This Staten Island Woman Isn't Worried about Trumpcare

Andrea Wachholtz is getting her dancers ready for a show — checking their positions on stage, making sure the lights and face makeup work together, and adjusting the sound levels of a calypso rendition of Pachelbel’s Canon.

“If all of a sudden, Emma crashes into a wall, we’ll re-block it, ok?” Wachholtz tells the dancers as she stands in front of the stage in the tiny Little Victory Theatre on Staten Island.

It’s an apt name, because for Wachholtz , opening her school for young dancers five years ago and keeping it open has been a series of little victories.

“People think all the money they pay for their kids goes right into my pocket, and I go out and get my nails done,” she said. “But I have a very small studio, and there are months when I barely make ends meet.”

The official name of Wachholtz’s business captures her industrious energy: AIM Studio. The acronym stands for Andrea in Motion.

But she also gets help being an entrepreneur from the federal and state government, in the form of subsidized health coverage. She’s one of more than 900,000 New Yorkers who get private insurance through the state health exchange — and she's one of the 75 percent of them who get some of the most generous subsidies available anywhere, through the state’s unique and fast-growing Essential Plan.

Wachholtz was already getting a steep discount on her coverage when we first met in 2014, the first full year of Obamacare. At the time, she paid around $100 a month for her plan from EmblemHealth, much less than the $400 she estimates she paid monthly prior to the Affordable Care Act.

But Wachholtz  is a Trump supporter who’s very ambivalent about the Obamacare she receives. During the launch, she lost her old plan abruptly and had trouble enrolling in a new one, leaving her coverage in limbo for four months. And since then, she’s also had problems with her annual renewal.

On the other hand, her physician network has steadily improved. She was recently able to get a brain scan at Lenox Hill Hospital on the Upper East Side for a vertigo diagnosis. And as her studio has struggled, and her income has declined, since 2016 she's been able to find an Essential plan that allows her to pay nothing.

“Right now, I don’t have a copay, and I don’t have a monthly payment,” she said.

The free coverage allows her to keep her studio open without sacrificing her health coverage.

“I would have to go without it,” she said – even at the old sub-$100 rate.

Authorized by the Affordable Care Act, this “basic health plan” started in New York last year and now exists only here and in Minnesota. Other people with slightly higher incomes than Wachholtz pay $20 a month.

But it’s not clear how the plan will survive if the GOP replaces Obamacare.

“The coverage for people enrolled in the Essential Plan could really be in jeopardy, and that concerns us very much,” said Donna Frescatore, director of the state health exchange, known as New York State of Health.

The repeal-and-replace bill passed by House Republicans and now being revamped by the Senate doesn’t explicitly terminate these plans, but the federal financing that makes them possible is precarious. Trump-Ryan Care would stringently curtail spending on the main subsidies that make Obamacare possible — the income-based ones that reduce exorbitant insurance premiums. Even more vulnerable are the related “cost-sharing reductions” that dramatically lower deductibles and co-pays for Obamacare enrollees.

By definition, people in health plans purchased on state or federal exchanges make too much to qualify for Medicaid. The people on the first couple of rungs up the income ladder — particularly people who make from $16,000 to $24,000 — have been eligible for the most generous subsidies.

New York last year introduced its Essential Plan for two groups: people in that income tier, and legal immigrants awaiting citizenship. Most states don’t cover them, but since 2001 New York has paid for 100 percent of their health costs, under a ruling by the state’s highest court.

Frescatore said the first group of people — the one that includes Wachholtz  — are now saving an average of $1,100 a year. They're also saving the federal government money, because even though they're getting a more generous subsidy than in the first years of Obamacare, Washington is getting a better per-person price on them from insurers, and bigger matching payments from Albany.

The second group, the legal immigrants, isn't saving any money for individuals — they already weren't paying anything on Medicaid. But their plan does  save a lot of money for New York state, because starting in 2016, the Obama administration let the state transfer these immigrants to the Essential Plan, where the federal government picks up most of their insurance costs.

Transferring them back to New York would cost about $1 billion — on top of an estimated $2 billion that would be lost in subsidy cuts. Frescatore says that taken together, changes to the Essential Plan, the rest of the state health exchange and Medicaid would mean “increasing taxes, cutting benefits dramatically or putting people who currently have insurance on the rolls of the uninsured.”

Republicans say Frescatore and Democrats in general are fear-mongering. New York managed to cover all these people before the Essential Plan, and could once again. And many critics think New York should do a better job containing Medicaid costs, since the state spends more per person than almost any other state. 

Wachholtz  hasn’t followed ANY of these debates — but she isn’t too worried.

"Why am I going to upset myself over something that may or may not occur?" she said. "I’ll deal with it when it happens."

Wachholtz ’s Congressman, Dan Donovan, was one of 20 Republicans who recently rejected the House health care bill supported by Trump. But like many people on Staten Island, Wachholtz is willing to give Trump a chance. 

“People say, ‘Donald Trump is just going to pull the plug and get rid of it,’ but that’s not going to happen,” she said confidently.

Wachholtz  still resents the previous administration for terminating her old insurance, leaving her with that four-month coverage gap. She doesn’t think anything that could emerge from Washington in the future could be worse than that.

I asked her what would happen to her financially — not if the president and Congress “pull the plug,” but if they give her a new plan with monthly premiums of $100 or more and high deductibles and co-pays.

Wachholtz shrugged, smiled, looked down at her hands and twisted the lid on an imaginary vessel.

"Leave the can of worms closed, because it’s working right now," she said. "That’s how I feel about it."