What 'Skinny Repeal' Means for California: One Million Fewer People Covered

Senate Republicans have cast two separate votes this week trying to dismantle the Affordable Care Act. The first bill to be voted down was a "repeal-only" proposal and the second was a plan for replacement.

With their options narrowed, Senate Republicans are now trying to remove some key provisions of Obamacare in what's being called the "skinny repeal."

The language is not yet final, but one version of the repeal bill would remove the requirement for individuals and businesses to buy health insurance. This is a key feature that works to expand risk pools and lower costs. The GOP plan would also get rid of the medical device tax -- a revenue source for the current health law.

But what does this all mean for California?

“The implications for 2018 are stark," said Peter V. Lee in a statement Thursday. He's the executive director of Covered California, the state's health insurance marketplace. About 700,000 fewer Californians would have individual coverage, he said.

"Many of those people would drop coverage not because there is no penalty but because the increase in premiums could be as much as 20 percent more due to a less healthy risk mix," Lee said in the statement.

Apart from those coverage losses in the individual market, 300,000 Californians would likely not enroll in Medicaid due to the elimination of the individual mandate, the group said, noting its analysis was consistent with prior estimates of the elimination of the mandate developed for it by PricewaterhouseCoopers.

In short, Covered California said the "skinny repeal" would lead to increases in uncompensated care that would have implications for the entire state.

Sen. Dianne Feinstein, citing the group's findings, said Thursday she was concerned the Republican bill would "take California backward in terms of coverage gains achieved over the last four years."

The Senate is expected to debate the bill through late Thursday, following fast-track budget rules that limit the negotiations to 20 hours. But amendments can still be added.

When debate time expires, those amendments are voted on in what Senators call a "vote-a-rama." This could turn into an all-night session tonight, where the Senate Republican definition of skinny could keep evolving.

California's 55-member congressional delegation has split along party lines on the health care votes, with all 14 House Republicans supporting GOP legislation to roll back Obamacare and their Democratic counterparts, including the state's two senators, remaining opposed to such efforts.