American Health Care Act: The Fight’s Not Over

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On Wednesday, May 3, 2017, I kicked off our biggest Day at the Capitol event ever with a celebration of the Affordable Care Act (ACA) on the West Steps of our State Capitol. I stood shoulder-to-shoulder with more than 300 community health center advocates and elected leaders, reflecting on the success we’ve had under the ACA. In California alone, the uninsured rate fell from 17.2 percent in 2013 to 8.6 percent in 2015 – giving more than 5 million Californians access to both care and coverage. The celebration of this monumental success was unfortunately overshadowed the following day when the House voted to repeal and replace the ACA with the American Health Care Act (AHCA), also known as TrumpCare.

The ACA is working in California and that is why it is so distressing that Congress is working hard to repeal and replace it. In California, the uninsured rate dropped across all racial and ethnic groups, with the greatest gains seen among Latinos. Community health centers saw a 63 percent increase in the number of Medi-Cal insured patients and, according to a study by the California HealthCare Foundation (CHCF), safety-net clinics are providing care to 54 percent, or 1.3 million, new patients enrolled in California’s Medicaid managed care plans after expansion. Yet even after all of these successes, Congress has introduced the American Health Care Act (AHCA) that threatens to rollback insurance coverage to 24 million Americans and decimate the Medicaid program. 

We all worked very hard to stop this bill from passing. We made phone calls. We held rallies. We talked with our congressman about why we didn’t support the AHCA and why they shouldn’t either. Our efforts paid off, initially, when on March 24 House Republicans pulled the bill because they didn’t have the votes.

But their efforts persisted and the two (2) amendments that somehow got the AHCA across the line do not make the AHCA any better. In fact, they make it worse. The MacArthur Amendment – added to appease the more conservative Republicans – weakens protections for people with pre-existing conditions and allows states to opt-out of the Essential Health Benefits. So now sicker individuals, who will have more expensive health care costs and catastrophic plans, will once again be allowed.  The Upton Amendment aimed to soften the blow for Republicans that did not want to renege on their promises to cover pre-existing conditions by allocating an additional $8 billion over 5 years to states that aim to create high-risk pools. Yet, experts agree that amount is not nearly enough to cover such an expensive endeavor as there are currently 2.2 million people with pre-existing conditions and $8 billion is barely enough to cover health care for 600,000 people.

What’s more shocking is that Members of Congress voted on this bill less than 24 hours after the final language was released and before it was scored by the Congressional Budget office (CBO). California’s entire GOP delegation were among the YES votes. How Members of Congress could pass a bill before analyzing the text and understanding its full impact is extremely disturbing.

Particularly distressing for Californians is that fact that our entire Republican delegation, all 14 members, voted for this bill.   With this vote, California’s Republican Representatives are threatening to undermine the health insurance coverage of more than 13 million Californians – many of whom are their very own constituents – by voting in favor of legislation that dismantles the Medicaid Program and rolls back the Medicaid expansion, among other draconian provisions.

Roughly one-third of California’s population is enrolled in Medi-Cal, with the highest number of enrollees living in counties represented by Republicans. In particular, forty-percent of the population in counties represented by Representative Nunes, Representative McCarthy, Representative Denham and Representative Valadao – all of whom voted in favor of the AHCA – are Medi-Cal beneficiaries. Any step to remove the existing Medicaid funding guarantee, whether it be through caps, block granting, reduction in federal share of cost or the elimination of expanded eligibility, is a step in the wrong direction for California.  It is a wrong step for the very constituents they pledged to represent.

Fortunately, both Republicans and Democrats in the Senate have publicly shared that this bill is not a viable replacement for the ACA. They have vowed to make significant changes to the AHCA. Many have said they are starting over from scratch.  We don’t know what will be in the Senate version – it could very well still be devastating for California.  Eventually, the revised bill will make its way back to the House and when it does, it is our job to keep up the pressure, be vocal and make sure that California’s Republican delegation does not make the same mistake twice. There’s simply too much at stake for them to put politics before their constituents’ well-being.

The ACA works in California thanks in large part to the legislative leadership we have in our state. Millions of Californians have benefited from the ACA. In a world of uncertainty, we are fortunate to have leadership in both the State Senate and Assembly looking out for the needs of California’s most vulnerable communities.  We look forward to working with them in the future to ensure that the needs of these communities continue to be met.