How is this for a cosmic coincidence? Last week, Bakersfield Rep. Kevin McCarthy, the House Republican leader, declared anew that once Donald Trump becomes president, Congress will repeal the Affordable Health Act, popularly known as Obamacare.
“Once it’s repealed you will have hopefully fewer people playing politics and everybody coming to the table to find the best policy,” McCarthy told reporters. “I just want to make sure we get it right.”
As McCarthy was speaking in Washington, 2,377 miles away in Sacramento, the liberal California Budget and Policy Center was releasing a report on Obamacare’s importance to low-income residents, revealing the state’s greatest impact in the state would be felt in McCarthy’s district – making some of his constituents victims of the repeal he advocates.
The ACA gave states the option of expanding Medicaid – called Medi-Cal in California – to a new cohort of low-income residents whose incomes had been too high to qualify previously. This economic segment has been dubbed “the working poor” and its members historically comprised a large portion of the state’s medically uninsured.
California was one of the first to exercise the option, since the ACA also offered to cover all but a tiny portion of the extra cost. Over the next few years, 3.8 million newly qualified Medi-Cal recipients were enrolled.
Additionally, an intensive recruitment campaign drew in about 2 million more Californians who were qualified under the old rules but had not enrolled. In total, California’s Medi-Cal rolls have grown 75 percent from 7.9 million to 13.8 million, more than a third of the state’s population. It means 5.7 million more people are insured now than were insured previously.
Not surprisingly, Medi-Cal’s expansion was the heaviest in the state’s rural counties, which have a disproportionate portion of its low-income families – which the California Budget and Policy Center report drives home.
Tulare County, some of which is represented by McCarthy, had the state’s highest level of Medi-Cal enrollment, 55 percent of its residents, on Jan. 1. The county’s two other congressional members are also Republicans. And in fact, most of the rural Central Valley counties with high rates are represented by Republicans.
Were Obamacare – and its financing – to disappear, as McCarthy suggests, California would face a gigantic dilemma on the fate of its 3.8 million optional Medi-Cal enrollees.
The Department of Finance says that during the current fiscal year, their coverage is costing $16.17 billion, 95 percent coming from the feds.
Were that to disappear, California would either have to tell 3.8 million people they are no longer covered – hitting those Republican-represented rural counties the hardest – or cough up more than $15 billion a year to maintain coverage.
To put that in perspective, it’s roughly what the state spends on all of its colleges and universities and more than it spends on prisons. It would be twice what’s raised by an extra income tax on the state’s highest income residents, which voters just extended for an additional 12 years.
“It’s very premature to say what we’re going to do,” Gov. Jerry Brown said this week. He knows the stakes.