The possibility that Republican legislators in the House and Senate could roll back or repeal the Affordable Care Act (ACA) has many Americans wondering just what the future holds for the sweeping health care reform law that was one of the centerpieces of former President Barack Obama’s tenure in the White House.
The same appears to be true locally, where a repeal of the ACA without any replacement program could jeopardize health care coverage for as many as 31,000 SLO County residents.
“We just don’t know what they are going to do,” said Joel Diringer, a long-time health care policy advocate and founder of the SLO-based consulting firm Diringer and Associates.
The ACA included an expansion in the number of individuals eligible for state and federal Medicaid and Medi-Cal, which provides health insurance to the poor, children, and individuals with disabilities. Under that expansion, more than 18,400 individuals in SLO County qualified for health care coverage they’d not previously been able to obtain, according to data collected by the UC Berkley Labor Center.
“These are lower-income people that could not get medical coverage before and probably could not afford insurance,” Diringer told New Times.
In addition to those covered by the expansion, a repeal of the ACA could also impact the estimated 12,710 SLO County residents enrolled in health care plans through Covered California. California is one of 17 states that set up a state-run health care exchange to administer the ACA after it was passed into the law. As of early November, more than 1.3 million Californians purchased coverage through Covered California. Diringer said that many of the individuals who enrolled are people who can’t get health insurance through their employers but don’t qualify for programs like Medicaid or Medi-Cal. Nearly 90 percent of the SLO County residents who purchased insurance though Covered California qualified for government subsidies through the ACA, according to Diringer.
The thousands at risk for losing coverage include some of the most vulnerable populations in SLO County. Those include not only the economically disadvantaged, but individuals suffering from serious medical conditions. The specter of repealing the ACA has the nonprofit organizations that serve those populations seriously concerned.
“[A repeal] would literally take away health care from the majority of our clients,” Elena Ramirez, client services manager for Access Support Network in Nipomo, told New Times.
Access provides a wide range of support services to individuals diagnosed with HIV/AIDS and Hepatitis C in SLO and Monterey counties. The organization serves an estimated 600 clients in SLO County alone, and about the same number in Monterey County. Ramirez said that prior to the ACA, which expanded Medicaid and prevented providers from denying coverage based on pre-existing conditions, there was little that her organization’s clients could do to get the medical care and treatment they needed.
“There was a whole lot of nothing, and the costs of care were through the roof,” she said. “Post-ACA, we’ve actually had clients who were able to re-enter the workforce because they could get health care.”
Access Support Network isn’t the only local nonprofit raising concerns. Raye Flemming, the health and prevention division director for the nonprofit Community Action Partnership of SLO County (CAPSLO), was similarly worried about a potential repeal of the ACA. Like the Access Support Network, CAPSLO is a certified enroller for Covered California. Flemming described many of the individuals they enrolled as “the working poor” and “working middle class” who were unable to get insurance through their employers for themselves or their families. She estimated that about 80 percent of the people who CAPSLO helped enroll had never qualified for health insurance before.
“We had a lot of people that came in to sign up that hadn’t seen a doctor in a long time, or ever, because they didn’t have health insurance,” she said.
Without the ACA and Covered California, Flemming said those same people would likely resort to going to the emergency room—or not going to the doctor at all—for their health care needs.
Just how much of the ACA the Republican-led House and Senate might move to repeal and how it would impact Covered California remains unknown, according to Cynthia Cox, associate director for the Henry J. Kaiser Family Foundation, a nonprofit organization that studies and tracks national health care issues.
“It’s not clear whether California will be able to continue with those [health care] reforms under the ACA if it’s repealed,” Cox said.
Congress has already taken some tentative steps toward dismantling the ACA. On Jan. 13, the U.S. House of Representatives voted 227 to 198 to approve a budget resolution that sets the stage to roll back major parts of the law. The U.S. Senate passed the resolution earlier that week. On his first day in office, President Donald Trump signed an executive order directing his administration to take steps to pave the way for a repeal. In his very first speech on the floor of the House, U.S. Rep. Salud Carbajal (D-Santa Barbara) spoke against repealing the ACA without a suitable replacement, stating that more than 45,000 of his constituents had access to health care because of the law.
“This will have real consequences for American families, and it’s simply reckless governance,” Carbajal said.
The murky future of the ACA has left many of Ramirez’s clients at the Access Care Network uncertain and frightened.
“They are scared,” she said. “What are they going to do to meet the health care needs of their families? How will it impact their lives?”
Staff Writer Chris McGuinness can be reached at firstname.lastname@example.org, or on Twitter at @CWMcGuinness.