This week we are celebrating community health centers on a national level as part of National Health Center Week. We are celebrating the community health center movement, the historic role health centers have played in community health, and the value they have in our communities – which is especially important in our current political climate.
Community health centers were founded by community health and civil rights activists who fought more than 50 years ago to improve the lives of Americans living in deep poverty and in desperate need of health care. Over the years, health centers have grown to become a model of care throughout the country — offering more services beyond just primary and preventative care, including behavioral health, prenatal care, dental care, nutrition counseling and more. Community health centers are also known for offering patients supportive services that can include nutrition education, translation services, care coordination and case management, transportation to and from health care sites, outreach and enrollment activities.
Today, more than 1,200 community health centers serve the state of California, and provide comprehensive, high quality care to 6.2 million people – one out of every seven Californians. Community health centers are economic engines within their communities. In fact, according to a 2017 report from Capital Link, California’s community health centers contributed more than $8 billion to the California economy and supported nearly 60,000 jobs in 2015. Health center staff and providers are often from the very communities they serve – giving them the unique ability to live, work and give back to their community. Health centers also provide a highly-competitive working environment that offer staff opportunities to build on and learn new skills allowing for upward mobility.
The legislation that created the community health center program also created the Medicare and Medicaid programs, all of which have helped millions of Americans access health care services. These monumental programs, along with the network of community health centers throughout the nation, laid the ground work for the Affordable Care Act (ACA) and helped make it a reality and a success nationwide. Unfortunately, that success is being threatened by the President and certain GOP members of Congress who are working to dismantle the ACA and leave millions without health care coverage. While initial proposals have been thwarted – through the amazing advocacy efforts and the GOP’s own inability to achieve agreement on this issue – the fight is not over.
In addition to the attacks on the ACA, the Trump Administration recently released its proposed budget. While it shouldn’t surprise anyone that it gives tax breaks to the wealthy, the devastating impacts to lower-income Americans and people of color is astounding. Included in these cuts are $800 million to the federal Medicaid program – a program aimed at empowering people and communities to be healthier and thrive. In California alone, 3.7 million people enrolled in Medi-Cal – California’s Medicaid program – under the ACA expansion. Additionally, more than 180,000 undocumented children have enrolled in comprehensive Medi-Cal coverage under the Health4AllKids (Senate Bill 75) expansion. All of these Californians stand to lose their coverage if these cuts to the program are realized.
Trump’s proposed budget also includes cutting the funding to programs aimed at reducing poverty. We all know that where a person lives and what resources are available to them directly impacts their quality of life. Yet, numerous programs that address these critical resources are on the chopping block. For example, Trump would like to see 25 percent ($193 billion) cut from the Supplemental Nutrition Assistance Program (SNAP) – also known as the food stamp program – over the next 10 years.
SNAP, which is called CalFresh in California, is the largest food assistance program in the nation and services about 43 million low-income individuals. Those eligible for the program generally have a gross monthly income at or below 130 percent of the poverty level. Trump’s budget proposes implementing more stringent eligibility and work requirements for SNAP recipients. And what group is the largest recipient of SNAP benefits? Children. According to the Public Policy Institute of California, children are more likely than adults to receive CalFresh assistance – in California 62.2% of low-income children ages 0 to 5, 58.7% of those ages 6 to 12, and 44.7% of those ages 13 to 17 received CalFresh benefits on average in any given month in 2014.
Cuts to SNAP are just the tip of the iceberg. Trump has also proposed cuts to the Children’s Health Insurance Program (CHIP), which provides about 6 million low-income children with health insurance, a $6 billion cut to Housing and Urban Development which provides low-income housing and a cut to the Temporary Assistance for Needy Families (TANF), also known as CalWORKs in California, which gives financial support to extremely low-income parents and children. Additionally, he’s proposed slashing funds for unemployed insurance, the Earned Income Tax Credit, Supplemental Security Income, Social Security Disability Insurance and Social Security Old-Age and Survivors insurance. These cuts to vital programs will hurt our most vulnerable populations the most – negatively impacting the ability of these communities to thrive and be healthy.
