As the Republican-controlled Congress gears up to repeal the Affordable Care Act, and the nonpartisan Congressional Budget Office releases an estimate that doing so could cost 32 million people their health insurance, local Jewish groups are scrambling to figure out how to blunt the effects of an impending implosion of Obamacare.
John Kastan, the Jewish Board of Family and Children’s Services’ chief program officer, warns of dire consequences. If Obamacare were replaced with the Republican plan that Congress passed and Obama vetoed last year — the plan the CBO based its report on — “it would have a devastating impact,” he told The Jewish Week Tuesday.
“The Medicaid expansion part of the ACA was obviously very, very significant to us. Medicaid is our largest payer,” he said during a telephone interview. He added that 50 percent of all care provided by the Jewish Board is paid for through Medicaid.
“We’re very, very concerned about it,” he said. “It would be a huge burden.”
Congregation Beth Elohim in Park Slope, Brooklyn, hosts monthly meetings of #GetOrganizedBK, which has a subgroup working specifically on stopping the repeal of the ACA,” Rabbi Rachel Timoner told The Jewish Week via email. The most recent meeting, held Monday night, drew about 900 people, she said.
Reform Jews have been fighting for a better healthcare system long before President-elect Donald Trump arrived on the Obamacare repeal scene, Barbara Weinstein, associate director of the Union for Reform Judaism’s Religious Action Center, told The Jewish Week during a telephone interview from RAC’s headquarters in Washington, D.C.
“When the ACA came on the scene it really mobilized Reform Jews and Reform congregations,” she said. In 2009, then-RAC Director Rabbi David Saperstein was already quoting Jewish law, such as Mishneh Torah, Hilchot De’ot IV: 23, which commands communities to provide healthcare to their inhabitants.
The RAC is currently running a call to action urging people to call their congressional representatives and urge them to vote against the repeal. “This is very much at the forefront on our minds and agenda,” Weinstein said.
The Republican plan passed by Congress last year cuts funding for the ACA’s Medicaid expansion and for subsidies to help low-income people buy insurance. While it also preserves the requirement that insurance cover people with pre-existing conditions at standard rates, it gets rid of tax penalties for those choosing not to buy insurance; that is a key component of the ACA for keeping insurance companies in the red by offsetting the pre-existing condition requirement with a large pool of relatively healthy customers.
According to the CBO report released Tuesday, replacing the ACA with such a plan would cause 18 million people to lose their insurance the first year, and could cost 32 million people their insurance by 2027.
Before the ACA was passed in 2010, Jewish Family Service of Metro Detroit organized local doctors to provide free care to Jews who lacked health insurance.
The Detroit agency closed the doctors’ program after enactment Obamacare, and instead worked to enroll people in health insurance, either through Medicaid or the state insurance exchange.
But now that Obamacare could be repealed, the Detroit agency may have to organize doctors once again. Its CEO, Perry Ohren, expects more families to seek emergency financial aid if they lose coverage.
“People will be hurting and they will have more expenses,” Ohren said.
As Congress moves to repeal and possibly replace the healthcare law, the more than 100 Jewish Family Service agencies across the country are grappling with the question of what will happen once it’s gone. Even as some JFS executives are lobbying Congress to maintain some of the law’s protections, others are planning for a future where philanthropy and state government will have to fill in where Obamacare once was.
Last Thursday morning, Republicans in Congress voted on a budget measure that will move the repeal process forward. It remains unclear what will replace it, as well as when that replacement would be passed.
JFS agencies also receive Medicare and Medicaid reimbursements for the counseling services they provide. According to the Jewish Federations of North America, whose local affiliates provide subsidies to JFS agencies, Jewish communal agencies receive a total of $6 billion a year from Medicaid, which was expanded under the ACA, as well as $1.5 billion a year from Medicare, whose coverage for seniors was also expanded.
“People are sort of on edge, because there are a lot of unknowns,” said Reuben Rotman, executive director of JFS of MetroWest New Jersey.
Even under the existing law, some individuals have had to rely on community support to pay high premiums or get special treatments. Sheryl Grossman, 41, has Bloom syndrome, a genetic disorder that makes her more likely to develop cancer. Grossman has already had cancer nine times, and relies on the support of her community in Baltimore to pay for medicine and doctors’ visits.
She currently has health insurance through a former employer that will last until August. If Obamacare is repealed by the time she needs to purchase new coverage, she expects an individual plan to be too expensive for her, even with friends’ help. If she is without a plan, she’ll be forced to move into an assisted living home.
“If I have to go out and try to get an individual health insurance policy, I won’t be able to get it because I have a genetic condition that predisposes me to cancer,” she said. “People who have pre-existing conditions, a lot of us are facing worse health, if not death.”
Repeal would also affect those with disabilities who rely on the law’s protections. Jessica Belasco, a rabbinical student at the Conservative Jewish Theological Seminary who has a congenital muscle disorder, wants to do work with Jews with disabilities once she graduates, and expected to rely on Obamacare for insurance while she launches her efforts.
“What I have to offer in the Jewish world is something based on entrepreneurship, and I now do not feel free to do that,” she said. “I certainly want to see an outcry in the Jewish world about this.”
JFNA is coordinating Jewish leaders nationwide to lobby congressmen to maintain the law’s protections, which include preventing those with pre-existing conditions from being denied health insurance, assuring that women don’t have to pay higher rates than men and banning caps on lifetime coverage.
A new organization that combines existing umbrella groups for the JFS agencies, the Network of Jewish Human Service Agencies, will also advocate a replacement that maintains care for disadvantaged Americans. Rotman has been named its inaugural CEO.
William Daroff, director of JFNA’s Washington office, recognizes that some sort of repeal will likely happen.
“So we’re working with everyone to ensure that we find pragmatic, bipartisan, common-sense solutions to these seemingly intractable problems,” he said.
Daroff said repeal could happen within a matter of months. But no one can say for certain what the future will hold.
“You can’t dismantle a system where millions of people have coverage in 10 seconds,” said Rotman. “Everyone is trying to stay on top of the news.”
JTA contributed to this report.