The Make-or-Break Moment for Our Health System

The next week or two may be the make-or-break moment for those seeking repeal of the ACA—and for our health system as a whole. The GOP leadership doesn’t have the votes now—so they plan to jam a repeal bill through, daring their own members to vote against a bill called “Obamacare repeal.”

While virtually all their members campaigned on repeal, they also in the same breath voted to replace it, with something better. And they have different ideas on what that replacement looks like—the ultra-right wing wants nothing to replace it, while others, seeing the enormous crowds and protestors at Congressional town halls across the country, have different ideas on allowing people to continue coverage in Medicaid, or the subsidized marketplaces.

Despite the division in their ranks, the GOP leadership will start the repeal process in the House of Representatives, introducing a bill Monday or Tuesday, having committees start to vote on it Wednesday—even without the normal independent analysis (the Congressional Budget Office “CBO score”) to determine coverage and financial impacts. In a final attack against President Obama, their hope is to have a House floor vote on the anniversary of the ACA’s passage, March 23rd. The Senate would seek to bypass committees and then try to jam that same bill—one vote to the President.

While it’s unlikely that the Senate agrees with the House bill entirely, that’s a scary prospect given what’s likely to be in the House bill:

  • The reduction of subsidies to help people afford coverage (now through Covered California, helping over 1.2 million Californians with an average of $309/month)—and shifting them from income-based to age, away from low-income individuals who need them to stay covered.
  • The elimination of the Medicaid expansion by 2020 (which covers over 4 million Californians).
  • The capping of the overall Medicaid program (which now covers over 14 million Californians) through a per capita cap—which is estimated to cut tens of billions of dollars—as much as one-third to one-half of federal support for this program.
  • A massive tax giveaway for the wealthiest, by repealing the ACA’s taxes, and expanding Health Savings Accounts (HSAs).
  • The taxation of some employer-based benefits directly on employers and employees.

This wouldn’t be a rollback of health progress for five years, but for fifty—not just the ACA, but the two main pillars of our health system, Medi-Cal and employer based coverage, and the loss of coverage for millions.

Depending on what happens, Representatives from California need to understand the real policy tradeoffs, and tough life-and death decisions that these options entail. That’s the work of the next week or two.

They are hearing from their constituents! This weekend, Rep. McClintock held yet another town hall—this one attracting over 1700. The first of the members to have voted to start the process to repeal the ACA in California, Rep. Steve Knight of Palmdale. His contituents starte lining up at 2am to get in—the 300+ person venue was packed, with many folks protesting outside until he was police escorted to his car.

The first vote will be in House Energy and Commerce Committee this Wednesday—which has several California members, including one from the majority party—Rep. Mimi Walters of Orange County. Before she votes, we need to make sure Rep. Walters understands the devastating impact of this proposal on California’s health system. And if the committee passes the bill, then all of our House members need to hear from their constituents before that House floor vote.