Last week, Congressional representatives across the country and California heard a loud and powerful message from their constituents angry about attempts over proposed plans to repeal the Affordable Care Act. Their constituents were right to be concerned—in California alone, the proposal to repeal the ACA alone would undo coverage for over five million Californians—over 4 million who now get coverage through the ACA’s Medi-Cal expansion, and the over 1 million who get financial help through Covered California to afford coverage. People concerned about the loss of this affordability assistance, or of key consumer protections including for those with pre-existing conditions, are understandably upset, concerned, and active, and made their presence felt.
Californians made their concerns about ACA repeal heard in town halls with members of Congress from Los Angeles to San Francisco, from Mariposa to Sonora. While none of the 13 California Congressional Representatives who voted to begin the process of repealing the ACA in January saw fit to hold town hall meetings, local communities took it upon themselves to hold their own town halls and events. While the Representatives didn’t appear, hundreds of people did come out in Modesto, Orange County, and elsewhere. In San Diego, community members crowd-sourced $20,000 to fund a newspaper ad to invite Rep. Issa to a town hall just a week ago—and while he didn’t show, over 2,000 of his constituents did. Other community members found times when their members would be at fundraisers or other events, with hundreds protesting outside in Bakersfield and in Auburn. Frustrated by the refusal of their elected Representatives to meet with their constituents and answer questions about the real impacts of repealing the ACA and what a replacement might look like, many communities organized candlelight processions through the Congressmembers’ neighborhoods to express the depth of their concern.
At the end of the week, some of these questions were answered, when the House leadership’s legislative language leaked for all to see on Friday. Over the weekend, a leaked Powerpoint presentation at the National Governors Association revealed what industry consultants see as the impacts of the House leadership’s plans. That’s the only information that has been made public. Apparently, a newer version was rumored Thursday–one locked away in a room in the Capitol basement, guarded and not allowed for anybody other than certain Republican Congressmembers to see. But when Senator Rand Paul and Representative Steny Hoyer went looking for it, it was nowhere to be found. So the leaked version is still all we have–and the contents are worth your attention.
The upshot is that if Californians were concerned about their coverage last week, they should be alarmed and angry this week. The proposal does rollback ACA coverage expansions of Obamacare for five million Californians—ending the Medicaid expansion in 2020. This includes:
- An $8-17 billion cut to our Medi-Cal program, probably eliminating coverage for 4 million Californians
- Reducing the affordability tax credits which now helps over one million Californians with an average subsidy of $309/month. The proposal would also shift subsidies away from low-income Californians up the income scale by age-disproportionately impacting California, which has the biggest percentage of young people 20-35 in our exchange in the country, at 37%.
The shocking revelation about the leaks is not that it repeals the direct help providing to five million Californians under the Affordable Care Act, but how much further it goes in undermining coverage for the rest of the state as well, and the two big pillars of California’s health care system, capping Medi-Cal and taxing employer-based coverage. The proposal would place a “per capita cap” on Medicaid, removing the guarantee that 14 million Californians depend on. The plan would also begin to remove the deduction for employer-based coverage, taxing a portion of health benefits as income for employees while encouraging employers to drop or scale back their on-the-job health benefits.
This draft by Speaker Ryan and Majority Leader McCarthy isn’t repeal and replace—this is repeal and destroy, with policies that seek to undermine two main pillars of our health system of employer-based coverage and Medi-Cal, the public and private coverage that nearly every Californian relies on.
Under the leaked House leadership’s proposal, millions of Californians in public and private coverage will lose their care. The plan goes far beyond repealing the Affordable Care Act and the coverage for five million Californians by also undermining employer-based coverage (which covers 18 million Californians) and Medi-Cal (covering 14 million Californians), the two main ways Californians get insured.
- Employer based coverage is the mainstay of our health care system. But while nearly 60% of the country gets coverage through on-the-job benefits, either as a worker or a family member of a worker, California’s rate is just under 50%. This puts at risk the health care of 18 million Californians with employer based coverage.
- If half of Californians get coverage through employers-based coverage, the other big pillar of our health care system is Medi-Cal, which covers 14 million Californians–over a third of our state’s population. Medi-Cal covers more than half of all children, and more than half the people in some areas of our state, like key Central Valley counties. While much has been made of the effort to repeal the ACA’s Medi-Cal coverage, there has been less attention to the massive cuts of tens of billions of dollars proposed to the full Medi-Cal program, and what that means.
- Beyond employer based coverage and public programs, the other way that people get coverage is to buy it as an individual. Of the 3 million who buy coverage as individuals, about half do it through Covered California, and get a tax credit. But reducing and changing those subsidies would cause hundreds of thousands to leave the marketplace, leaving the rest in a smaller and sicker insurance pool, causing rates to skyrocket—doubling over and above medical inflation within a decade, likely crashing the individual market.
So under this repeal and destroy plan, no coverage is safe—not public or private, not group or individual market.
We should keep what works in health care and fix what doesn’t, yet the Ryan/McCarthy plan would do the opposite. While they promised not to pull the rug out from under anyone, this plan undermines the whole health system. All Californians should be alarmed by Congress’ rush to repeal coverage with a plan that would leave millions with much higher health costs if not uncovered altogether.