Health Care

With Obamacare, she can run her own business. Without it, she’ll have to close.

David Woolsey, an emergency room physician at Jackson Memorial Hospital, speaks about the strain that repeal of the Affordable Care Act would place on Miami-Dade’s safety net hospital with uninsured patients likely seeking care in the emergency room.
David Woolsey, an emergency room physician at Jackson Memorial Hospital, speaks about the strain that repeal of the Affordable Care Act would place on Miami-Dade’s safety net hospital with uninsured patients likely seeking care in the emergency room. rkoltun@miamiherald.com

Healthy meals are the cornerstone of the small business that Gaby De Jesus of Miami founded in 2015 to help people struggling with weight gain and heart conditions. But affordable health insurance is the key to the company’s survival, she said Tuesday.

Speaking at a press conference opposing repeal of the Affordable Care Act, De Jesus said she launched the private chef service and catering company, Fork & Knives, because the health law better known as Obamacare had given her the option of starting her own business rather than finding a job with health benefits.

“Stop talking politics and take care of your people,” she said, directing her words at Congress, “because the people are the ones pushing to make this country to become what it can become.”

Now, as the Republican-led Congress rushes to repeal the health law, De Jesus is among the more than 1.6 million people in Florida who risk losing the coverage they have gained through the ACA exchange at healthcare.gov.

“I’m stranded here,” said De Jesus, 25, who was diagnosed in December with Chiari malformations, a structural defect in the brain that causes her intense pain, fatigue and Irritable Bowel Syndrome. “It’s either me closing down the business, or me finding another job with health benefits.”

About 18 million Americans could find themselves in the same position as De Jesus within a year after a partial repeal of the ACA, the nonpartisan Congressional Budget Office reported on Tuesday — losing their health insurance coverage and facing a spike in premiums.

By 2026, the number of uninsured Americans could increase by 32 million people and premiums for those who buy their own coverage outside of the workplace would about double, the CBO found.

The report estimated the financial effects of repealing much of Obamacare by passing the Restoring Americans’ Healthcare Freedom Reconciliation Act of 2015, which was proposed by President-elect Donald Trump’s nominee for secretary of Health and Human Services, U.S. Rep. Tom Price of Georgia, a Republican whose confirmation hearing is scheduled for Wednesday.

The CBO report did not consider the impact of any ACA replacement plans proposed by congressional Republicans, who have yet to reach consensus on a plan.

But the bill would repeal only portions of the health law while leaving some of the ACA’s most popular insurance market reforms in place, such as the prohibition on insurers denying coverage to people with pre-existing conditions.

Some of the law’s least popular provisions — including the individual mandate that requires most people to buy health insurance or pay a penalty and the requirement that large employers offer coverage that meets specified standards — would be eliminated under the proposal.

Yet even as Republicans vow to repeal the health law, an NBC News/Wall Street Journal poll also released Tuesday found that Obamacare has never been more popular — a sentiment echoed in Miami by Martha Baker, a registered nurse for Jackson Health System, Miami-Dade’s public hospital network, and president of Service Employees International Union Local 1991.

“Florida is the bull’s-eye of this huge, national debate,” Baker said. “Floridians need the care.”

Without health insurance coverage, Baker predicted, thousands of Miami-Dade residents currently covered under the law would likely turn to emergency rooms for medical care — receiving medical attention only after their health condition has deteriorated.

“We’ll pay five times more to amputate your leg if you’re a diabetic,” she said. “But we won’t pay for you to get insulin.”

Repealing Obamacare would also cut off billions in federal dollars currently flowing into the state to help people pay for their ACA plans, said Katy Huddlestun, an attorney with the nonprofit Florida Legal Services, which advocates for coverage under the health law.

The average monthly subsidy for Floridians with ACA coverage is $305, according to the Centers for Medicare and Medicaid Services.

With nearly 600,000 people in the Miami-Fort Lauderdale market signed up for 2017 coverage on healthcare.gov, according to CMS, the region risks losing about $2.2 billion a year if the health law is repealed without an adequate replacement — which may lead many uninsured patients to seek care at safety net hospitals, such as Jackson, Huddlestun said.

“We’re talking about how do you plug someone into a safety net that has holes big enough to drive a truck through,” said David Woolsey, an emergency room physician at Jackson Memorial Hospital in Miami.

For De Jesus, the 25-year-old Miami woman who started Fork & Knives, waiting for a medical emergency to see a doctor at a safety net hospital is not the future she had envisioned when launching her own business.

De Jesus said she pays $110 a month for a Florida Blue plan she bought on the ACA exchange. She pays an additional $50 a month for her mother’s plan. Together, she said, they receive about $650 a month in government financial aid to cover most of their insurance costs.

Without that financial aid, she said, buying her own coverage on the individual market likely would be out of reach. And so would her dream of building her own business.

“It’s my life at risk now,” De Jesus said.

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