The Impact in Your District in Inyo and the IE…

It’s best to understand the impact of the American Health Care Act at the local level, so let’s explore the Inland Empire of California. Representative Paul Cook had an op-ed in the San Bernardino Sun last week, asking for input on how this would impact his district.

We provided some answers in a follow-up opinion piece. But even since that opinion piece, more analysis has come out. Covered California, the state’s marketplace, issued a region-by-region analysis comparing financial assistance issued under the Affordable Care Act and the American Health Care Act. (March 20, 2017)

In Covered California’s Region 13 (in Rep. Cook’s district including Inyo and Mono Counties), folks of all ages making $17,000 or $30,000 would have to pay significantly more for coverage, given the flat tax credit that does not adjust for income or premiums in high-cost areas.

  1. Someone in Inyo County making $17,000 a year would pay $622 for coverage today—but would pay $4,533 for coverage if they were 27 years old; $4,967 if they were 40 years old, and a whopping $13,911 if they were 62 years old.
  2. In Region 17, which includes San Bernardino County, a 62-year old worker in San Bernardino would see premiums increase to $6,395—from $2,494 if they made $30,000/year, and from $622 if they made $17,000/year.

UC Berkeley’s Labor Center published a policy brief of AHCA cuts to Medicaid (Medi-Cal in the state) expansion funding, entitled, Medi-Cal Expansion under AHCA: Severe Coverage and Funding Loss unless State Backfills Billions in Federal Cuts.  (March 21, 2017)

  1. In San Bernardino County, just due to the Medicaid expansion rollback alone, 225,100 people are projected to lose coverage by 2027, a 9.3% reduction in overall coverage for county—a $1.5 billion cut to the health system. Rural parts of California face similar losses.
  2. In Congressman Cook’s District (8), the Medicaid expansion rollback would mean 81,400 constituents are projected to lose coverage—for a cut in Medi-Cal funding of $548 million. 

California’s Department of Health Care Services, which administers our state’s Medicaid program, published a summary of fiscal impacts of AHCA on the state’s Medicaid/Medi-Cal program. (March 22, 2017)– showing that AHCA’s new Medicaid funding methodology (block grant or per capita caps) affects nearly all enrollees and funding, which represents a fundamental change in a 50 year-old federal-state partnership and the creation of Medicaid.

  1. With proposed AHCA overall Medicaid funding cuts, it is estimated that California will be responsible for a state share of $680 million in 2020 and $5.3 billion by 2027.
  2. With proposed AHCA Medicaid expansion cuts, 4.8 million people will not be eligible for enhanced federal funding, and instead will be a 50-50 state to federal cost-sharing ratio. This will cost $4.8 billion in 2020, and grow to $18.5 billion in 2027.
  3. The state’s share would be $3.3 billion in 2020, and grow to $13 billion in 2027.


Several other sources confirm that the 8th Congressional District will be deeply impacted:

In 2016, 22,493 of district constituents bought affordable coverage through Covered California, the state’s marketplace. Your constituents received a total of over $65 million in federal funding, nearly $55 million in premium tax credits and $10 million in cost-sharing reduction subsidies. [iv] There were 20,576 (91%)[v] individuals that received financial assistance to afford coverage, at an annual, average rate of $3,417 for premium tax credits and $625 for cost-sharing reductions.[vi]

In the district, 318,689[iii] (44%) of constituents are on the Medicaid program, which would be cut by 25% under AHCA, both through the roll-back of the Medicaid expansion and implementation of per capita caps. An estimated 87,000 of district residents gained coverage through Medicaid expansion and would lose coverage in 2020.

This would reverse the trend, where the uninsurance rate fell by 54% under the ACA, from 17%[i] in 2013 to 8%[ii] in 2015In San Bernardino County, 12,000 jobs and $900 million in GDP are projected to be lost.[vii]

Safety-net providers in your district provide critical services and will be greatly impacted by cuts to Medicaid funding. There are 4 community clinics and health centers in your district that had nearly 26,000 patient encounters and served over 12,000 residents, 60% of which are on Medicaid.[viii]

Hospitals in your district rely heavily on Medicaid funding. The CBO estimates the AHCA would cut Medicaid funding by 25%,[ix] resulting in drastic reductions for hospitals. Arrowhead Regional Medical Center had more than 275,000 inpatient and outpatient visits and is one of only two trauma centers in San Bernardino County. It stands to lose $120 million in annual revenue.[x]

California cannot return to the days when nearly one out of every five Californians was uninsured, and when insurance companies could deny coverage to the sick and kick people off insurance if they ran up big bills.


[i] US Census, American Fact Finder, American Community Survey, Health Insurance Coverage in the U.S. 1-Year Estimates 2013.

[ii] US Census, American Fact Finder, American Community Survey, Health Insurance Coverage in the U.S. 1-Year Estimate 2015.

[iii] UC Berkeley Labor Center, Fact Sheet: Medi-Cal Enrollment by U.S. Congressional District, February 2017.

[iv] Covered California, 2016 Bridging Health Care Coverage Within Reach, March 2017.

[v] Ibid.

[vi] Ibid.

[vii] UC Berkeley Labor Center and UCLA for Health Policy Research, Fact Sheet: What does San Bernardino County Stand to Lose Under ACA Repeal? January 2017.

[viii] California Health+ Advocates, California Community Clinics and Health Centers, Congressional District 8 Profile, 2017.

[ix] Congressional Budget Office, American Health Care Act Cost Estimate, March 13, 2017.

[x] California Association of Public Hospitals and Health Systems, Impact of Medi-Cal Expansion: Arrowhead Regional Medical Center, 2017.