Move to Repeal and Replace Obamacare Could Hurt Jewish Agencies

Uncertainty surrounding the fate of the Affordable Care Act has made Jewish agencies uneasy about what lies ahead, with concerns about clients losing health insurance among the main worries.

Now that House Republicans have succeeded in approving a bill to replace the Affordable Care Act, otherwise known as Obamacare, the consequences of doing so are hitting home for a lot people.

Compared to ACA, proposed changes include phasing out the expansion of Medicaid, leaving it up to the states for funding the federal-state program of health insurance for the poor; ending cost-sharing subsidies for private health care; increasing prices of premiums; and letting insurance companies charge older customers as much as five times more than younger — and healthier — individuals.

Backlash has ensued, armed by the Congressional Budget Office’s estimate that 24 million Americans will be affected by the change, leaving them without health insurance by 2026 and cutting $880 billion from Medicaid over a decade. Local Jewish agencies, while relatively measured in their responses, are similarly concerned.

Joanna Johnson, director of individual and family services for Jewish Family and Children’s Service, said the ACA has been a real benefit to JFCS clients.

“Medicaid expansion has helped a lot of people who are lower income — who never had an option of purchasing health insurance — have health care,” she said.

As the replacement bill is configured, Johnson said her clients with would have far fewer options — or no options — in terms of health insurance.

“Before the Affordable Care Act passed, as a social worker we had people sitting across the desk from us who would say, ‘I don’t understand, there’s nothing I can do. I can’t get health insurance due to a pre-existing condition, or just the astronomical costs of insurance.’ We just wouldn’t have options for them,” she recalled. “Whereas now, through the Affordable Care Act, we’ve really been able to help a lot more people get connected with insurance.”

Many people she works with are employed in no-contract jobs or work two or three part-time positions, meaning they don’t come with health insurance, so ACA is their only option.

But Andre Krug, president and CEO of KleinLife, said while he is unsure of what is to come of this repeal, he’s heard many complaints of ACA.

“The problem with Obamacare is it’s getting very expensive for people who are not on subsidies,” he said. “The choices are getting very, very limited.”

Someone who makes $45,000 to $50,000 a year, he used as an example, is not eligible for subsidies.

“That was a shortcoming of Obamacare and what people are complaining about,” explained Krug. “Unless the government finds some kind of comprehensive solution to the problem, it’s not going to be a good thing.”

KleinLife clients will still have health insurance down the road, but what kind is unknown.

“If repeal and replace is in the form that it looks like right now, which is going to limit the state’s access to Medicaid funds, obviously a lot of our clients are going to feel the pinch because the last Medicaid dollars you have in the system [is] the last kind of care you’re going to get,” he said.

There isn’t an easy solution to the nation’s health care affordability crisis, but Jay Spector, president and CEO of JEVS Human Services, said repealing ACA is “devastating.”

“Medicaid expansion allowed people to step beyond the limits on Medicaid and start earning some income and take jobs,” he said. “We have clients who are like that who without that, they’re not going to take any risks with going to work.”

Spector said a challenge to creating a beneficial solution is the general lack of education.

“People think about Medicare, and they know what they’re talking about,” he said. “But Medicaid in people’s eyes is largely viewed as an anti-poverty program, where poor people are getting medical care because they don’t want to work. Subsequently, that’s why you have in that House bill a work provision.”

He noted that Medicaid supports people in nursing homes, people who have a disability or those who are aging.

Kristen Rantanen, JEVS communications and public affairs senior vice president, said seniors now have options to receive services through organizations like JEVS for less costly services in their home as opposed to a nursing home — about a third to a half of the cost.

The impact of Medicaid caps on states like Pennsylvania would be about an $18 billion loss — she cited a recent study by the Robert Wood Johnson Foundation — which translates to a $13 billion shortfall in the state.

“We serve about 6,000 clients through these Medicaid waiver funds a year,” she said.

The states will either have to decrease payments to providers or change what they spent money on, she added, to eliminate benefits.

“We operate our group homes, for example, on a shoestring,” she said. “Probably 85 to 90 percent of the cost in those programs are for staff, which we’re required to have.”

Cathryn Miller-Wilson, HIAS Pennsylvania executive director, said she’s concerned the majority in Congress doesn’t recognize the good that has come out of ACA.

“There’s no question that Obamacare is not the panacea, but it clearly is one step closer,” she said. “Instead of recognizing that, they seem bent on rolling things backward regardless of the costs.”

To be proactive on this matter, Miller-Wilson participates in a “Take Action Philly” initiative along with the Philadelphia legal community.

The next event will be June 13 on the topic of Medicaid cuts.

“Medicaid pays for doctors in residency, for hospitals, for disabled children, adults who don’t have insurance through their jobs and are earning such low wages that they’re eligible,” she said.

“It employs thousands of people who rely on Medicaid for their health care and for their employment.”

For refugees HIAS works with, they are currently eligible for Medicaid for eight months from the time they get here. When HIAS resettles refugees, one of the first things they do is set up medical appointments.

“Many of them have been living in refugee camps without health care for years,” she said. “They have been malnourished, and that includes their children.

“They have flown war and persecution. They have come to this country with nothing but the clothes on their backs, and so it’s ridiculous. It’s a recipe for total failure.”

With the proposal to leave it to the states to divvy up funding, Miller-Wilson is unsure if that would be granted to refugees as opposed to anyone else.

“Of the populations that currently receive Medicaid funding, there isn’t one that needs it more than another. They all need it — that’s why they have it,” she said.

Contact:; 215-832-0737


  1. I am disgusted to read the remarks from HIAS that new refugees get eight months of Medicaid coverage when they arrive in the U.S. We have approximately 500,000 homeless Americans and 10 percent (approximately 50,000) are military veterans, and who knows how many are children.


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