Californians will suffer under ACA repeal

Californians will suffer under ACA repeal

If the Affordable Care Act is repealed, Californians will suffer. Members of the United States Congress need to know that before they vote. Millions of lives will be impacted. The actions of the congressional majority will have real consequences affecting the health of their constituents.

If Congress repeals the Affordable Care Act without a viable, simultaneous replacement, five million Californians will lose their insurance coverage. California’s uninsured rate will likely double, returning to rates not seen since 2013.

Nearly four million low-income, uninsured and uninsurable Californians, who are covered under the Medicaid expansion, will be left out in the cold. Covered California’s 1.2 million consumers, who are empowered by the ACA to shop for affordable healthcare plans that offer comprehensive coverage in the state run exchange, will be left alone to navigate a commercial marketplace in turmoil.

The impact on jobs and the economy is just as bad. According to a University of California Berkeley Labor Center Report, it is estimated that 209,000 California jobs would be lost if the ACA were repealed. Financially, California’s gross domestic product would take a $20 billion hit along with a $1.5 billion reduction in tax revenue.

Many of those jobs, which pay well and offer employee benefits, would be located in the low-income communities served by community health centers. Fresno, Kern, San Bernardino, San Joaquin, Stanislaus, and Tulare Counties would be especially harmed due to their community’s high level of reliance on Medicaid expansion and above-average unemployment rates.

Additionally, 800,000 mostly low-income women will lose their ability to pick the healthcare provider of their choice if Planned Parenthood, which provides myriad of primary care services to women and men, is defunded.

If Congress doesn’t address the expiration of key health center funding by this September, community health centers in California will lose up to 70 percent of the federal grant which helps keep our doors open and preserves our ability to serve everyone who is need.

People covered by private insurance or employer-sponsored insurance are not immune. The chaos in the insurance marketplace caused by all of these disruptions will drive premiums up.

If the path to ACA repeal cannot be reversed, the replacement plan must address three key issues.

First is ensuring access to care through the preservation of California’s healthcare safety-net. Community health centers serve 1 in 7 Californians, 57 percent of whom are on Medicaid. Our patients are among the states most vulnerable and include more than 400,000 agricultural workers, nearly 300,000 people experiencing homelessness, and more than 28,000 veterans. Thirty six percent of our patients don’t speak English and 32 percent of our patients are children. We cannot abandon them.

Protecting the safety-net requires broad healthcare coverage programs like the Medicaid expansion and protecting federal health center funding. Ensuring access to care also includes the preservation of Planned Parenthood, which makes up a significant portion of the state’s primary care network for low-income communities.

Second is affordability and clarity. Covered California, which is our state-run healthcare exchange, built a competitive marketplace that for the first time put consumers in the driver’s seat by giving them a clear picture of the coverage plans from which to choose. They also kept the plans affordable. In December 2016, Covered California reported that 60 percent of consumers receiving tax credits could get a Bronze plan for less than $10 per month that provides free preventive care and protection for high-cost medical events.

Third and last is a commitment to healthcare workforce. This might not seem as obvious in the healthcare debate as coverage and affordability, but it is just as important. California is experiencing a primary care workforce crisis that is limiting access to care for everyone, not just people who are low-income. The ACA addressed workforce issues by creating Teaching Health Center Graduate Medical Education Program, among others. In California, the legislature and Governor need to recommit to the $100 million healthcare workforce investment that was promised in last year’s budget, but eliminated in this year’s budget proposal.

If Congress repeals the ACA without a viable, simultaneous replacement that addresses these key issues, Californians will suffer. Californians will be sicker. We cannot allow that to happen. We cannot go backwards. The consequences in our local communities are dire and Congress needs to know that when they vote.

Don’t Be Misled: HSAs and Tax Credits Are Not the Answer for Low-Income People

Don’t Be Misled: HSAs and Tax Credits Are Not the Answer for Low-Income People

In House Republican Leader Kevin McCarthy’s words, the care and coverage provided under the Affordable Care Act is akin to the federal government giving some people cars, but those cars are missing two tires, leak gas, and have a busted transmission. Other people are being forced to buy cars they don’t want.

McCarthy and the Republicans in Congress believe they can fix the proverbial “car crisis” and save our patients (I can’t in good conscious refer to our patients in automobile terms) through the judicious use of health savings accounts (HSA) and tax credits. In their view, HSAs and tax credits provide a broad-based, responsible foundation of healthcare reform.

If that was the case and these were viable solutions, I would be very supportive. But they’re not, so I’m not. HSAs and tax credits don’t work for low-income communities. Allow me to explain.

HSAs are tax-advantaged savings accounts that are normally tied to high-deductible health plans, which can be used to pay for certain medical expenses. People who use HSAs in high deductible plans can place a portion of their income, tax-free, into an HSA and then use that money, tax-free, to pay their medical bills. Because their high deductible plan would not start covering any medical expenses until they’ve spent at least a thousand or more dollars out of their own pocket (or their HSA), they would have a lot of medical bills to cover.

Current law requires an HSA-qualifying high deductible plan to have at least a $1,300 deductible for single coverage and $2,600 for families, along with a $6,550 out-of-pocket maximum for singles and $13,100 for families. This means that a family using a high deductible plan will spend $2,600 out of their HSA before their coverage kicks in and require that same family to potentially spend up to $13,100 in a single year, too.

For the low-income communities we serve, these out-of-pocket expenses are inconceivable and it is misleading to say they’re not. Our patients are struggling to provide their family with food and shelter, but now they have to come up with thousands of dollars to cover their share of medical expenses before their insurance even kicks in? That’s a plan for bankruptcy, not healthcare.

Republicans have discussed a refundable tax credit to offset these bankruptcy-inducing costs, but that is misleading as well. Under the Republican proposals that have been floated so far, flat-rate tax credits (that ignore family income) would be issued monthly to purchase healthcare coverage and anything left-over can go into an HSA.

While it sounds simple, it’s not. For low-income families, it can be disastrous. For example, if President Trump succeeds and allows people to buy insurance across state lines, out-of-state insurance plans may start manipulating the price point of insurance premiums to match or exceed the monthly tax credit amount, forcing families to spend one-hundred percent of the tax credit on premiums in a high deductible health plan, without any funding for the HSA that helps pay the plan’s high deductible.

In this situation, families will be forced to purchase bare-bones high deductible plans that don’t cover vital primary care needs and won’t have an HSA to help cover the high deductibles – they will have to pay out-of-pocket. Again, a plan for bankruptcy, not health care.

HSAs and tax credits may work for more affluent people, but they cannot be the foundation of the healthcare replacement plan for the low-income communities we serve. Quite simply, it diminishes the quality of coverage and dramatically increases financial risk for communities who are already struggling to make ends meet.

For these reasons, I cannot support them.