Health advocates fear serious consequences in places such as the Northern San Joaquin Valley if Republicans led by President-elect Donald Trump repeal the Affordable Care Act.
In a plan released Thursday, Trump promised to work with a GOP-controlled Congress to repeal Obamacare and replace it with coverage that includes Health Savings Accounts, an option that evolved in the insurance market before President Barack Obama signed the health reform law in 2010.
Policy experts say Republicans have enough Senate votes to defund the expansion of Medicaid, which allowed thousands of low-income adults in Stanislaus County to enroll in the Medi-Cal program in the last three years.
A Trump administration will create “a patient-centered health care system that promotes choice, quality and affordability with health insurance and health care, and take any needed action to alleviate the burden imposed on American families and businesses by the law,” says a statement on www.greatagain.gov.
A repeal would threaten coverage for 66,400 people in Stanislaus, San Joaquin, Merced, Mariposa and Tulare counties who have family or individual health insurance through Covered California, the state exchange created under the Affordable Care Act. About 1.4 million Californians are insured through Obamacare and 3.5 million were enrolled in Medi-Cal through the law.
Conservatives have slammed Obamacare for its rising premiums and deductibles, narrow physician networks and the financial losses of participating insurers. Trump’s plan has few details on what would replace Obamacare, said Anthony Wright, director of Health Access California, a health advocacy group.
“What the plan does not include is any recommitment to ensure that 22 million Americans will not lose health coverage resulting from the repeal of the Affordable Care Act,” Wright stated.
In interviews Friday, Trump said he wants to keep parts of Obamacare such as the ban on denying insurance based on preexisting health conditions. Trump proposes high-risk pools for people who are ill and have trouble keeping insurance, but those options have traditionally been expensive and offered limited benefits, Wright said.
Trump, along with House Speaker Paul Ryan, wants to reduce health costs for consumers by allowing insurance sales across state lines, requiring doctors and hospitals to disclose their prices and letting consumers purchase less expensive drugs imported from foreign countries.
Future of exchange
On average, consumers are facing an 8 percent rate increase next year for Covered California health plans in the five-county pricing region that includes Stanislaus. In that region, close to 95 percent of Covered California customers rely on federal subsidies to lower their monthly premiums.
The GOP doesn’t have 60 votes in the Senate to stop a Democratic filibuster that could block repeal of Obamacare next year. According to policy experts, Republicans have the votes for a budget-related bill to remove funding for the cost-sharing federal subsidies and the expansion of Medicaid.
Without the subsidies, Covered California could not offer affordable health plans for customers who struggle to pay their premiums. To keep the exchange viable, state lawmakers could try to support Covered California with state-funded premium assistance.
“They can’t afford it,” said Ed Persike, owner of Persike Benefit Solutions in Modesto. “That is not a practical solution, based purely on economics.”
Persike, who was thrilled with the election outcome, said the federal government needs to address the costs of health care and insurance, which is crippling households and reaching the limit for employers.
“I just renewed a policy of $32,000 a year for a family,” he said. Trump can take some steps to reduce prescription drug costs and remove borders to selling insurance across state lines, Persike said, but should still require insurers to issue policies regardless of a person’s medical history.
Laura Hunt of Modesto said she needed Obamacare because she survived an illness that made it impossible to buy insurance.
“If we lose the subsidies, most of the people I know on Obamacare will not be able to pay for it,” Hunt said. The cost for her Covered California plan next year is $589 a month, without premium assistance, about the same as her mortgage, the widow said.
Robert Laszewski, a health policy consultant in Washington, D.C., wrote in his blog this week that replacing Obamacare will require a bipartisan legislative effort.
Republicans, who are under voter pressure to repeal the health law, could agree to keep popular Affordable Care Act provisions, such as parents keeping grown children on their insurance until the age of 26.
A repeal of Obamacare would also affect local health agencies and safety-net clinics that provide services for people granted benefits through the Medi-Cal expansion.
Mary-Michal Rawling, government affairs director for Golden Valley Health Centers, said a significant amount of Affordable Care Act funding for community health centers is due to sunset next year, and the Merced-based nonprofit will advocate for continued funding.
It is too soon to know what will happen, she said, if the Medicaid expansion is defunded and thousands of adults in the Valley lose Medi-Cal eligibility.
Golden Valley, which has health centers in Stanislaus and Merced counties, has a “no-questions-asked” policy for undocumented people who pay for clinic visits on a sliding scale.
Those services will continue despite Trump’s campaign promises to enforce immigration laws, Rawling said. “The Republicans and Democrats see value in community health centers, and I am confident they will continue to value the work we do at Golden Valley,” Rawling said. “I believe we will still provide the services for undocumented folks, because we have been doing that for so many years.”
Golden Valley is helping people with enrollment in Covered California health plans for 2017 and advising residents to take advantage of the options. An enrollment period began Nov. 1.
With the expansion of Medicaid in 2014, about 9,000 adults were moved from Stanislaus County’s indigent health program to Medi-Cal and the county no longer needed a contract with Doctors Medical Center for hospital care for indigents.
Mary Ann Lee, director of the county Health Services Agency, said she doesn’t know yet how the county will react if expanded Medi-Cal loses funding. Lee said that former indigent health patients continued to see doctors at county health clinics after joining Medi-Cal.
“We are certainly paying attention (to talk of repealing Obamacare) and will have to watch and learn,” Lee said. “It all depends on what happens at the federal level. What the local impact is remains to be determined.”
The county’s Community Services Agency used federal funding to hire employees and expand a Hackett Road call center in 2014 to help with Medi-Cal enrollments.
Local hospitals, which see fewer uninsured patients in their emergency departments, could also be impacted by decisions made at the federal level.
The stock value of Tenet Healthcare Corp. fell 25 percent after Trump’s surprise victory in Tuesday’s election. Tenet owns Doctors Medical Center in Modesto, as well as Doctors Hospital of Manteca and Emanuel Medical Center of Turlock.
Jan Emerson-Shea, a spokeswoman for the California Hospital Association, offered no insights on what could happen with Obamacare but stressed the industry will take part in the discussion. “Our primary goal is making sure hospitals are adequately reimbursed for the care provided to patients,” she said.
Ken Carlson: 209-578-2321