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Low-income Californians will be hit hard by proposed American Health Care Act

Valley doctors explain how to improve U.S. health care

Doctors Don Gaede, Gene Kallsen, Alan Birnbaum and Alan Kelton offer their ideas for improving insurance and health care in the U.S.
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Doctors Don Gaede, Gene Kallsen, Alan Birnbaum and Alan Kelton offer their ideas for improving insurance and health care in the U.S.

The federal health care plan being pushed by President Trump that would repeal the Affordable Care Act would have devastating effects financially to the medical safety net and on people’s health in the central San Joaquin Valley, said dozens who spoke at a state Assembly Health Care Committee hearing at Fresno City Hall on Wednesday.

From a self-employed couple who got health care through Covered California (the state’s health care exchange) to mothers of severely handicapped adult children on Medi-Cal, people lined up at the three-hour hearing to express their concern over the potential passage of the proposed American Health Care Act. The House is scheduled to vote on the legislation Thursday.

Said one mother of the potential for a major restructuring of Medi-Cal that could cut off people like her son: “They will be homeless.”

In opening the committee hearing, committee chairman Jim Wood, D-Healdsburg, said the proposed American Health Care Act will “pull the rug out from under” millions of low-income Californians.

The Affordable Care Act is not “in a death spiral” as House Republicans have described it, but on the contrary has been a success in California, said Wood, who is a dentist by profession. The state’s uninsured rate has fallen to a record low of 7.1 percent, he said.

But on Thursday, the seventh anniversary of the Affordable Care Act, Wood said the House of Representatives is “poised to take it away from us.”

The economic impact in Fresno County alone would be $516 million.

Assemblyman Joaquin Arambula

Fresno Assemblyman Joaquin Arambula, a former emergency department doctor and chairman of the Budget Subcommittee on Health and Human Services, said in reference to the proposed American Health Care Act that “Trumpcare will strip health care away from the very people who need it the very most.”

Florence Crowson, 48, of Merced, came to the hearing to testify. She said she had gone without insurance for about 30 years until she signed up for Medi-Cal under the expansion made possible by the Affordable Care Act, also known as Obamacare. Medi-Cal is California’s version of Medicaid, which provides health services to people with lower incomes.

“I could never afford health insurance,” said Crowson, an in-home caregiver who earns minimum wage. When she got Medi-Cal insurance, Crowson said she was diagnosed with diabetes and a thyroid condition. And she learned she had a condition that had prevented her from bearing children.

The Medi-Cal expansion has enrolled about 4 million people in California and hundreds of thousands in the San Joaquin Valley.

Crowson said she is worried about a passage of the American Health Care Act. “I will still be diabetic, but will I be able to afford my health insurance? Will I be able to afford my medication?”

J.C. Aguirre, 14, of Merced, just took a college entrance exam so he can enroll in trigonometry at the community college in Merced. It’s a first step toward his goal of becoming a doctor and working for the federal Centers for Disease Control and Prevention. He depends on California Children’s Services, a state health program, and on Medi-Cal, for his health care. His life could be in danger without the care he receives, he said. He has a malformed heart and vertebrae in his neck. “My mom and I make about $1,300 a month. We cannot afford a car or a TV. So how can we afford more medical expenses?”

Arambula said Fresno was an appropriate place to hold a hearing on the potential cost to California of the American Health Care Act.

My mom and I make about $1,300 a month. We cannot afford a car or a TV. So how can we afford more medical expenses.

J.C. Aguirre, 14, of Merced

“We have some of the most concentrated areas of poverty in our country, let alone our state,” Arambula said. “Because of that poverty, we have dramatically increased the number of people we have insured and covered. We’ve seen some of the largest gains in the Affordable Care Act, hence we have the most to lose if it is repealed.”

Arambula cited a report by the University of California at Berkeley Center for Labor Research and Education that estimated Fresno County would lose 6,000 jobs with a partial repeal of the Affordable Care Act. The Valley would lose more than 20,000, and statewide 209,000 jobs would be lost.

“That is more jobs than we lost in the drought in 2015. We felt that effect and I’m very concerned about the effect it will have on our communities.”

And Arambula said: “The economic impact in Fresno County alone would be $516 million.”

On Wednesday, California’s Department of Health Care Services and the Department of Finance released a report that said the proposed American Health Care Act would increase California’s costs of providing Medi-Cal coverage by nearly $6 billion in 2020, growing to $24.3 billion by 2027.

The state’s general fund would share a big portion of those costs: $4.3 billion in 2020 and increasing to $18.6 billion in 2027.

And the costs could jeopardize optional benefits the state provides, such as adult dental care, and could nix any any provider reimbursement increases. Doctors in the central San Joaquin Valley and elsewhere have shunned Medi-Cal because of the low reimbursement rates.

The state expects to exceed a per capita limit on Medi-Cal enrollment that would be imposed for the first time in the 50-year history of the program. Under the proposed law. California estimates the cap would cost the state about $680 million in 2020, increasing to $5.3 billion by 2027. “If you overspend, the state has to pay that entire over-expenditure back to the federal government every quarter in a year,” said Mari Cantwell, chief deputy director and state Medicaid director at the California Department of Health Care Services.

California also expects other proposed changes to Medi-Cal for the 4 million people who enrolled in the Medi-Cal expansion program under the Affordable Care Act. The cost to the state would be $4.8 billion in 2020.

Medi-Cal enrollees would have to reapply for benefits every six months instead of the current yearly reapplication. The state expects the administrative hurdle will cause a 42 percent enrollment shift annually. And the federal government will reduce its share of cost for any enrollee who re-enrolls after a break in coverage of a month or longer.

The proposed law also would eliminate “presumptive eligibility” for people who enter a hospital and need services. Now if they appear to be eligible for Medi-Cal, they are enrolled. About 25,000 people a month are given “presumptive eligibility, said Jennifer Kent, director of the Department of Health Care Services. The estimated loss would be $400 million to hospitals, she said.

In addition to effects to the Medi-Cal budget, the state estimates a loss of $400 million in 2020 for in home supportive services, a program that allows frail seniors and the disabled to have care-giving services to stay in their homes.

And a one-year freeze would be imposed on federal payments to any provider of abortions who offers abortion services in addition to family planning services. This applies primarily to Planned Parenthood California.

Pedro Elias of Planned Parenthood Mar Monte told Arambula and Wood that the clinics in Fresno provide primary care to thousands.

Wood said Planned Parenthood has his support. And the proposal in the American Health Care Act to freeze funding “I feel is punitive, it’s petty and it’s wrong.” And he said: “We are going to do everything we can to fund and protect Planned Parenthood because it is the right thing to do.”

Several people urged the assemblymen to support a single-payer system in California. Sens. Ricardo Lara, D-Bell Gardens, and Toni Atkins, D-San Diego have introduced Senate Bill 562 that would create a single-payer system so everyone could have coverage and the government would pay for health care rather than private insurance.

Arambula said he and Wood are going to study single-payer. And Wood said the state can work toward universal coverage for everyone, but California will need federal funds. “We cannot afford to do this without some of that federal money we currently get.”

Barbara Anderson: 559-441-6310, @beehealthwriter

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