OAKLAND, Calif. – While in Washington D.C., Republicans were starting to tear down the Affordable Care Act, here in California the emphasis is on how to keep and improve the program.
California has been a leader in implementing all aspects of the health care law, including the ACA’s provision for expanding Medi-Cal (the state’s Medicaid program). Over 3.6 million Californians are newly covered under the expansion, bringing the total covered by Medi-Cal to 14.3 million, or more than one-third of Californians. Sixty percent of the state’s children are now covered by Medi-Cal.
An additional 1.4 million people have been able to get coverage through the state’s exchange, Covered California. Most get financial help so they can afford it.
The budget proposals Gov. Jerry Brown delivered to the state legislature Jan. 10 reflected his concerns over the uncertainties ahead, as well as his customary caution. Brown called for “tempering spending growth” and increasing the state’s reserve fund, and urged dropping some spending proposals introduced but not acted on last year.
At the same time, he called for increasing the number of Californians covered “under the optimal expansion provisions of the Affordable Care Act” to 4.1 million, which he said would raise the state General Fund’s share of the cost from the present $888 million to nearly $1.6 billion.
Just days later, Brown warned the new Republican-led Congress that ending the ACA “without passing a suitable alternative” would not only harm millions of Californians, but would also “destabilize the commercial market for small business owners and individuals,” potentially causing many to be priced out of the market.
The governor was responding to a request for comment from House Majority Leader Kevin McCarthy, who represents a California district. Brown said the ACA had helped to cut the ranks of uninsured Californians from 17.2 percent in 2013 to 7.4 percent now, the lowest level ever.
While the state is ready to work with Congress on “decent and real solutions,” Brown warned that shifting billions in costs to the states would be “a very cynical way to prop up the federal budget.”
Anthony Wright, executive director of the nearly 60-organization Health Access California coalition health-access.org, noted that Brown’s budget proposals continue support for Medi-Cal, but warned that Californians should be concerned with Congress’ rush to repeal coverage without any replacement in place, not just for those newly covered but “for the health system and the state as a whole.”
On Jan. 5, some 85 health-related, labor, immigrant rights, religious, environmental and other organizations sent a letter initiated by Health Access to members of California’s Congressional delegation. “Our organizations are very concerned about proposals that would throw California’s health system into chaos, removing the guarantees provided to us by Medicare, Medicaid, and the Affordable Care Act,” they said. “We urge you to invest in and improve our health system, and not pursue efforts to repeal the Affordable Care Act, cap the Medicaid program through a block grant or per capita cap, and privatize Medicare.”
The organizations pointed out gains under the ACA, including cutting the uninsured rate, free preventive services, a ban on denying or charging higher premiums to those with preexisting conditions, and elimination of lifetime caps. They also noted that the federal ACA funding flowing to California’s health care providers creates jobs and boosts local economies.
“The health and lives of millions of Californians are at stake,” the letter said. “We ask you to uphold the significant gains that have been made and ensure that any action taken by Congress safeguards the coverage, benefits, consumer and financial protections that the people of California currently enjoy.”
Early in January, state Senate President Kevin de Leόn, D-Los Angeles, and Health Committee chair Sen. Ed Hernandez, D-West Covina, called on Rep. McCarthy to “contemplate and assess the real impact” repeal of the ACA “would have on the real lives of our most vulnerable constituents … Rather than repeal the ACA, we suggest focusing on measures that increase coverage, while improving affordability and market stability.”
They urged instead that changes focus on cutting what people must pay, making sure benefits are “at least as comprehensive” as now, not shifting or increasing costs to states, and requiring all plans to meet state regulatory requirements.
It is ironic that House Majority Leader Kevin McCarthy, R-Bakersfield, is among those leading the charge to repeal the ACA. McCarthy’s district covers most of Tulare and Kern Counties in the heavily-rural Central Valley. Tulare County has the highest percentage of residents on Medi-Cal – 55 percent – of any California county, with Kern County in the top 10 at 45 percent. In fact, most of the rural counties with the highest rates of Medi-Cal participation are represented in Congress by Republicans.
Pro-ACA demonstrators have repeatedly targeted McCarthy’s Bakersfield office, including a rally Jan. 12, with SEIU participants displaying a giant bill showing the cost if the ACA is repealed and not replaced.
On Jan. 15, thousands rallied across the country to save the ACA, launching a series of actions initiated by U.S. Senator Bernie Sanders, labor and leading Congressional Democrats. Among California actions were demonstrations in Los Angeles, Sacramento and San Francisco.
A Los Angeles rally, held at noon in front of the LA County/University of Southern California Medical Center, featured new U.S. Senator Kamala Harris, as well as LA County Supervisor Hilda Solis – a former Labor Secretary under President Obama – and patients and physicians. Solis cited “a remarkable 46 percent reduction” in LA County’s uninsured population. With many people now fearing they will lose their coverage, she said, it’s vital to make sure that doesn’t happen.
In San Francisco, House Minority leader Nancy Pelosi and folk singer and activist Joan Baez were joined by other area members of Congress and by the city’s mayor, Ed Lee at a rally in Civic Center Plaza. Lee told the crowd, “A repeal vote will start us down the path toward the road to chaos. It means turning our backs on the most vulnerable.”