Republicans in Congress will soon make good on their long-held promise to pass legislation repealing much if not all of the Affordable Care Act, the federal health reform widely known as Obamacare.
President Barack Obama, of course, will promptly veto the bill, but Republicans see their action as a message to voters demonstrating what they will do if a Republican wins the White House in 2016.
Many observers still doubt that Republicans would follow through with their threat if they actually had the chance. It’s one thing to vote for a bill that you know will never become law. Voting to actually take people’s health insurance away would be a much tougher sell.
Consider the impact in California, which was one of the first states to fully embrace the new law and has implemented it aggressively. Since the law started taking effect in 2010, the number of people without health insurance in the state has dropped by half.
About 1.4 million Californians are now getting their insurance through Covered California, the health insurance marketplace the state created to implement the law. Another 2 million-plus Californians have been added to the rolls of Medi-Cal, the state and federal health program for the poor. About one-third of all Californians, and half the state’s children, now get their health care through Medi-Cal.
The law is not without its problems. Many of those who are insured through Covered California complain about the narrow networks of doctors and hospitals the insurance plans put together to keep costs down. In some parts of the state, it can be almost impossible to find a doctor who takes new patients using the insurance.
And while the subsidized monthly premiums charged by the plans are reasonably affordable, most plans come with high deductibles that require customers to pay thousands of dollars out of pocket before they begin to see real benefits from their coverage.
The new enrollees in Medi-Cal, meanwhile, also face a shortage of doctors taking new patients. That’s always been a problem with the program because low reimbursements and other issues have led many doctors to steer clear of Medi-Cal. Adding 2 million more people to the system has only made it worse.
Despite these problems, it seems unlikely that very many people who have gained coverage under Obamacare would give it up willingly. Covered California reports that 9 out of 10 of its customers re-enrolled after the first year. Some of those might have been motivated by the prospect of tax penalties looming for people who go without coverage. But most Californians actually welcome the opportunity to have insurance.
What would happen here if the Republicans did repeal the ACA in 2017?
Democrats in the Legislature would surely try to maintain the program without federal assistance, but it would be difficult.
The federal subsidies for people who are buying their insurance through Covered California are projected to total more than $4 billion this year. And even after the federal government stops paying the entire cost of the expansion of Medi-Cal, the feds would still be paying about $9 billion of the total $10 billion cost in 2020. That means it would cost California somewhere around $13 billion a year to maintain the status quo, and probably more, since health care costs will continue to climb.
California, in other words, has been the biggest beneficiary of the ACA. And Californians have the most to lose if Republicans repeal it.
Daniel Weintraub is editor of the California Health Report. He can be contacted at firstname.lastname@example.org.