But that’s not all – health center funding is also at stake. Policymakers have long recognized the value of community health centers on a bipartisan basis, and have made investments through both Republican and Democratic administrations. A key source of funding for health centers is the Health Center Trust Fund, created by the ACA, which is comprised of both discretionary and mandatory funding and is currently scheduled to expire in September of this year. If Congress does not take action to restore the Health Center Trust Fund to previous levels, grants will be cut by more than $160 million.
While community health centers will continue to treat anyone and everyone who walks through their door, regardless of their ability to pay, the absence of these dedicated funds may force health centers to close some sites, eliminate services, and even lay off health care providers and staff. This would be truly devastating for the many communities our health centers serve throughout the nation. Health centers have been and remain the front line responders in addressing emerging public health challenges, and they generate $24 billion in savings to the health care system every year by efficiently managing and treating chronic disease, even among the most economically challenged populations.
So as we celebrate all that community health centers have accomplished over the next week, let us not lose sight of what is still at stake for so many. Cutting programs that millions of Californians depend on to be healthy is detrimental to everyone. We must remain vigilant against attacks on our most vulnerable and continue to be vocal and advocate for those that need us most. We must come together and support the programs that provide assistance and improve the quality of life of all Californians.
The Castellano Family Foundation, created by my parents, Alcario and Carmen Castellano, recently celebrated its 15th anniversary on June 23, 2017, at the Mexican Heritage Plaza in San Jose. This is such a huge milestone for my family and an important opportunity to reflect on what it means for the Latino community of Santa Clara County to house this unique and extraordinary philanthropic endeavor.
When my father won the lottery in 2001, my family was thrown into the spotlight and the story made national news. After the excitement of their win settled down, they made it a priority to establish the Castellano Family Foundation. Having been committed to the Latino community in San Jose for years, it only seemed right that they found a way to give back to the people that they have so much love for.
The Foundation was founded with a mission to uplift the Latino community in four main areas: education, arts & culture, leadership, and diversity. Over the years, we’ve awarded five million dollars in the form of grants and scholarships, supporting organizations that advance the Latino community. Our grantees are the reason why we continue to do what we do. We are thrilled with their incredible work and the important contributions they are making to Santa Clara County. For example, Movimiento de Arte y Cultura Latino Americana (MACLA), an organization my parents were longtime donors to even before winning the lottery, is supported by the Foundation and we appreciate their continued commitment to celebrating the arts in the Latino community. Somos Mayfair is another important organization we’ve supported that has shown dedication to uplifting Latino leadership, families, and the community in the San Jose Mayfair neighborhood. The School of Arts and Culture at the Mexican Heritage Plaza is an organization my father played a role in helping to establish and we are proud of how far it has come and the role it is playing in advancing the arts among youth. There are many other organizations we have supported over the past 15 years that have been an excellent investment for advancing our mission.
I can’t help but reflect on my parents’ very humble beginnings. My father was a grocery clerk for Safeway and a farmworker in his youth. My mother was an executive secretary at San Jose City College for decades. And in addition to their regular jobs, they were both also working to advance the Latino community by promoting their children’s education, and through championing change as community volunteers. For as long as I can remember, my parents have been active, involved community members in San Jose. From a very young age, they instilled in my siblings and I a love for being involved in and giving back to the community. Attesting to these deeply held values is the fact that, in addition to my mother, my siblings and I now serve as Trustees of the Foundation. Continuing our parents’ legacy of giving back to the community is a role we cherish.
Now that the Castellano Family Foundation is celebrating its 15th year, we debuted something truly special during the anniversary celebration at the Mexican Heritage Plaza on June 23, 2017. It was the premiere of my father’s documentary, “Memories of Cinco de Mayo and 16th of September Celebrations in San Jose 1986-1997” which highlights the phenomenal celebrations that occurred in San Jose as sponsored by the San Jose GI Forum during the 80s and 90s. All the footage and photographs in the documentary were captured by my father and the video represents the only comprehensive record of these historic events.
