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Representatives of Washington Healthplanfinder, the state’s official Affordable Care Act-compliant health benefit exchange, wait to answer questions at a sign-up event in Tukwila, Wash., in November 2014.

Crime Victims Stand to Lose Aid, If Obamacare Goes Away

Without it, state compensation funds would again bear more of the burden.

When Washington State expanded health insurance under the Affordable Care Act, hundreds of thousands gained access to health insurance. It also had a lesser-known impact: it allowed the state to better serve crime victims.

That’s because people haven’t had to rely as much on Washington’s Crime Victims Compensation Program, which helps reimburse medical costs and other expenses for victims of crime statewide. These programs exist across the nation, and are payers of last resort, meaning people who are victims of crime must first exhaust all their options, including health insurance, before turning to the state for help.

Because of this, victims compensation funds have always been most vital for those with little or no insurance. With the advent of the ACA, however, the funds in some states have had to pay out far less for medical and dental bills, allowing the compensation funds to help victims in other ways. But now, with the effort by Republicans to repeal and replace the ACA, it’s not clear if the savings for compensation funds will continue.

In Washington, health-related payments from the funds have dropped by half, going from about $5 million in fiscal year 2014, around the time new insurance markets opened and Medicaid expanded, to about $2.3 million in fiscal year 2016. Shortly after the ACA’s implementation, and amid a growing economy, the state’s lawmakers increased the maximum benefits from $50,000 total per victim to $190,000, including up to $150,000 in medical benefits.

Other states have reported similar outcomes. According to a report by the federal Office for Victims of Crime, 17 states reported a reduction in the number of victims compensation claims in fiscal year 2015. And according to reports submitted to the federal government, eight states recorded recent decreases in claims or payments to crime victims that were likely attributable, at least in part, to expanded health care access under the ACA. In California alone medical and dental payments have gone from $20.7 million to $10.4 million between fiscal years 2014 and 2016. Victims compensation programs are funded by both federal and state money, most of which is collected through fines charged to people convicted of crimes.

Compensation funds pay for a variety of expenses incurred by a crime victim, and the recent healthcare savings have been a boon. In Arizona, a savings of more than $400,000 on medical and dental bills from fiscal years 2014 to 2016 helped increase payments toward funeral expenses and lost wages. In Michigan, where payments decreased by nearly $2 million over roughly the same two-year period, processing times have sped up, and the state is now working on legislation to increase the rate paid to health care providers for sexual-assault exams.

But with years of threats of ACA being overturned, budgeting for victims compensation can be difficult to predict, especially since the new Republican plan, now in the Senate, is incomplete. “We have to wait and see what happens before we can anticipate how it will effect the crime victims services we offer here,” said James McCurtis, director of Michigan’s Crime Victims Services Commission.

But other factors make the overall impact on compensation programs difficult to quantify. Payment caps and guidelines vary by state, but many require that victims cooperate with law enforcement, that they weren’t part of the criminal act, and that they report the crime and apply for benefits within a certain time frame. And not all states, even those that fully adopted the ACA by expanding Medicaid, saw reductions; some have seen claims increase despite widening insurance coverage, which could be due to a variety of factors, including efforts to encourage more victims to apply.