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ACA: UTSA Professor Discusses What's Next

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Wendy Rigby
/
Texas Public Radio
Dana Forgione, Ph.D., is a professor of accounting at UTSA. He leads the MBA in the Business of Health program.

Obamacare is on the chopping block in Washington. What happens next will affect millions of people across the country. South Texans have signed up for the Affordable Care Act by the thousands. Wendy Rigby talked to Dana Forgione, Ph.D., University of Texas at San Antonio professor, who is a specialist in healthcare business and legal policy for some perspective on this important issue.

Rigby: The Affordable Care Act was a game-changer for a lot of people, wasn’t it?

Forgione: Absolutely. It was a huge game-changer.

Rigby: Now that there’s this whole debate in Washington about repeal, replace, there’s a lot of uncertainty.

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Credit Wendy Rigby / Texas Public Radio
Even though it's future is uncertain, people are still being recruited for coverage by the Affordable Care Act.

Forgione

: There are about 12 million or so people signed up through the exchanges and probably a number of others who are outside the exchanges and it would certainly impact them if those policies were to go away. I don’t expect politically that’s how it will happen. My guess is that there’s going to be not wholesale repeal, but probably modification, marginal changes. But then again, there’s this push to get it repealed with the budget legislation and that could make it happen fast.

But that’s got a lot of pitfalls to it because one of the complaints about the ACA is that it was a rush job and that there were thing that were not thought out properly. And if the Republicans do the same thing, they’re going to be vulnerable to the same criticisms. So it’s yet to be seen how that’s going to pan out. Certainly it would affect a number of people, especially those who had pre-existing conditions or uninsurable conditions where they couldn’t get coverage elsewhere and now they have plans. And if it were to all of a sudden go away, that would be a very devastating thing for them economically and health-wise. I think politically that’s not real acceptable. I don’t know if that’s the way it’s going to happen but we’ll see.

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Credit Wendy Rigby / Texas Public Radio
Counselors in San Antonio are signing up people for insurance under the Affordable Care Act before a Jan. 31, 2017 deadline.

One of the big issues is that we were never able to sell this to the “young and healthies.” We only got at most about 25 percent. They targeted 40 percent. And without them to subsidize the cost, we ended up with a high cost, adverse risk selection, a lot of the older, sicker patients who needed a lot more resources. And that made it very unprofitable for the health plans that were counting on that risk diversification that they never got.

Rigby: Three huge companies in Texas pulled out.

Forgione: That’s one of the issues. There are some areas that have one plan available. Some areas have no plan available in Arizona and they’ve had to negotiate heavily between the insurance commissioners and the insurance companies to get somebody to pick up those areas.

Rigby: What do you think is going to happen?

Forgione: If it weren’t for this pressure to get a repeal in tied to the budget legislation, I would say it would probably be modification and marginal changes. But you don’t know. They might say we want to get this done on a 51 percent vote and not a 60 percent vote and they may push it through. Trump is now counseling not to do that. But he doesn’t control the Congress. They make their own decisions. Can you say it hasn’t had an adequate and fair chance? Well, maybe so, but this is politics, right? And it was passed without a single Republican vote and this is what happens, right?

Forgione has been working in the business of healthcare for 30 years. He teaches seminar on Medicare regulation and accounting for healthcare organizations.