- The Washington Times - Monday, January 9, 2017

D.C. officials have vowed not to leave the city’s most vulnerable residents without health insurance if Congress repeals the Affordable Care Act, despite the possibility of a $623 million shortfall for health care in the District.

As the chairman of the D.C. Council’s newly formed Health Committee, Vincent Gray is uniquely positioned to take the lead in dealing with the aftermath of a dismantled ACA in the District.

“We’re not going to leave people in the cold. That just won’t happen,” said Mr. Gray, Ward 7 Democrat. “Just from a moral or ethical perspective, we need to find a way to make sure those folks are covered. It’s something to be very worried about.”

Mr. Gray said the biggest threat to residents’ health care could come if Congress takes apart the Medicare expansion that was extended through the ACA.

D.C. Department of Health Care Finance statistics show that the ACA’s expanded Medicaid coverage has insured about 75,000 childless adults who previously weren’t receiving benefits.

Covering those people alone could cost the city hundreds of millions of dollars, which is too much of a cost for the District to shoulder, Mr. Gray said.

“Even though we’re doing extremely well, we’ve never had a $600 million surplus to just convert to health care costs,” he said. “It just wouldn’t be possible.”

That means some compromises might need to be made as to how extensive coverage could be under a city-run plan, he said.

“We’ll be faced with what we can and cannot cover,” said Mr. Gray, a former D.C. mayor. “There will be some very difficult choices. What the Medicaid expansion provided might not be possible.”

The Republican-controlled Congress and incoming Trump administration set up a potential political battleground for Mr. Gray in a mostly Democrat-run city that prides itself on pushing back against federal interference. Mr. Gray noted his limited legislative power in dealing with Congress on the ACA, but he could end up as one of a few major players in rebuilding the District’s health care system.

Mr. Gray hasn’t said whether he intends to run for mayor next year, but he is widely seen as a top challenger to Mayor Muriel Bowser, who ended his re-election bid in the 2014 Democratic primary.

Miss Bowser also has said she will do whatever she can to make sure residents who need health coverage the most don’t end up without any. She said she’s waiting to see details before she can assess how to move forward, but noted that access to health care is a “core value” for the city.

“Until we actually see the details of how Republicans would repeal ACA, it’s difficult to know the full extent of what the impacts would be on District residents and what our options would be for moving forward,” Bowser spokesman Kevin Harris told The Washington Times.

Mr. Harris said the mayor remains opposed to repeal of any kind, “but should it occur, she has long said we would have to evaluate what our options would be for helping people who would be in need of affordable and comprehensive health care options.”

In the letter to House Majority Leader Kevin McCarthy, California Republican, Miss Bowser touted the District’s success with the ACA, citing that 96 percent of the city’s residents were extended coverage through the law. She estimates repealing the law will cost the city $623 million.

“ACA has also created more competition and driven down costs, and now many District residents and small businesses have affordable health coverage for the first time,” Miss Bowser said. “The repeal of all or part of the Affordable Care Act would disrupt our insurance market, impair insurers, and increase costs to the District and consumers.”

Through the D.C. Health Link — the city’s insurance marketplace — about 19,000 residents have found individual insurance plans, the mayor said, adding that about 60,000 people have done so through the city’s small business insurance marketplace.

“Many of these persons have complex medical problems, would be considered high risk in the private market and could not afford unsubsidized premiums,” Miss Bowser said.

Though city leaders are bracing for a crisis should the ACA be repealed, House Speaker Paul D. Ryan, Wisconsin Republican, vowed last week that the GOP would be thoughtful in how it replaces the law.

“We’re going to be methodical, we’re going to be deliberative, and we’re going to do this the right way,” Mr. Ryan said. “We’re going to get this law repealed, we’re going to get this law replaced, and we’re going to have a transition period so that people do not have the rug pulled out from underneath them while we get to a better place.”


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