Like so many other Americans, I have tried mightily to understand why the Senate is in such a headlong rush to repeal the Affordable Care Act, or ACA, in a way that would disrupt and diminish the lives of millions of Americans while rearranging one-sixth of the nation’s economy.
The impact of this repeal bill would be severe. The Graham-Cassidy bill would eliminate federal funding for the ACA’s subsidies and expansion of Medicaid – each of which is designed specifically to help low-income Americans get coverage. That funding would be replaced with less funding through a block grant which would be eliminated altogether after 2026. After 2019, California would not even have the option of covering the expansion population, even at a lower federal funding match rate.
It would radically restructure and severely cut federal funding for the rest of Medicaid, which serves low-income children, seniors, pregnant women and people with disabilities. And it allows states to waive consumer protections against insurers charging higher rates to sick people and remove requirements that health plans cover basic, essential health benefits.
The Congressional Budget Office has said it does not have time to evaluate this health care bill to estimate its impact on the country before the Senate’s self-imposed Sept. 30 deadline. With experts estimating that more than 32 million Americans could lose their health care, opposition has been flooding in.
Groups representing consumers, physicians, nurses, public and private hospitals, seniors, nursing homes, health plans, academic medical centers, and other industries and interests unanimously reject this plan. Countless organizations focused on cancer, heart disease, diabetes, lung disease, arthritis, birth defects, multiple sclerosis and other diseases have told Congress not to pass this bill.
There is no good reason for the Senate to act precipitously when the lives and financial security of so many Americans hang in the balance. Because of the ACA, there are countless families who today receive essential care and important financial protections that enable them to remain productive members of our society.
Thanks to California’s commitment to implement the ACA to its fullest effect, California’s uninsured rate has dropped by more than half since 2013. Sixty-five percent of Californians support the ACA – with majority support in every region of the state. There is broad bipartisan support for Medi-Cal, California’s version of Medicaid, with nearly 90 percent of Californians saying the program is important to the state.
Yet the Graham-Cassidy proposal not only repeals the ACA and eliminates the Medi-Cal expansion, it ends Medi-Cal as we know it. California would lose more funding for coverage programs than any other state, a devastating $58 billion in 2027, according to the Center on Budget and Policy Priorities.
A new UC Berkeley study projects that 6.7 million Californians could lose coverage under Graham-Cassidy in 2027. This could include 1.5 million children, seniors and people with disabilities who rely on Medi-Cal, as California would face excruciating choices on Medi-Cal eligibility.
California’s rural counties, which have a disproportionally high percentage of Medi-Cal recipients – and where Medi-Cal funding is critical to hospitals, doctors and clinics as well as the overall economy – would be hit the hardest.
A bipartisan group of senators was already working to find a way to address some of the concerns with the ACA without losing the remarkable coverage gains it has created. Those discussions should continue.
If the Senate passes this misguided and cruel plan, millions of our friends, neighbors, co-workers and families in California and across the nation will face a darker future.
Sandra R. Hernández, MD, is president and chief executive officer of the California Health Care Foundation. Follow her at @srhernandezmd.