The new repeal-and-replace legislation passed by the House of Representatives on Thursday is not much different than the original Republican healthcare bill that nobody seemed to want in March.
Health advocates renewed their dire predictions for low-income residents and people who struggle to buy health insurance in Stanislaus and other counties in the Central Valley.
“It will still have a devastating effect on many of the counties in the Central Valley, where 40 to 50 percent of the population are on Medi-Cal,” said Jen Flory, a policy advocate for the Western Center on Law and Poverty.
The latest plan, like the first one, includes caps on federal Medicaid funding for states, prompting experts to release the same bullet points on the impacts in California. The bill is expected to:
▪ Reverse expanded eligibility in the Medi-Cal program that covered 3.7 million California residents under the Affordable Care Act.
▪ Result in a $24 billion cut to the Medi-Cal program and the state budget over 10 years.
▪ Result in a reduction in subsidies, and sharp premium increases for families and single adults who buy affordable insurance through the Covered California exchange.
▪ Increase the charity-care burden for hospitals in Stanislaus and other counties that treat Medi-Cal patients and people covered through the ACA.
In Stanislaus County, about 65,000 residents were enrolled in Medi-Cal due to the expansion of eligibility.
The new bill would gradually diminish federal matching funds for the Medi-Cal program, forcing state leaders to make hard decisions on cutting health services, reducing payments to healthcare providers or continuing with the Medi-Cal expansion.
“There would be a massively large hole in California’s budget and no way to fill the hole without making cuts to Medi-Cal,” said Hannah Katch, a senior policy analyst with the Center on Budget and Policy Priorities (CBPP) in Washington, D.C.
The House bill would change the way tax credits are provided for consumers who purchase insurance on the individual market. Under the GOP plan, the credits would be based on age, instead of the multiple factors for determining levels of premium assistance in the Affordable Care Act.
According to a CBPP analysis, the average annual subsidy would decrease by $2,072 for people in Stanislaus County, $2,055 in San Joaquin County and $3,082 for residents in Merced County.
The bill contains no support for Obamacare cost-sharing subsidies that help low-income families in the Valley pay for out-of-pocket medical expenses.
On average, affected residents are expected to see a $3,445 annual increase in premiums, deductibles and out-of-pocket costs in Stanislaus County. The average increase is projected at $3,436 for residents in San Joaquin County and $4,570 in Merced County.
A late amendment to the legislation would provide $8 billion for supporting high-risk pools in states that choose to allow insurers to charge higher rates to consumers who have previous health problems. It is not considered likely that California would revert to policies that once allowed insurance companies to consider a person’s medical history.
Some experts said that $8 billion would fall short of adequately funding high-risk insurance programs for people with cancer or other illnesses.
The repeal-and-replace bill would do away with the individual mandate that has charged a tax penalty to people who lack insurance. An end to the individual mandate, coupled with the demise of cost-sharing subsidies, was expected to cause turmoil in the individual insurance market in a recent analysis commissioned by the Covered California exchange.
The study predicted that 340,000 state residents would no longer be covered, including people who could no longer afford health care and younger, healthy adults who choose to drop insurance. The analysis predicted premium increases between 28 and 49 percent in 2018, leading to further instability in the state’s insurance market.
Anthony Wright, executive director of Health Access California, said the ultimate effect of the legislation could be 5 million state residents losing coverage, reversing the health policy gains of former President Barack Obama.
“This bill is scary not just for the 5 million Californians who now get help under the ACA, but anyone who may need to rely on Medi-Cal or the ACA’s patient protections in the future,” Wright said.
Ken Carlson: 209-578-2321