V.I. government officials and other stakeholders discussed potential risks Virgin Islanders face upon the repeal of the Affordable Health Care Act, also known as Obamacare, sponsored by Republican members of Congress, and agreed certain steps can be taken to improve the territory’s access to federal health care funds under a new law.
Sen. Nereida “Nellie” Rivera-O’Reilly, Senate vice president and chair of the Health, Hospitals and Human Services committee, leads the American Health Care Act task force comprising two dozen representatives from the Departments of Health and Human Services, the delegate to Congress, the medical facilities, AARP and the private sector.
Monday was the second meeting of the task force and several agencies talked about anticipated funding losses and the resulting effects on health care and insurance faced by Virgin Islanders.
According to the task force, the territory receives $36 million in Medicaid funds, but a repeal of the ACA would cut the funding in half. Up to 10,000 of the 23,000 individuals insured through Medicaid would lose eligibility and, with no viable health care insurance providers in the territory, they would have no coverage.
Furthermore, if tax credits are used under the new plan, the local treasury – not the federal government – would be required to participate, putting a strain on the V.I. treasury.
Health Commissioner Michelle Davis said passage of the AHC bill, as it stands, would affect most of the department’s programs including epidemiology, laboratory, children’s health, vaccinations, heart, hypertension, dialysis and vital statistics.
“At risk is $10 to $15 million, on top of the local cuts we’ve just received,” Davis summarized.
Felecia Blyden, Human Services commissioner-designee, said that since many residents would lose Medicaid health insurance and more funding would fall on the local government if the bill passes, her agency is striving to increase the number of people served by Medicaid to increase the amount, unknown at this time, of federal funding.
The hospitals, Frederiksted Health Care Inc. and Health expressed frustration at the slow process of implementing Medicaid’s 17-month-old presumptive eligibility program to enroll patients seeking care before treatment.
Blyden said it is “doable.”
Diane Capehart of Health said the lack of “connectivity” has delayed implementation but Rivera-O’Reilly did not accept it as a good excuse.
“You do have the people. You need the commitment. People have to do more with less or go home,” Rivera-O’Reilly chided.
Tim Lessing, chief financial officer at the Gov. Juan Luis Hospital, said a staff person has been put in place recently to register incoming patients for Medicaid under the presumptive eligibility program.
In response to a question, both commissioners told Rivera-O’Reilly they were looking at the possibility of consolidating jobs and cutting staff in response to a new health care law.
Christopher Finch, former Health commissioner, estimated that based on current coverage, $56.4 million would be needed to cover V.I. health care needs.
Other suggestions to counteract the effects of a new law included asking the Legislature and delegate to Congress to request “rebasing” from the U.S. Centers for Medicare and Medicaid to update the 1996 reimbursement rate for services provided by hospitals and clinics.
Moleto Smith, chief executive officer of the St. Thomas East End Medical Clinic, said Medicare and Medicaid cover almost 70 percent of STEEMC patient care. The Virgin Islands will not be able to absorb the changes without revamping the health care delivery system, he said. Several others at the meeting agreed.
Other suggestions to lower costs included educating the public to utilize physicians, clinics and home care instead of the more costly emergency rooms.
At the end of the meeting, Rivera-O’Reilly said she would forward a draft to all participants of a draft bill to privatize V.I. hospitals. She also said discussion should begin about turning over to a private party the management of Medicare and Medicaid services.