has undercut the law, with Donald Trump stopping payment of billions of dollars of cost-sharing subsidies and repealing the individual mandate for health care coverage. Although some polls show Americans are supportive of the ACA, advocates are concerned that increases in costs of premiums for Obamacare plans — fueled by the elimination of cost-sharing subsidies — could erode that support.

During the news conference in which Merlino told his story, Nevada congressional candidate Allison Stephens discussed how medical costs for her son, who was diagnosed at age 3 with juvenile arthritis, affected her family.

Stephens, a former UnitedHealthcare employee, said she was transitioning into another job and faced the decision of whether to obtain COBRA coverage — an extension of her employer’s health plan in which she would pay the full premium — or pay for her son’s prescriptions out of pocket. The COBRA plan cost $1,000 a month, she said.

“When I called, it turned out that his prescriptions would have cost me over $5,000 a month,” she said. “Those are the realities that people have to face when they don't have insurance, and that shouldn't be the case.”

Adding in specialists’ services, doctor’s visits and blood work, Stephens said her son’s monthly expenses would be roughly $8,000. Although she has had employer-sponsored health plans to cover her son’s expenses, Stephens said the costs point out the need for the ACA and Medicare expansion. Stephens is seeking the congressional seat currently held by Rep. Ruben Kihuen, D-Nev., and is a member of the Nevada Board of Regents.

“Let's proceed with the ACA, not go backward and not repeal,” she said. “We need to move forward so that everyone has access to health care.”

Maggie Salas Crespo, communications coordinator for the Children’s Advocacy Alliance, said Nevada had been one of the nation’s biggest success stories in terms of the ACA’s impact on children.

“Since the implementation of the ACA and the Medicaid expansion, Nevada had the largest percentage increase of insured children across the nation to 93 percent,” she said. “We also made significant improvements in children accessing health care in small towns and rural areas. We decreased the rate of uninsured children in these areas from 21 percent to 7 percent.”

But despite the advances, Nevada still has room to improve, Salas Crespo said. The state hasn’t reached the national average in the rate of children covered by insurance — 95.5 percent.

“As health care advocates, we should be pushing to increase access to health care instead of focusing on attempts to repeal the ACA,” she said.

Alberto Ochoa, principal of SmartBuy Insurance, said after the news conference that the ACA’s uncertain future had become a source of worry for him. SmartBuy, a Nevada Health Link licensed broker, helps people and businesses with the ACA application and enrollment process.

“We see a number of people coming to us with a number of chronic illnesses — diabetes, COPD and many more — and you worry about those people. And you just hope they can continue to get the coverage they need,” he said.