As ACA faces repeal, California has a better alternative

Deborah Burger
Deborah Burger

In the coming days, we may finally see an unveiling of the details and text of the “replacement” plan pledged by those in Congress who have lusted for years to repeal the Affordable Care Act.

But from the leaks that have emerged, they should have saved the premiere for Halloween. It already looks like a horror show. And it won’t come close to promises made by President Donald Trump that “we’re going to have health care for everybody” that is “far less expensive and far better.”

What’s incontrovertible is that tens of millions of Americans gained health coverage under the ACA, mainly through the expansion of Medicaid for low- and moderate-income individuals, and for those previously shunned by insurance companies due to even minor pre-existing conditions.

Still, supporters of the ACA allowed those gains to be overshadowed by several persistent, gaping holes that its strongest advocates failed to remedy. The main gaps are the 28 million people who remain uninsured and the escalating out-of-pocket costs that priced far too many out of using their insurance for needed care, even if paying the premiums.

Those gaps would be made far worse by the proposals now circulating by the repeal-and-replace crowd. Some lowlights:

▪  Refundable tax credits in place of the subsidies to buy private insurance on the ACA exchanges (Covered California).

The amount of the ACA subsidies was based on income; the GOP plan is based on age, so older people of all incomes would get more. And it would be far less, 41 percent less by 2022, according to a new Kaiser Family Foundation analysis.

Further, the GOP plan repeats a major criticism its architects made of the ACA – no restraints on the price gouging so endemic to insurers, hospitals and drug companies. With the lesser financial aid, far more people will either be unable to buy private insurance or be unable to use it when they need to because of the exorbitant deductibles, copays and other fees.

▪  Reversing Medicaid (Medi-Cal) expansion, to some 3.5 million in California.

The GOP plan would end the open-ended federal funding. Instead, states would be given capped funding, that would hamstring typically tight state budgets. The inevitable result: Many states would impose substantial limits on eligibility for coverage or big cuts in covered services.

▪  Selling insurance across state lines.

A longtime conservative favorite that permits insurers to be licensed in the least-regulated states and then sell bare bones plans that pre-empt public protections in states like California where we have won gains such as requiring maternity coverage, ensuring parity for mental health services, and preventing insurers from dropping patients who get sick.

Repeal of the ACA could double our state’s uninsured rate to some 7.5 million people. Fortunately, Californians have an alternative.

New legislation by state Sens. Ricardo Lara and former Assembly Speaker Toni Atkins, sponsored by the California Nurses Association, would establish a more humane system that treats health care as a societal good, not a commodity to inflate corporate profits.

Senate Bill 562 would create a genuinely universal system for all Californians, with comprehensive covered services, no insurance networks that restrict patient choice of doctor, hospital or other provider, and no more copays, deductibles or surprise medical bills.

By pooling what the state already pays for health care services, using the power of a single-payer system to negotiate bulk discounts, and eliminating the waste and profiteering of the insurers, we can protect all California families and set a model for other states about to be hammered by whatever comes out of Washington.

Deborah Burger is a registered nurse and co-president of the California Nurses Association. She can be contacted at