The new repeal-and-replace legislation passed by the House of Representatives on Thursday is not much different than the bill that was dropped in March.
Health advocates renewed their dire predictions for low-income residents and people who struggle to buy coverage in Merced and other counties in the Central Valley.
“It will still have a devastating effect on many of the counties in the Central Valley, where 40 to 50 percent of the people are on Medi-Cal,” said Jen Flory, a policy advocate for the Western Center on Law and Poverty.
As of December, slightly more than half — about 51 percent — of Merced County residents were enrolled in Medi-Cal, according to data from the UC Berkeley Labor Center.
Experts warn that the same bullet points apply in terms of impacts on California, because of caps in the bill on federal Medicaid funding for states. The bill is expected to:
-- reverse expanded eligibility in the Medi-Cal program that covered 3.7 million California residents under the Affordable Care Act.
-- result in a $24 billion cut to Medi-Cal and the state budget over 10 years.
-- Reduce support that helps families and individuals obtain insurance through the Covered California exchange, leading to sharp premium increases.
-- increase the charity care burden at hospitals in Merced and other counties that have treated people enrolled in Medi-Cal or were covered through the ACA.
It would be catastrophic for California in general and Merced County even more so
Anthony Wright, executive director of Health Access California
The new bill would gradually diminish federal matching funds for the Medi-Cal program, forcing state leaders to make tough decisions on cutting services and payments to health care providers or continuing with the Medi-Cal expansion.
“There would be a massively large hole in California’s budget and no way to fill the hole without making cuts to the Medi-Cal program,” said Hannah Katch, a senior policy analyst with the Center on Budget and Policy Priorities in Washington, D.C.
If the bill were to pass, Merced County would be most impacted by the funds cut from Medi-Cal, especially because it has one of the highest Medi-Cal enrollments in the state, according to Anthony Wright, executive director of Health Access California, a statewide health care consumer advocacy coalition.
“Merced County would be disproportionately damaged by this bill,” Wright said. “The cut to Medi-Cal is staggering. It cuts and caps the entire program in which half of Merced County residents rely on.”
Even for people who don’t rely on Medi-Cal are going to be affected if the bill passes. Doctors and hospitals depend on Medi-Cal funding and the proposed cuts will have a “significant” impact, Wright said.
Around 200,000 jobs in the state could be threatened by the bill, Wright said, and, in Merced County, local hospitals would have to cut health services, doctors, and hospital staff.
The House bill would change the way tax credits are provided for consumers who purchase insurance on the individual market. The credits would be based on age, instead of the multiple factors for determining the level of premium assistance in the Affordable Care Act.
A CBPP analysis projects the average annual subsidy would decrease by $3,082 for people in Merced County, $2,072 in Stanislaus County and $2,055 in San Joaquin County. There is no support in the bill for cost-sharing subsidies that help low-income families with Obamacare insurance pay for out-of-pocket medical expenses.
On average, affected consumers are expected to see a $4,570 annual increase in premiums, deductibles and out-of-pocket costs in Merced County, $3,445 in Stanislaus County and $3,436 in San Joaquin County.
“It would be catastrophic for California in general and Merced County even more so,” Wright said.
A late amendment to the legislation would provide $8 billion for supporting high-risk pools in states that choose to allow insurers to charge higher rates to consumers who have previous health issues. It’s considered unlikely that California would depart from rules in the ACA that prevent insurance companies from considering a person’s medical history.
For a place like Merced County with higher rates of preventative illnesses like asthma, Wright said, the bill can have a negative impact.
Five out of the six leading causes of death in Merced County are considered pre-existing conditions and are preventable causes of death, according to the 2016 Community Health Assessment from the Merced County Department of Public Health.
Heart disease is the number one leading cause of death; cancer the second; respiratory disease the fourth; strokes the fifth and diabetes is the sixth.
The proposed bill would raise health costs by thousands of dollars throughout the state in general, Wright said, and even more in Merced County.
“If the bill is enacted it will create a ripple effect in health care system,” Wright said.
Ken Carlson: 209-578-2321