Trump health nominee to get grilled as Obamacare debate heats up

WASHINGTON — A festering debate about who has been hurt or helped more by President Obama's health law  comes as the Senate Finance Committee meets Tuesday to consider the nomination of physician and ACA opponent Rep. Tom Price, R-Ga. When he introduced an ACA replacement bill in 2015, Price said that "under Obamacare, the American people are paying more for health care and getting less — less access, less quality, and fewer choices."

Price, new White House officials and other Republicans in Congress emphasize the cost and inconvenience borne by those who weren’t eligible for Medicaid or subsidies to pay for health care on the ACA exchanges. A Republican Obamacare replacement bill introduced Monday, however, gives states the option of retain subsidies and Medicaid coverage for lower income Americans.

About 20 million people obtained insurance because of the law, according to the Obama administration. It’s much harder to quantify how many people lost their doctor or health plan or faced considerably higher deductibles and premiums. That’s especially true when the numbers include people who lost health insurance when their jobs became classified as part time, a group that counselor to the president Kellyanne Conway included in interviews Sunday.

The estimates used by the new administration tend to be mo harder to prove. There could be as many as 5 million to 10 million people in this group when you add it all up, says employee benefits attorney and former Republican Senate aide Christopher Condeluci. “Objectively, I think it is reasonable to say that it’s in the millions," he says.

"With any big law there are winners and losers," says Condeluci, who helped draft portions of the ACA while working for the Senate Finance Committee.

Prep for the polls: See who is running for president and compare where they stand on key issues in our Voter Guide

Kheng Yap-McGuire of Huntington, W.Va., says she and her husband are in those millions, who she calls "the forgotten people.” She defines her group as those older than 26 and younger than 65 who don’t qualify for subsidies to buy their insurance. She wrote a letter to Obama, Trump and House and Senate leaders in December complaining about the "outrageous" premium increase of 45% facing her and husband, Grant, an attorney.

Yap-McGuire and her husband have decided to go without insurance this year, although they pay for son Loy to have insurance through his college. Their son, Forrest, 24, is insured through his job. She wishes they could buy catastrophic insurance but notes it's only for people aged 30 or younger.  "Please help to make health insurance affordable and cost of doing business one that benefits all Americans," she wrote in her letter to Washington. "No one wins otherwise."

How many people "lost" insurance can be a matter of semantics, however. Urban Institute researchers estimated in 2014 that about 2.6 million had their plans canceled because they didn't meet the ACA requirements, but many would have been able to get subsidized plans on the exchanges or Medicaid.

Many plans that were canceled were also grandfathered in for one or more years and other plans were still available. Insurers have cut the number of doctors and hospitals covered by the individual plans sold on the exchanges, just as many with employer-provided insurance find each year that their plans cover different doctors or benefits.

Numerous groups, including the Kaiser Family Foundation, Robert Wood Johnson Foundation and Urban Institute, have quantified the number of people who have gained insurance under the ACA. For example, the percentage of people who were uninsured and not eligible for Medicare was at its lowest level — 10.4% — last year since at least 1972, according to the Kaiser Family Foundation. 

Read more:

Trump: Regulators should remove burdensome Obamacare penalties

GOP senators outline first Obamacare replacement plan

Price, HHS nominee, says Trump doesn't want to 'pull the rug out on anyone'

Conway also said this week that more women live in poverty and lack health care coverage because of the ACA.

There are 2.6 million people without insurance who live at or below the poverty line and can't get Medicaid because their state didn't expand the program as allowed under the ACA, the Kaiser foundation reported last fall.

There are conflicting data on whether companies have cut employees' hours to avoid the mandate that the businesses provide insurance. FiveThirtyEight reported two years ago that this was occurring, and Condeluci says he is aware of it anecdotally in his benefits work. Early last year, ACA critic Michael Cannon published a roundup of media reports in Forbes on jobs and hours cut by employers that he said were because of the ACA.

The benefits outweigh the losses attributable to the ACA, other experts say.

"At the beginning of the ACA, changes were made to the individual market and there were people who had to shift or change their health plans, but of all Americans that’s a relatively small share," says Diane Rowland, executive vice president of the Kaiser Family Foundation. "Since then, there's been nothing but gains in coverage, in the employer sector, in Medicaid and in the exchanges."

All of these people would be helped, Conway suggested, when insurance becomes more affordable, although the administration hasn't released its plan to do that yet.

When it comes to those in poverty highlighted by Conway, the Medicaid program is the most obvious health care solution.  The single quickest way to covering more families and protecting them from bankruptcy is to expand Medicaid under the ACA to millions of working families as many states have now done," former Centers for Medicare and Medicaid Services acting administrator Andy Slavitt said Sunday.

During the Obama administration, several states resistant to expanding Medicaid did so only after their alternative plans were granted waivers from federal Medicaid rules. The administration claimed they accommodated states as much as they could while staying true to the mission of Medicaid.

Some Republican governors thought able-bodied people should be required to work to get benefits. Indiana tried to get such a waiver, through a plan designed by Trump's nominee to head CMS, Seema Verma, but it was denied by Obama administration officials. Instead the waiver allows the state to voluntarily refer recipients to job training.

Tell us your health care story at healthinsurance@usatoday.com