Doctors, mothers concerned about loss of coverage through ACA

Mary Ann Claytor shares her concerns about the impending repeal of the Affordable Care Act at a roundtable discussion Thursday in Charleston hosted by West Virginians for Affordable Health Care. 

CHARLESTON — A Republican-led Senate vote Thursday brought the repeal of the Affordable Care Act one step closer to reality — a move that could cause 184,000 West Virginians to lose health care coverage. 

Supporters of the ACA are urging lawmakers to reconsider repealing the health care measure until a replacement can be crafted. 

Dr. Jessica McColley, a maternal-child health physician at Cabin Creek Health Systems in Dawes, said she fears the West Virginia children she serves will lose access to critical services. 

West Virginians for Affordable Health Care reports West Virginia stands to lose $14 billion in federal funding for Medicaid, CHIP (Children's Health Insurance Program) and financial assistance for marketplace coverage if the ACA is repealed. 

McColley said she often asked herself before the ACA and Medicaid expansion, "How can I diagnose and treat this child without bankrupting his parents?"

She said she felt like MacGyver having to diagnose a patient without all the tools available to her. 

"Instead of being able to take a specific diagnostic test, the gold standard, you'd have to start three levels down... What may have taken two weeks to figure out would take six months to figure out."

Now, she is able to provide a full spectrum of care to her young patients — children she watched grow and develop on an ultrasound monitor and then helped deliver. 

She said a repeal of the ACA would mean loss of coverage for habilitative services. For example, an autistic child may be covered for occupational therapy to enhance skills they already had, but he or she would not be covered for speech therapy to learn new adaptive skills to improve their quality of life. 

"With the ACA and Medicaid expansion, there are few barriers to care for the pediatric population, including preventative and well visits, all the way up to important diagnostic tests and imaging," McColley added. 

"It is imperative that we in the health community continue to have the ability to provide the highest level of care to those who need it most."

Even those who are covered by private insurance through their employers are concerned about losing protections under the ACA, such as the removal of lifetime limits and access to care regardless of pre-existing conditions. 

Mary Ann Claytor of St. Albans shared her concerns about loss of coverage for her 29-year-old son, Cedric, who has suffered a host of medical conditions and is now paralyzed. 

When Cedric was 20, he was diagnosed with a rare disease that causes massive blood clots in his legs, heart and liver. 

Her private insurance covered her son, but only to a certain point — he had a lifetime limit of $1 million. 

"Just the breakdown of blood clots cost about $600,000," Claytor shared.

She started receiving letters from her insurance company warning her she was approaching the limit. 

The question wouldn't leave her mind, "Are we going to run out of insurance before it's time for his liver transplant?"

Luckily, he received his health care needs without reaching the limit. But it's a worry Claytor could have gone without. 

"You can't just concentrate on the healing and what you have to go through. You have this added stress of, 'What's going to happen when we run out of insurance?'"

With the implementation of the ACA, lifetime limits no longer exist. Insurance companies can also no longer deny access to someone with a pre-existing condition. 

Claytor and her son are now covered by West Virginia Public Employees Insurance Agency (PEIA). She fears if the ACA is repealed, her son will lose coverage because he's well exceeded the prior $1 million lifetime limit. 

"If they do away with ACA, are we going to get some kind of grandfathered rule? What's going to happen? Are we going to get to a notice saying we'll only be covered so much longer because we've met the $1 million? Or are we going to start over with the $1 million? It's the uncertainty of it all."

She and several others at the West Virginians for Affordable Health Care roundtable Thursday in Charleston were critical of Sen. Shelley Moore Capito for casting a vote in favor of repeal without a replacement. 

"I urge our representatives to look in their own children's faces and imagine they're in this situation," Claytor said. "We are being played like pawns, like we’re part of a chess game. Take care of our people — that’s what you were elected to do." 

— Email: wholdren@register-herald.com and follow on Twitter @WendyHoldren

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