Four years ago, when the Affordable Care Act was in its infancy, California had fewer than eight million residents covered by Medi-Cal, its health care program for the poor.
One aspect of what came to be known as Obamacare was an expansion of the program, known in other states as Medicaid, and California fully embraced it. The federal government would cover most costs of both newly eligible residents and previously eligible Californians who would be enrolled by an intensive recruitment campaign.
Today, with Republicans poised to take control of the White House and Congress and promising to repeal Obamacare, 13.5 million Californians have Medi-Cal coverage, a 71 percent expansion since 2014 and more than a third of the state’s population.
It means that California has, by far, the greatest stakes in the forthcoming battle over whether Obamacare lives or dies. And if its fate is the latter, California would have to decide whether to kick millions off the Medi-Cal rolls or cover them with state tax money.
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A new report from the California Budget and Policy Center, which advocates for programs serving the poor, contains a county-by-county breakdown of those stakes.
It reveals, not surprisingly, that rural counties with the state’s highest levels of unemployment and poverty, have the most to lose. Tulare County, in the San Joaquin Valley, has the highest level of Medi-Cal enrollment, 55 percent of its population, followed by Merced at 51.5 percent and Fresno at 49.9 percent.
Not surprisingly, too, the lowest levels are found in the state’s most affluent counties, with Marin at 17.2 percent the lowest and Placer, 17.5 percent, just slightly higher.
The report also demonstrates that the rural counties with the highest Medi-Cal enrollment rates are mostly represented by Republican congressional members. Kevin McCarthy, the second-ranking Republican congressional leader, calls Kern County home, and it has one of the state’s highest levels of Medi-Cal coverage, 45.1 percent. He told reporters in Washington Tuesday that Obamacare should be repealed and replaced with a program that gives patients more choice.
McCarthy’s district also includes a portion of adjacent Tulare County, with the state’s highest rate, and the remainder is represented by Republicans Devon Nunes and David Valadao.