A few years ago during a visit with my father I sat with him in the family room, watching footage of the fiestas he recorded decades ago in San Jose. Seeing the joy and sense of pride on his face and hearing him speak with a high level of nostalgia concerning his past involvement as a GI Forum volunteer, I knew we couldn’t let this footage continue to gather dust on his office shelves. With the support of the Castellano Family Foundation, we decided to turn his video collection into a documentary. For over two years, my father and I spent hours at a time meticulously looking at each video scene-by-scene to pick out the footage that would later go into the documentary that premiered on June 23rd.
Words cannot accurately express what an amazing experience it was to work with my father on this project. Not only did I help produce the film, I had the privilege of conducting the foundational interview of my father, which ultimately served as the documentary narration. My father speaks with love, passion and humor about a whole range of topics and items featured in the parades and fiestas. From the floats and the ballet folklorico, the music and horses, the food and the low rider cars to the elected officials and the grand marshals. There wasn’t any item in the footage about which he didn’t have an observation or an opinion on its cultural relevance or significance to the community. I learned so much about his passions during this process and am honored to share this part of my father with the community.
My father played a very important role behind the scenes in these fiestas. He was responsible for bringing the unprecedented art show to the San Jose Convention Center, which featured local Latino artists. He took a lead on bringing local community colleges to display at the Fiestas and reach out to our youth. He developed the “Go to School – Stay in School” motto which was prominently featured at the Fiestas to attract youth and encourage them to stay in school. And he played an instrumental role in bringing voter registration efforts to the events. I want people to understand who my father was before he won the lotto. Through this documentary people will come to recognize that his commitment to the community – to arts and culture, education and leadership – the mission of the Foundation – is something he has lived for decades.
The Castellano Family Foundation’s 15th anniversary celebration was truly a momentous occasion and we were honored to share it with the community that it all started in. From the Foundation’s establishment to our father’s documentary, our collective hope is that the Castellano Family Foundation continues to enrich the Latino community in Santa Clara County and beyond.
I have always thought it was important that women in leadership positions invest time and effort in helping other women to advance in their careers. More and more I have realized the importance of encouraging young women to pursue leadership positions as they plan their education and pursue their careers. I have made a personal commitment to do more to encourage young women down a leadership path.
Earlier this month I gave a keynote presentation at an event focused on healthcare career pathways. The audience was comprised of high school and college students. My goal was to encourage the group to pursue their higher education and consider a career in community health centers specifically, but certainly health care more broadly. I wanted to impress upon them the possibility of pursuing a leadership role in whatever health career they chose. I told them about my own personal and professional journey which led me to become a Managing Attorney of a law firm at the age of 28 and the CEO of a nonprofit at the age of 31. I hoped to strike a balance between encouragement and inspiration to help them realize their potential for a leadership role was within their grasp.
I was very moved when a young woman came up to me after my presentation – she was in tears as she spoke to me – and she told me it was the first time in her life that an accomplished Mexican-American woman had told her that she could do it. She told me that my presentation made her feel that even though she would have struggles along the way, and it would be hard, that she too could become a CEO one day. I could tell that she had greatly needed to hear the words of encouragement I spoke that day, and it reaffirmed for me that I, and others like me in leadership roles, need to do more to support young women – particularly Latinas – and help them realize their full potential. These young women are the future. We need to do more to reach young women and encourage them to shoot for the stars.
Looking back on my path toward becoming a CEO, I am often reminded of the tremendous support I had along the way. As a child, I was instilled with the confidence and wherewithal that I could do anything I set my mind to. My parents were instrumental in my success from the beginning. In particular, my mother served as a role model and mentor to me from a very young age. As an Executive Secretary at San Jose City College, seeing my mother in action professionally during in my youth helped me to understand the importance of professionalism, commitment and high standards.
She also supported me unconditionally in the high educational goals I set for myself – such as aspiring to attend UC Berkeley and Yale Law School – which are now both my alma maters. My mom was my first mentor, showing me through her own actions the importance of a strong work ethic and leadership ability. She empowered me through her example that I could do anything or be anything I wanted – but she also showed me I was going to have to work hard to achieve success – just as she did. It would not be handed to me.
