As President Trump and Republicans in Congress pledge to "repeal and replace" the Affordable Care Act, some members of the University of Maryland community are concerned about what a potential repeal could mean for health care coverage in Maryland and nationwide.
Throughout his presidential campaign, Trump promised he would work with Congress to repeal former President Barack Obama's signature health care law, also known as Obamacare, starting on his first day in office. Congressional Republicans have called for repeals and moved to undo or limit the scope of the law since it was passed in 2010, but now that the party controls the House, the Senate and the White House, lawmakers are faced with the challenges associated with crafting a replacement system.
About 260,000 Marylanders joined Medicaid through the program's expansion under the ACA, and 140,000 have obtained health coverage through Maryland Health Connection, a state marketplace created as a result of the law, according to the state Department for Health and Mental Hygiene.
In Prince George's County, an estimated 88,000 people remained uninsured as of Dec. 5, 2016 — down from 133,000 before the law was enacted, according to Prince George's County Health Connect, a program under the county's Department of Social Services that provides information and enrollment assistance.
Stephen B. Thomas, Maryland Center for Health Equity director and an associate professor of the health services administration, called the ACA "one of the most important pieces of legislation in a generation." The act expanded access to preventative health care and enabled millions of Americans who were previously uninsured to gain health insurance, Thomas said.
"That includes the students on our campus. It also includes their parents, their families especially the residents of Prince George's County," he said. "There is a lot at stake here."
Because Republicans have not come up with a plan to replace the ACA that would ensure the same level of coverage, Thomas said he believes the act will stay in place.
"In my optimistic days, I think that they'll just change the name. They won't call it Obamacare, they'll call it something else, but all the provisions will still be there," he said. "I don't think in the long run the American people will stand for losing their benefits."
Frances Lee, a university government and politics professor, said while there is consensus that Republicans would like to repeal Obamacare, the party has "failed to coalesce around a replacement plan."
"Do they have … a plan that could unify Republicans and also win bipartisan support in the Senate? I think they're a long way from getting there," Lee said. "… To say replace doesn't tell you enough. To replace with what?"
In a closed door meeting, Republican lawmakers voiced concerns about how to "make good on a long-standing promise" to repeal the ACA, The Washington Post reported on Jan. 27. If they move forward with plans to repeal, they'll have to work through questions of who may lose coverage or end up paying more, how to avoid damage to the health care market, keep premiums affordable and have a replacement ready to launch.
Austin Moon, a senior community health major, said his family received health insurance through the ACA's Medicaid expansion for about a year, which allowed them to get check-ups, receive blood tests and visit the hospital at a more affordable rate.
Moon said the act accomplished what it set out to do — insure a large portion of the uninsured population — and added that repealing the ACA without a replacement plan "could be dangerous."
"None of the proposals that have come out … are really fleshed out," he said.
Sophomore Steven Clark said he is in favor of a repeal, but agrees lawmakers need to have a replacement ready simultaneously, or close to simultaneously.
Clark, a government and politics major and secretary of UMD College Republicans, said he doesn't like the mandates in place that force people to buy insurance, and that his parents have seen a 60 percent increase in their health insurance premium as the result of the ACA.
"It's $300 extra a month, and that makes a big difference to middle income families," Clark said. "That's simply something that can't continue to happen and it's only going to get worse."
Clark said that he does like two provisions of the law, one that prevents health insurers from denying coverage because of preexisting conditions and another that allows young people to remain on their parents' health insurance plans until age 26. He said that he would like to see these provisions stay in place in a Republican replacement system.
The University Health Center does not have many students whose coverage would be in jeopardy under an ACA repeal, center director David McBride wrote in an email. But McBride wrote that he has spoken to some students about the potential changes a repeal might cause, and that a common concern among students is pregnancy prevention coverage.
Jenna Messman, university sexual health coordinator, said the center has completed more intrauterine device and LARC consultations, and "certainly inserted many more IUDs" since Trump's election. IUDs prevent pregnancy for up to 10 years.
The health center was averaging four IUD or Nexplanon implant insertions per week since Trump's election on Nov. 8. During the 10 months prior to the election, the average was about one per week.
Senior American studies major Ami Kutzen said women she's talked to since Trump's election are stressed about what types of birth control will be covered and affordable under the Trump administration. More and more of her friends are getting IUDs inserted and discussing different birth control options, she said.
"Either people are talking about it more openly, talking more about what birth control they're using, or it really has picked up a dramatic amount," Kutzen said.
On Tuesday, Democratic state lawmakers introduced a bill that calls on Gov. Larry Hogan and Maryland's congressional delegation to "strongly oppose and resist any repeal of the ACA."
Hogan sent letters in January to House Majority Leader Kevin McCarthy and Sen. Orrin Hatch praising the state's performance in health coverage under the ACA, but the letters did not serve as "a statement in support of any act of Congress."
Del. David Moon (D-Montgomery) said he would like to see the governor do more to protect the state's residents from a federal repeal. A repeal could cost the state an estimated $7.7 billion over the next four years, he said, and would hurt those in Baltimore and rural areas most.
"I couldn't think of an action that Congress could take that would more negatively impact so many different groups — seniors, women, young people, the working poor, rural Marylanders, city dwellers," Moon said. "This ought not be seen as a party line issue … in fact this repeal is going to hurt people in Baltimore City and in the rural parts of the state the most."
College Park Mayor Patrick Wojahn said it is "troubling" to think about College Park residents, students and young people losing their health coverage as the result of a repeal, recalling his time working in legal services after law school, representing people with HIV.
"I met people who were very sick and were not able to get healthcare because they were determined to have a preexisting condition … and as a result were getting sick and dying" Wojahn said. "I'm afraid that that's what we're going to go back to without the Affordable Care Act in place."