The House on Thursday narrowly voted to approve a Republican-drafted bill that would eliminate many of the provisions of the Affordable Care Act. It was the first step toward keeping one of President Trump’s campaign pledges and a victory for GOP lawmakers who have long railed against Obamacare, as the ACA is commonly known. The vote was 217-213.
The measure moves to the Senate, where its fate is far from certain. But what could it mean for California?
Nothing immediately for patients, but insurance companies in the state are in the middle of setting premium rates for 2018. Even the uncertainty about the bill's fate could prompt more insurance companies to drop out of Covered California -- or raise rates to hedge against that uncertainty.
If the current bill becomes law, here is how it could affect different categories of patients:
- Those with pre-existing conditions who buy their own insurance: The bill pushes decisions about their fate back onto the states. Each state could decide whether to keep consumer protections for patients with pre-existing conditions, or ditch them by asking the Trump administration for a "waiver." Given California’s Democratic leadership, the state would probably keep those protections. But in states that opt to remove the protections and grant insurers more flexibility on pricing, insurance premiums for patients with pre-existing conditions could skyrocket.
- Californians on Medi-Cal: Like the earlier version, this bill radically restructures how the federal government helps pay for Medicaid (Medi-Cal). California has calculated it would lose $24 billion/year for Medi-Cal funding by 2027. Where would it find the money to backfill that loss? Medi-Cal services might be cut, or eligibility rules tightened. It's estimated that the 3.7 million Californians who gained Medi-Cal coverage under the Affordable Care Act (Obamacare), would eventually lose that coverage.
- Californians who buy plans on Covered California: The federal tax credits that help these Californians buy health plans would be restructured. The tax credits would range from $2,000 to $4,000, depending on your age. Who would lose? Poorer consumers who get thousands of dollars more right now, under the Affordable Care Act, would get less of that financial assistance. Some younger consumers could get more money. But the maximum assistance would be $4,000 a year for premiums, which doesn't go far in many parts of California.