Later in my professional life, I had the benefit of befriending some amazing women who have helped to guide me with their constant motivation, guidance and constructive feedback. I have been blessed with amazing mentors — women who provided more than just support – they were my constant cheerleaders and they provided critical professional and personal advice to me along my leadership journey — all of them helped to make me who I am today.
There is a glaring need for more women in leadership – both in the nonprofit sector and in corporate America. A 2015 Guidestar report found that women make up less than half – 43 percent – of nonprofit CEOs. A similar study by the University of Denver and The White House Project, found that women constitute only 21 percent of leadership roles among nonprofits, though they make up 75 percent of the workforce.
As President of the Castellano Family Foundation, I have become much more aware of how these issues are playing out in philanthropy. The latest data from the Council on Foundations Grantmakers’ Salary and Benefits research found that women hold only 31 percent of the CEO positions in the largest foundations and only 41 percent of all surveyed foundation board members are women. This is despite the fact that women represent 73 percent of full-time foundation staff. When I look around at my fellow association CEOs in Sacramento, I see hardly any women and nearly no women of color. The issue in corporate leadership is even more dire with Forbes reporting that only 23 Fortune 500 companies have women CEOS – that’s less than five percent! This is truly unacceptable! And this doesn’t even get to the issues of pay equity and the fact that women make 80 percent of what men make for the same work according to a 2017 report from the American Association of University Women. We will save that for another day.
The bottom line is we need to do more – and it starts with us. As women we should look to our daughters, our nieces, our cousins, our friends, our employees, and our peers. We can lead by example, show them and tell them that women can lead. That they are leaders now and they should work to be the leaders of the future. As women we often hold ourselves back – whether it be a promotion or a new job or a new opportunity of some kind. We owe it to ourselves and each other, and more importantly, to those coming up behind us. As women, we all need to take a more proactive role in empowering and challenging the young women in our lives to see themselves in leadership roles. If we don’t let them know of the possibilities and most importantly – that we believe in them – they may never reach their true potential.
Which is why I am giving back and encourage all of you to do the same. Because we had so much support along the way, we really need to make that investment in each other. As women it’s important that we support each other personally and professionally – as friends and family. Or in leading by example – something each and every one of us can do as well – showing the young women in our lives what is possible through our own actions.
I’m hoping to take what I have learned from the trailblazing mentors in my life to help to empower our future leaders of tomorrow. We must ensure that women have a seat at the table, as they will have a say in shaping the future. It is up to us to empower future generations, to push them, and to show them that anything is possible. As I looked into the eyes of the young woman who approached me at the career pathways presentation, I saw the impact of her realization that more was possible for her. The impact of knowing that there was someone in the world who had achieved a leadership position, and that someone believed in her and knew she could do it, too. Every young girl can be a CEO – it is possible – and working together we can help make it happen.
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.
I spent two days last week at the California Primary Care Association (CPCA) office in Sacramento attending our Workforce Convening: A Pathway to Building a Long-Term Primary Care Strategy aimed at developing strategies to address California’s primary care workforce shortage. I am proud to have sat across the table with leaders and stakeholders from all sectors – academia, nonprofit, government, and business – to develop public policy and programmatic priorities and identify advocacy strategies.
We can no longer afford to wring our hands about this problem. The time for action is now. For many years, community health centers have become increasingly vocal about the primary care workforce shortage in their communities. Each year, despite incremental efforts to address their concerns, the crisis has only worsened. The tremendous success of health care reform, resulting in the expansion of health insurance to five million Californians, only exacerbated this brewing crisis. Two years ago, CPCA decided it was necessary to tackle the issue head-on. We had to make it THE issue for CPCA and our newly formed advocacy affiliate, CaliforniaHealth+ Advocates.
To help quantify the challenge, CPCA commissioned a report last year that found California would need 8,243 additional primary care physicians, or 32 percent of our current workforce, by 2030. The report, titled “Horizon 2030: Meeting California’s Primary Care Workforce Needs,” provided a sobering analysis of the situation and underscored the challenges health centers face in the recruitment of primary care clinicians.
