Key to the House Republicans’ victory on Thursday in repealing and replacing Obamacare was the support of many of California’s 14 GOP congressional members, including three who at the last minute co-sponsored an amendment that adds $8 billion more to fund “high risk pools’’ for millions of Americans with pre-existing conditions.
Though they had earlier announced their opposition or serious concerns to the replacement bill, called the American Health Care Act, and as late as Wednesday afternoon had declared that they were undecided, Reps. Jeff Denham, R-Turlock, David Valadao, R-Hanford and Steve Knight, R-Lancaster, had quietly changed their minds.
Knight’s office released this statement to explain his change of heart:
“As a husband to a nurse, I’ve seen firsthand the challenges families and patients face under our current health law, which is why today I voted in support of the American Health Care Act.”
Neither Denham or Valadao could immediately be reached for comment.
The bill now heads to the Senate where it is expected to receive more scrutiny and — at the very least — several changes before their vote, if it is not rejected altogether.
Still, Thursday’s vote to dismantle the law is a huge blow for the millions of Americans who obtained health insurance under President Barack Obama’s 2010 signature health care law.
And if the GOP bill becomes law, nonpartisan congressional analysts estimate, 24 million more Americans would be uninsured by 2026, including 14 million by next year.
The reverberations are even more pronounced in California, among the earliest states to embrace “Obamacare,” expand Medicaid to adults without children and establish a robust state health care exchange.
As a result, the Golden State has reduced its uninsured rate to a record low of 7.1 percent since 2013, just before the Affordable Care Act took full effect.
“California, having made the most progress under Obamacare, has the most to lose,’’ said Daniel Zingale, a senior vice president at the California Endowment, a private health foundation in Los Angeles that was among the state’s biggest backers of Obamacare. “I think a lot of people are wondering: Am I in that 24 million who are going to lose coverage?’’
Said Anthony Wright, executive director of Health Access California: “This back-from-the-dead bill should be scary not just for the five million Californians who now get help under the Affordable Care Act, but anyone who may need to rely on Medi-Cal or the ACA’s patient protections in the future.’’
Strongly opposed by doctors, patients’ rights groups, hospitals and health care advocates, the bill seeks to:
- Eliminate the Medi-Cal expansion that over 3.7 million Californians now depend on;
- Cap the Medicaid program, resulting in an overall $24 billion cut to Medi-Cal funding within a decade;
- Cut assistance to the state exchange, called Covered California, to subsidize health coverage, leading to an average spike in health costs in California of $2,800 annually by 2020;
- Undermine patient protections, like minimum standards for the essential health benefits that insurers must cover, or the prohibition against charging patients with pre-existing conditions more.
Critics labeled the vote a rush-job, short-cutting the standard review and scoring of the bill by the nonpartisan Congressional Budget Office.
Dr. Michelle Quiogue, president of the 9,700-member California Academy of Family Physicians, for one, condemned the vote.
“We are deeply discouraged by those in the House of Representatives who voted to advance a bill that would eliminate insurance protections and affordable coverage for millions of patients,” she said. “We call on the Senate to refuse passage of the American Health Care Act.”
California Assembly Speaker Anthony Rendon, D-Paramount, had this to say in a release in the wake of the historic vote:
“Today’s vote on Trumpcare proves that cowardice must be a pre-existing condition. Kevin McCarthy and California Republicans in Congress chose Donald Trump and Paul Ryan over the needs of their own constituents. They should be ashamed and they must be held accountable.”
“The guiding principle for health care is, ‘First do no harm.’ If it becomes law, this bill would do serious harm to tens of millions of Americans struggling to get by — the very people who need affordable health care to reach their full potential,” agreed Sandra Hernández, president & CEO of the California Health Care Foundation, in a statement. “America is better than this.”
Never one to mince words, Congresswoman Barbara Lee, D-Oakland, summed up her reaction this way: “Today Republicans’ core values were on full display, demonstrating the disgusting belief that only the rich are worthy of access to health care.”
The timing of the vote was another strategy, observers say, coming one day before the House is expected to head home to their districts for the next week — where many undoubtedly will face backlash from protesters who stand to lose Obamacare’s benefits.
“I think they are rushing to do this because if they allowed their members to go home before they took a vote, they (House GOP leaders) would likely lose some support,’’ Zingale said.
Gov. Jerry Brown called the bill “cruel and ill-conceived…. rushed to a vote with no fiscal analysis.’’ He said it “will hurt American families and it’s bad for California. Millions will lose coverage, those with pre-existing conditions will be abandoned and costs will skyrocket. … The fig leaf amendments tacked on in the eleventh hour don’t change this massive assault on so many decent and hard-working people.”
Valadao and Denham quickly released a joint statement challenging Brown’s comments.
“At the cost of families in rural California, Governor Brown has prioritized access to health care for those living in urban areas and along the coast over those most in need in the Central Valley,” they wrote. “If he truly cared about ensuring all Californians had access to healthcare, he would work to improve Medicaid reimbursement rates for the most prosperous state in the nation.”
Despite the staggering losses that loom, many Californians who have seen their health insurance premiums soar under a law they say is unfair welcomed the GOP victory.
“The GOP needs to get this done. The 2018 elections are rapidly approaching,’’ said Sally Pipes, president and CEO of the San Francisco-based Pacific Research Institute, a nonprofit that promotes limited government.
Under the GOP bill, states could get waivers from Obama’s prohibition against insurers charging higher premiums to people with pre-existing health problems, but only if the person has had a gap in insurance coverage. States could get those waivers if they have mechanisms like high-risk pools that are supposed to help cover people with serious, expensive-to-treat diseases.
She said moderates were brought on board because the GOP bill provides $8 billion over five years to help states finance their high-risk pools. This late addition, aimed at winning over votes, is on top of $130 billion over a decade in the bill for states to help people afford coverage.
“These are not cheap amendments,” Pipes said.
But in California, where a high-risk pool was established in 1991, critics said it was plagued by long waiting lists, exorbitant premiums, low annual and lifetime benefit caps, coverage exclusions for pre-existing conditions and limited participation of health insurance carriers.
The GOP bill also lets states get federal waivers allowing insurers to charge older customers higher premiums than younger ones by as much as they’d like. Obamacare limited the difference to a 3-1 ratio.
The bill also allows states to get waivers exempting insurers from providing consumers with the 10 essential benefits required under the Affordable Care Act, including health services such as hospital and outpatient care, pregnancy and mental health treatment.
As Larry Levitt, senior vice president for special initiatives at the Kaiser Family Foundation, put it: “This would be the biggest reversal of a government program ever.”
Still, the fight over the bill isn’t over, said Pipes, who wonders what the Senate will do.
“The Senate made major changes to the Affordable Care Act bill in 2010, including dropping the public option,” Pipes said. “I think the 52 GOP senators will have major problems with the House version.”