Legislature Passes Historic Medi-Cal Expansion Bills

“We are in an Extraordinary Session because we must do extraordinary things to move the state forward” said Assemblymember Mariko Yamada, in her testimony in support of ABX1 1 (Speaker Perez), the bill the expand and streamline the Medi-Cal program.

The bill enjoyed spirited debate before passing off the Assembly Floor today with a 53-22 vote.

ABX1 1 expands the Medi-Cal program to include adults who do not have dependent children, Californians who are currently ineligible for coverage, no matter how low their income may be.  The bill would expand coverage to all adults making less than $15,400 a year, and make it easier to sign up and stay enrolled in coverage.  ABX1 1 is expected to bring at least one million uninsured Californians into comprehensive health care coverage, which for the first three years, will be 100% federally funded.  After 3 years, the federal share of cost will be 90%.

A number of Republican members spoke in opposition to the bill.  Their opposition centered around  “concerns” that when the federal share of costs becomes 90%, it will result in astronomical costs to the state; that the federal government (as Speaker Perez points out, members of their own party) might “change their minds” at any time and withdraw funding; and that somehow health reform has not been adequately vetted and debated.

Members of the Assembly on the Democratic side testified passionately in support of the measure. Many members mentioned the fact that supporting a Medi-Cal expansion is the only economically sound choice that can be made.  Assemblymember Holly Mitchell asked her colleagues “are we really willing to leave billions of dollars on the table and walk away from the opportunity to provide coverage to millions of Californians because of what might happen down the line?”

Dr. Richard Pan, Chair of the Assembly Health Committee, asked colleagues concerned with the potential loss of federal funds to look at the precedent, and consider the fact that the federal government’s commitment to the Medicaid program, in the form of our federal matching funds, has not changed in fifty years. The same with the 2:1 match provided by the SCHIP program in the dozen years of its founding.

To the concern of GOP Assemblyman Wagner that it’s impossible to cut an entitlement once given, Assemblywoman Skinner and others pointed out the severe budget cuts made in the past several years, including Denti-Cal, as examples of when the Legislature did make budget adjustments and tough cuts to respond to new budget realities. Assemblywoman Garcia referred to the problems and need for help of many in her district, saying “You call it an entitlement, I call it equity.”

Speaker John Perez made a passionate closing argument asking for support of the bill, he admonished opponents for presenting a false choice between this expansion and other programs–he argued that if despite the President’s commitment and the existing funding in the federal budget, that federal funding is somehow reduced, the other side should help come up with solutions, rather than deny Californians the help they need.  He reminded members that this is an opportunity to take a major step forward for the most vulnerable Californians and that this is the responsibility of the Legislature and the reason they are here.

On the Senate floor, SBX1 1 (Hernandez), the identical Senate bill, saw a more subdued debate that touched on similar themes.  Senate President Darrell Steinberg made the economic argument for the expansion, pointing out that those who have insurance pay an estimated additional $500 a year to subsidize the uninsured, and that it makes more economic sense to provide coverage, which invests in preventive and primary care, than to subsidize the use of emergency rooms for those who don’t have any other access to care.

Senator Hernandez, the bill’s author presented two scenarios: (1) provide coverage to millions of Californians, draw down billions of federal dollars, make the population healthier, strengthen the safety net and create jobs and stimulate the state’s economy; or, (2) force low-income populations to seek expensive private coverage, force them to choose between food and health care, make the population sicker, then force these individuals to seek care more expensive care or enroll in coverage once they are sick, driving up costs to everyone in the insurance market.

SBX1 1 passed off of the Senate Floor on a 24-7 vote. (There were a few vacancies that will be soon filled by special election; a few members had excused absences due to funerals and other matters.)

Both of these bills will now move to the Health Committees of the second house, where they will likely be amended before moving forward to the Governor’s desk.

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