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Arizona doctors are calling on the state’s Republican congressional delegation to support the extension of health care premium tax credits, saying that allowing them to expire will have devastating consequences for hospitals and patients alike.
The dispute over whether to extend the tax credits is at the center of the federal government shutdown that began nearly a week ago. Republicans control all three branches of the government but still need the support of seven Democrats in the U.S. Senate to pass a budget. Senate Democrats, meanwhile, have vowed to defeat any plan that doesn’t renew the credits and restore nearly $1 trillion in Medicaid cuts that the GOP won earlier this year.
President Donald Trump and Republicans have refused to consider shoring up funding for either health care initiative, spurning Democratic efforts to kickstart negotiations and defeating a Democratic proposal that would have done both and prevented the government shutdown.
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Dr. Atsuko Koyama, a pediatrician and emergency room physician in Phoenix, blamed Republicans for the failure to reach an agreement on a spending plan to keep the federal government running and accused them of not prioritizing the concerns of their constituents.
“Republicans in Congress have forced this government shutdown rather than work with Democrats to make health care affordable for their constituents, our patients,” she said.
While the premium tax credits have flared partisan tensions in Congress, they are wildly popular among Americans, regardless of their political affiliations. A September poll found that the vast majority of Americans want the subsidies extended beyond the Dec. 31 deadline. Of the people surveyed, 92% who identified as Democrat said they agreed the credits should be renewed and over half, about 59%, of Republicans said the same.
Koyama pointed out that millions of Americans today depend on tax credits to be able to afford insurance through the ACA marketplace, and ripping away those subsidies would force them to consider foregoing coverage. Roughly 22 million Americans currently rely on the credits. In Arizona, 370,817 enrollees took advantage of the credits this year to lower their monthly premium costs.
Health care advocates warn that letting the program expire could cause premiums for everyone — not just those losing the tax credits — to spike at a time when they’re already expected to increase due, in part, to the Medicaid cuts. That combination could ultimately put health care coverage out of reach for many families.
Premiums in Arizona are projected to skyrocket as much as 55% next year.
“We cannot afford a one-two punch of Medicaid cuts and higher ACA premiums,” Koyama said. “Families are already stretched thin and Congress shouldn’t add to their burden.”
And while some skeptics have argued that overpriced medical services are to blame for projected premium increases, Dr. Mirielle Algazi countered that the problem is more complex. The dermatologist from Tucson noted that, while the cost of providing medical care has drastically increased over the years, the rate of compensation for providers hasn’t done the same. Much of that has to do with the fact that emergency rooms have detrimentally low reimbursement rates.
Federal law mandates that hospitals stabilize people experiencing health emergencies, regardless of their ability to pay or their health care coverage.
Family physician Dr. Michael Hamant added that, as the ability of millions of Americans to afford health care coverage is taken away, emergency rooms will become increasingly busy, increasing the cost of health care even for people with private insurance. That’s because the uncompensated care hospitals are required to provide in emergency rooms is made up for by charging insurance companies more for care, which in turn is passed on to people with insurance in the form of higher premiums.
Aside from the financial pressure an exodus of millions will have on the insurance ecosystem, the more urgent concern is the potential human cost, Hamant said.
“As physicians, we have firsthand knowledge of the consequences when patients delay or forgo care because of the cost,” he said. “They end up in emergency rooms with preventable complications or they skip medications that could keep them healthy. In the end, many patients will die unnecessarily.”