Responding to CPCA’s report, CaliforniaHealth+ Advocates developed a multi-pronged advocacy strategy to bring about much needed solutions. The centerpiece of this strategy was a successful joint advocacy campaign with the California Medical Association and the California Academy of Family Physicians, among others, to secure an investment of $100 million for primary care workforce programs in California. This monumental appropriation was designed to support and expand primary care residency programs, teaching health centers, and help recruit providers to practice in medically underserved areas. We were particularly pleased with the investment in Teaching Health Centers, which will result in utilizing community health centers as residency training programs for physicians – greatly increasing the likelihood that they will practice in primary care in an underserved community.
Coming into 2017, California’s health centers were excited and energized, ready to build on our funding victory to begin addressing the myriad of issues that plague our ability to educate, train, recruit and retain the professionals that keep our state healthy. But, our excitement and energy was dealt a devastating blow when, in his 2017-18 budget proposal, Governor Brown eliminated the $100 million workforce investment – all of it.
Backtracking on this investment hinders existing primary care residency programs and eliminates the potential for expansion or the development of desperately needed new residency programs in underserved communities. It was a shortsighted move motivated by placing immediate fiscal considerations over a recognition that California’s primary care work force, and thereby health care access for all Californians, is in jeopardy.
CPCA recently partnered with the Healthforce Center at the University of California, San Francisco to publish a report titled “California’s Primary Care Workforce: Current Supply, Characteristics, and Pipeline of Trainees.” This report finds that previously identified deficits in California’s primary care workforce persist and will be exacerbated in the coming decade as the supply of primary care physicians in California retire. Our pipeline is insufficient to meet the population’s needs. The report also found that there are large disparities between the diversity of the California population and the diversity of all medical clinicians.
While we have an overall shortage of physicians, our need is, and will continue to be, particularly great for physicians of color. By 2050, racial and ethnic minorities are projected to account for half of the U.S. population. Currently, Latinos represent 40 percent of California’s population, but only represent five percent of physicians. Less than 20 percent of physicians speak Spanish, and physicians who speak Middle Eastern or Asian languages are even less prevalent.
Among advance practice graduates, the statistics are starker. Latinos only represent seven percent of allopathic medical school graduates, three percent of osteopathic medical school graduates, nine percent of nurse practitioner graduates, and 14 percent of physician assistant graduates.
College degrees in science, technology, engineering and mathematics (STEM), which feed advanced healthcare practice degrees, may contribute to these insufficient results. According to a recent Addeco report, approximately 271,000 graduates a year earn a degree within a STEM, but in 2013, Latinos represented only nine percent of total STEM degree and certificate recipients.
This diversity shortage is particularly acute for community health centers. Of the 6.2 million patients we serve, 54% are Latino and 36% percent speak a language other than English. The current situation is simply unacceptable and is only projected to worsen. As organizations which have committed themselves to addressing this crisis, CPCA and CaliforniaHealth+ Advocates are already working to find solutions.
In the coming weeks and months, here are a few of the projects we will be advancing:
- Stop the Budget Cut: Governor Brown’s 2017-18 budget proposal eliminates the $100 million primary care workforce investment that the legislature and Governor committed to just last year, it must be stopped. This money was intended to support and expand physician training programs in California. If the funding is not reinstated, there isn’t room for expansion and existing programs may falter. We are advocating for funding restoration in the state’s 2017-18 budget and beyond. Thankfully the Assembly Budget Subcommittee, led by Assemblymember and Emergency Room physician Joaquin Arambula, took the first step towards defeating the proposal when they voted unanimously to reject the Governor’s proposal on Feb. 28.
- Save the Teaching Health Center program: Teaching Health Centers focus on training primary care physicians in community health centers. They are in jeopardy if Congress fails to enact legislation that extends funding for the Teaching Health Center Graduate Medical Education (THCGME) program past September 30, 2017. The two-year partial-funding extension Congress approved on a bipartisan basis early in 2015 will sunset unless Senators and Representatives agree on similar legislation in the next few months. We are advocating for a long-term extension of funding at pre-2015 funding levels.
- Advance policy solutions: The public policy priorities and advocacy strategies developed in the recent two-day Workforce Convening will form the basis of a multi-year public policy agenda. It was my honor and privilege to bring such a distinguished group together to find real solutions. Now we must put energy and effort into getting these solutions adopted and implemented.
