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.

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