After months of angry town halls, contentious debate and last-minute White House lobbying, Obamacare got a reprieve Friday, as House Republicans pulled their replacement health care proposal before it went to a vote.
For now that means the Affordable Care Act remains intact. While health care advocates in California say consumers “dodged a bullet,” it remains unclear if or when another repeal plan might appear.
“The existential threat to the ACA seems to be over for now. But there could be many decisions ahead from the Trump administration that could end up undermining the law,” said Larry Levitt, senior vice president of the nonpartisan Kaiser Family Foundation. “Some of the actions the administration could take would affect California, but the state is also in a unique position, with its own (health care) exchange, to determine its own fate.”
Friday’s decision to hit the pause button on health care repeal drew relief from California consumers, state legislators and health care advocates who rallied in recent weeks to keep the Affordable Care Act in place. Many of those, however, also acknowledged the current health system still needs improvement to combat rising premium costs, ensure better access to doctors and address other issues that fueled public dissatisfaction with the current plan, which was enacted in 2010.
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“I am elated that this health care bill has been pulled,” said Carmela Castellano-Garcia, president and CEO of CaliforniaHealth+ Advocates, a nonprofit that represents community health centers. “This was the biggest threat to low-income communities that we have seen, and those of us who have worked for decades to expand access to health care are breathing a huge sigh of relief. We have dodged a bullet.”
Obamacare will “remain the law of the land until it’s replaced,” House Speaker Paul Ryan said in a press conference Friday. He did not give specifics about what the next replacement efforts would look like or when they would materialize.
“This is a setback, no two ways about it. But it is not the end of the story,” Ryan said. “I don’t think the law as it is fashioned, or anything close to it, is really going to be able to survive. … We’re going to go back and figure out what the next steps are.”
California congressional members on both sides of the political aisle weighed in Friday.
U.S. Rep. Doris Matsui, D-Sacramento, said in a statement that Friday’s collapse of the vote was “a victory for American families, whose health care was on the line if this TrumpCare bill had passed. In Sacramento and across the country people raised their voices against this harmful legislation.”
Calling the current GOP proposal “an imperfect approach,” Republican congressman Darrell Issa of Vista said lawmakers can do better and urged bipartisan support for new ideas.
“Californians who had their insurance plans canceled, lost access to their doctors, suffered premium increases and sky-high deductible hikes are depending on us to repeal and replace Obamacare once and for all,” said Issa, in an email. “We will go back to the drawing board and get this right for each and every American concerned with high costs in their health care and ever-dwindling choices and access to care.”
Dr. Mario Molina, CEO of Molina Healthcare, Inc., said there's still an unmet need “to have a fundamental conversation about the high cost of health care. Unfortunately this bill did not address that. It was really about shifting more responsibility for Medicaid from the federal government to the states.”
Despite Friday’s pullback, there’s still confusion for insurers that the White House and Congress need to resolve, said Molina, whose companies offer health plans in six California counties, including Sacramento. The two biggest issues, he said, are whether the mandate requiring Americans to have coverage is intact and how much cost-sharing reductions should be offered to help low-income people cover their co-pays and deductibles.
“(Insurers) have to make their decisions about health plans in a few months and those decisions will impact how they determine their premiums,” Molina said. “If (Congress and the Trump administration) don’t address these issues, it’ll destabilize the marketplace. They can’t blame it on the ACA anymore, they’re now in charge.”
Speaker Ryan introduced the American Health Care Act earlier this month, revealing details of a long-awaited GOP plan to replace President Barack Obama’s 2010 law that mandated health care coverage for almost all Americans. But amid concerns over costs and who would be covered, the bill began losing support among both moderate and conservative Republicans.
This week marked the seventh anniversary of the Affordable Care Act, which Gov. Jerry Brown celebrated in a press conference Wednesday at the state Capitol. Currently, about 3.7 million low-income Californians are enrolled through a Medi-Cal expansion under the federal health law, and 1.3 million rely on individual coverage plans through Covered California, the state’s Obamacare health exchange. Californians make up about a fifth of all Americans who have received health coverage through the Affordable Care Act.
Under the GOP repeal plan, California would have seen a phaseout of federal funding for Medi-Cal expansion, reduced tax credits for most Covered California enrollees and lowered funding for certain health programs, including vaccinations and screenings for low-income families, disease prevention efforts and reproductive services through Planned Parenthood.
The Congressional Budget Office estimated that under the repeal plan 24 million Americans would lose coverage by 2026.
As GOP support started to waver, last-minute amendments were added, including a work requirement for Medicaid enrollees and a proposed cut in “essential benefits” such as maternity care, emergency room visits, prescription drugs and mental health treatment.
With those amendments, the bill “went from bad to worse,” said Stephanie Winn-McCorkle, western region spokeswoman for the American Cancer Society Cancer Action Network, Inc., who said it appeared that many preventative screenings, such as colonoscopies, might not be covered.
“The ACA does need improvement but anything that replaces it should be as good or better than what we have right now,” she said. “The current bill wasn’t even close to meeting our minimum benchmarks for adequate, accessible and affordable insurance. It would not provide insurance coverage that everyone needs, including cancer patients.”
One young Sacramento cancer patient, Victoria Dzorka, said Friday’s collapse of the vote was “a big relief for those of us undergoing treatment.” A California State University, Sacramento graduate student, she works part-time while undergoing chemotherapy treatments for lymphoma, which was diagnosed in January. When Dzorka turns 26 in May, she’ll lose coverage under her mother’s health plan, so will need to sign on to Medi-Cal, but worried that changes to the Affordable Care Act might hurt her ability to gain affordable coverage with a pre-existing condition like cancer.
State Sen. Ed Hernandez, D-West Covina, chair of the Senate Health Committee, said the bill’s withdrawal indicated GOP lawmakers were listening to their constituents. “The president is finally realizing the people of this country have spoken about how important it is to have affordable health care,” he said after Friday’s vote.
Looking ahead, he said, Democrats and Republicans need to deal with spiraling drug costs. Hernandez is sponsoring a bill to require more disclosure on drug pricing by pharmaceutical companies.
“If (House Republicans) truly want to reform health care, they should attack prescription drug costs,” Hernandez said, noting that prices for many common drugs have hit state budgets and individuals alike. “If we have true transparency, consumers can see the true amount that goes to health care premiums from pharmaceutical costs.”
Regardless of what happens in Washington, Covered California officials said they’ll continue to enroll individuals who need health care coverage.
“We want to make sure people know that Covered California is going strong, open for business and will be here for the foreseeable future,” said Covered California spokesman James Scullary, in an email after the vote.