California’s Pivotal Role in the #Fight4OurHealth

For six months since the election, we have been focused on the #Fight4OurHealth, working to stop those who would rollback our progress on health care, repeal the ACA, and cut and cap Medicaid. Tomorrow is the vote, and the whip count is very, very close.

As President Trump, Speaker Ryan, Majority Leader McCarthy make their final(?) push to pass the awful American Health Care Act (AHCA), it’s clear–it’s really up to California: With 14 Republican Representatives–more than any other state except TX & FL–Californians will make the difference on #Trumpcare. It would be fitting if we blocked the law–California gained the most from the ACA, and has the most to lose in repeal, especially in Medicaid. This Sacramento Bee article details how much California has and will make a difference, affirming our strategy to focus on the House:

The reporting just a day ago suggested that the only CA Congressmembers that are publicly supporting this awful #AHCA, beyond GOP Majority Leader McCarthy, are the four that already voted for it in committee: Duncan Hunter, Tom McClintock, Devin Nunes, and Mimi Walters. When we started six months ago, we hoped to peel off a few votes in the House to slow momentum in the Senate, focusing on the seven Representatives that are in districts that Trump lost: Denham, Valadao, Knight, Issa, as well as Royce, Rohrabacher, and Walters. A day ago, all are undecided or leaning no, along with Cook–and even Calvert and LaMalfa won’t take a position.

The question is whether California GOP Congressmembers will vote against the interests and wishes of their constituents? 

So tonight, it was deeply disappointing to see the text of new Upton amendments to the American Health Care Act (AHCA) released, in anticipation of a vote in the House tomorrow, with the co-sponsorship of three California Congressmembers who had earlier announced their opposition or serious concerns to the underlying bill.

California Congressmembers Jeff Denham, David Valadao, and Steve Knight had each been the most vocal in the delegation in expressing legitimate concerns about the AHCA, but the amendment they are co-sponsoring with Rep. Fred Upton does nothing to resolve those issues. The AHCA is still a disaster for California, by:

  • Eliminating the Medi-Cal expansion that over 3.7 million Californians now depend on;
  • Otherwise capping the Medicaid program, resulting in an overall $24 billion cut to Medi-Cal within a decade;
  • Cutting Covered California assistance to afford health coverage, leading to an average spike in health costs in California of $2,800/year by 2020;
  • Undermining patient protections, like minimum standards for the essential health benefits that insurers must cover, or the prohibition against charging patients with pre-existing conditions more.

For any California Congressmember to vote for the House health bill would be a betrayal of their constituents, given how devastating this would be for families and for our health system as a whole. This back-from-the-dead bill should be scary not just for the five million Californians who now get help under the ACA, but anyone who may need to rely on Medi-Cal or the ACA’s patient protections in the future. California took the most advantage of the benefits under Medicaid and Covered California, and thus we have the most to lose. Especially in California, this will be a vote Congressmember’s constituents will remember, if they do in fact vote to repeal coverage options and consumer protections, putting millions of Americans at risk, spike premiums, raise deductibles, and undercut the entire health care market.

The Upton amendment added $8 billion to support high-risk pools for people with pre-existing conditions for states that take up the option to undo protections for those patients. Either California would not take up those waivers–meaning the Upton amendment means nothing to our state–or it would undo key patient protections, violating many of the Representatives’ promise not to undo the benefits for those with pre-existing conditions. The amount, $8 billion over 5 years–or less than $190 million/year for California–is too paltry to make a big difference given the other cuts in the proposal such as the over $800 billion cut to Medicaid.

We would be outraged by a California triple-cross, if our Congressmembers who raised legitimate concerns with the bill then voted against the interests and wishes of their constituents. In each of the three members–all three in marginal seats where Hillary Clinton–it’s incomprehensible why they would sponsor the amendment, much less vote for the overall bill:

  • Rep. Denham told over 1,000 people in his town hall a few weeks ago that he was a no on the bill, until it became more responsive to his community–which none of the amendments do. It’s still the same bill that would undo coverage for potentially over 100,000 of his residents, cutting and capping Medicaid that 300,000 of his constituents depend on. Denham stated he wanted people who got Medicaid coverage to be able to keep that coverage–and this bill does the opposite by eliminating the Medicaid expansion.
  • Rep. Knight told hundreds at his town hall that undermining protections for people with pre-existing conditions was off the table, but his amendment helps put those protections on the chopping block. Knight also cited concerns about the price spike for people 50-64, but the bill still allows insurers to charge older people more, and chops the subsidies to help them afford it.
  • Rep. Valadao expressed concerns about Medi-Cal cuts, but this proposal still includes a massive cuts to Medicaid, which over half his district disproportionately depends on. The bill still eliminates the Medicaid expansion, of nearly 100,000 just in his district, while capping the rest of the program which 400,000 of his constituents rely on. The Central Valley deeply depends on Medi-Cal, and a vote for AHCA is to massively cut and cap this life-giving program.

We will be watching the vote closely tomorrow, for these Congressmen’s vote, and for the entire delegation’s action. Millions of Californians rely on Medicaid and the ACA, and won’t take kindly to those who seek to undermine their care.