As community leaders who are committed to the health of California, we need to lead the charge on addressing the workforce crisis. We need to protect funding for training and education. We need to protect our programs and create new ones. We need to find long-term solutions that will withstand the test of time. CPCA is committed to leading the charge to address the diversity of the primary care workforce of the future. The health of everyone in our state depends on it.
Every day since last November’s election, we have waited with anticipation, wondering what President Trump and the Republican Congress would do with the Affordable Care Act. Through all the tweets, leaks, concept papers and trial balloons, our concern and trepidation grew. The President told us it would be great. Congress told us they had “a better way.” These are promises we were leery of.
After 117 days, they finally released their plan – the American Health Care Act (AHCA) – and they were both wrong. Plain and simple it’s bad. It’s really bad. You can read our analysis here, but it’s everything we had feared, and more.
The Republicans are rolling back healthcare coverage for our most vulnerable communities. They are adopting a healthcare rationing formula called a “per capita cap” for Medicaid, which will force states to reduce Medicaid eligibility and coverage. Previously uninsured adults, who gained coverage for the first time under the Medicaid Expansion, will once again be at risk of losing coverage when the federal government reduces their share of program funding. The AHCA will defund healthcare exchanges by eliminating consumer subsidies. The AHCA will defund Planned Parenthood. Through the AHCA, Republicans are abandoning hard working, low-income people who need our help the most.
It’s truly devastating, because, in California, the Affordable Care Act is working. Five million people who previously were uninsured gained coverage under the ACA in California – 3.7 million under the Medicaid program and 1.4 million in Covered California – the most successful health care exchange in the country. People are healthier. Communities are healthier. Parents can go to work, children can go to school, and tens of thousands of healthcare workers have good jobs that provide for their families. It has changed millions of Californians’ lives for the better.
The AHCA, commonly referred to as TrumpCare, is the exact opposite. It will increase sickness, suffering, and pain for patients and healthcare providers. According to the report that was just released from the Congressional Budget Office and the Congressional Joint Committee on Taxation, 24 million people will lose their insurance coverage by 2026. 14 million people will lose their coverage in 2018 alone.
At the state level, the impact will be just as devastating. According to a report by Capital Link, 1.5 million Californians served by community health centers could lose access to Medi-Cal services if the ACA is rolled back, exchanges are eliminated, and Congress doesn’t renew operational funding for community health centers. The financial stakes are just as high; the state could see a $3.8 billion economic reduction and a loss of over 27,000 jobs from the community health center system alone.
For the people being kicked out of Medicaid and Covered California, Republicans have touted Health Savings Accounts and Tax Credits as the answer. But, as I shared on my blog in February, found here, HSAs and tax credits are designed for the rich. For low-income people, they are a plan for bankruptcy, not healthcare.
The per capita cap proposal transforms a compassionate entitlement program, which ensures every covered person gets medically necessary care, to a highly vulnerable budgetary line item that could be decimated by the state budget debate.
Patient protections enshrined in the ACA will be hit as well. Barriers to care, which the ACA systematically dismantled, will be restored under TrumpCare. Essential health benefits – eliminated; funding for prevention and public health – eliminated; income stability protections – eliminated; enhanced match rate for Children’s Health Insurance Program – eliminated. TrumpCare is a plan to make things worse.
Simply enrolling in Medicaid will become more difficult under the new plan. For example, TrumpCare eliminates an ACA-allowed grace period that allowed people to get care while they waited to get a copy of the required citizenship and immigration documentation. Now, all documentation must be presented at the time of enrollment. Retroactive eligibility, that allowed Medicaid to cover medical bills incurred right before enrollment, has been cut short, too. Another significant barrier is coverage redetermination, which will be required every six months, rather than the already arduous annual process.
Overall, TrumpCare creates more bureaucracy, less coverage, and fewer providers. That is the opposite of great.
I could go on and on about the negative implications of TrumpCare, but I will save you the grief because I think you get the point. TrumpCare abandons the low-income communities we have spent a lifetime protecting and I cannot support it. I hope you would agree.
By Carmela Castellano-Garcia, Esq.