One of the challenges communities like Pulaski face is getting people, especially young people, to consider moving to and staying here. One of the biggest challenges for people seeking to move here, I can tell you from personal experience, is finding affordable healthcare. When I left my job in New York, our family’s monthly COBRA premiums were over $1,800 dollars a month totaling over $20,000 per year. Fortunately, we were able to find a plan through the ACA’s Healthcare.gov that allowed us to purchase a high-deductible healthcare plan for approximately $525 dollars per month. If not for that plan, we certainly would not have moved to Pulaski. For many young people, a yearly cost of over $6,000 would be unreasonable (as it would be at least 10 brand new iPhones).
While there are many aspects of the ACA repeal to discuss, the biggest factor in determining individual insurance costs under the competing plans are tax credits (sometimes referred to as subsidies under the ACA). Under the current Republican American Health Care Act plan, the tax credits under the ACA which “takes family income, local cost of insurance, and age into account, “ will be replaced by “tax credits [based] on age, with a phase out for individuals with incomes above $75,000.” (See http://kff.org/interactive/tax-credits-under-the-affordable-care-act-vs-replacement-proposal-interactive-map/.) To put this in perspective, the Kaiser Family Foundation put together an interactive map showing the change in tax credits for individuals at 27, 40, and 60 years old at various income levels for each county. According to the most recent Census Board information, the median household income in the town of Pulaski is about $37,000 (compared to $47,000 for the county and $65,000 for Virginia). So a 27 year old making $20,000 would see his tax credit drop from $3,020 to $2,000. A 60 year old making $20,000 would see his tax credit drop from over $10,000 to $4,000. Young people making more than $40,000 – of which, data shows, there are relatively few in Pulaski – would see an increase in their tax credit, due to the current tax credit being very low. The ACHA, however, would repeal the individual mandate which encouraged young, healthy people to get health insurance and drive down cost. The ACHA would replace the individual mandate with a premium increase for those who fail to maintain coverage, which will likely fall hardest on those dealing with chronic illnesses and not young healthy people who would otherwise be encouraged to pay insurance premiums. The flat tax credits will therefore be of little use if premiums rise due to lack of enrollment, which the ACHA is likely to do.
Therefore, if the ACHA passes, we will see a massive transfer of wealth not merely from the enormous tax cuts for the wealthy, but from lower-income and older folks to higher-income and younger folks, mostly in other areas, due the changes in the tax credit system. This will make it harder and harder to attract younger people to places like Pulaski, and continue a cycle of depressing everything from wages, to school enrollment, housing prices, and also the availability of healthcare. In the end, everyone in economically depressed areas, with small exceptions for the extremely wealthy, will suffer economically and likely physically, from a lack of affordable healthcare.