California, LA County fret over what ‘Trumpcare’ could mean after Obamacare

Jan. 05--With the Trump administration and lawmakers moving swiftly to do away with Obamacare, many in Los Angeles County are bracing for the ripple effects in a region that could be among the hardest hit.

"Prior to the Affordable Care Act, Los Angeles was ground zero for the health care crisis," said Anthony Wright, executive director for Health Access, a California-based consumer advocacy group. "To undo the success made would set us back even worse to before the Affordable Care Act."

President-elect Donald Trump has said his first order of business when he officially takes office will be to repeal President Barack Obama's health care law, known as Obamacare. But a replacement plan remains murky. On Wednesday, Vice President-elect Mike Pence discussed the issue with House Republicans, urging them to dismantle Obamacare by Feb. 20, according to news reports.

It's unclear what that will entail, or how long it would take. But a study released in December by the UC Berkeley Center for Labor Research and Education found if Congress follows through on the repeal, the Golden State would lose about $20 billion in annual federal funding that goes toward Medi-Cal. The loss would mean 3.7 million Californians enrolled in the Medi-Cal expansion would no longer have coverage. Another 1.2 million people who receive federal subsidies to help pay for private health insurance bought through Covered California, also would go without assistance.

Wright said such a drop in enrollees would be a catastrophe in California -- and in particularly in Los Angeles County -- because the young and healthy who were lured into enrolling into health plan to avoid penalties and the promise of subsidies would drop out, leaving only the sick and needy in the system. That will mean higher premiums for all others, Wright said.

"This would create chaos in our health care system in fairly fundamental way," Wright said.

Los Angeles County funds a program that offers free health care to thousands of undocumented youth and adults and assigns them to specific community clinics. Called My Health L.A.,the program costs the county almost $60 million of its own funds to run since undocumented immigrants don't qualify for federally funded health care. But loss of federal funds linked to health care for residents may mean the county will have to shift priorities, some said. As of November, 145,056 had enrolled into My Health LA since it was announced in late 2014.

"Immigration is very linked to health and health benefits,' said Kimberly Wyard, chief executive officer of Northeast Valley Health Corp., one of the nation's largest corporations of its kind with more than a dozen clinics in the San Fernando and Santa Clarita valleys. The clinic sees 15,200 unique patients annually and earns $4.2 million in patient revenue through reimbursements.

At least 10,000 patients are enrolled into the My Health LA program, Wyard said.

She said any slide in federal funding would mean health centers would have to cut back services. She hopes any discussions about replacing Obamacare will involve both Democrat and Republican legislators who understand that in Los Angeles County at least, thousands of their constituents depend on community health centers.

"The goal here is to try to maintain services that we have and not to have to close clinics or cut extended hours," Wyard said. "I don't know what the replacement will look like or what Trumpcare will look like. But we're a good deal, we save money, we have bipartisan support. I take comfort in that."

The hiring of U.S. Attorney General Eric Holder by California lawmakers to advise them on legal challenges they expect from the upcoming Trump administration offered little comfort Wednesday for those watching and working in health care in the Golden State.

Many said California has the most to lose if the Affordable Care Act is repealed by Congress and Holder likely won't be able to stop it, Wright said. "The legal hooks are more clear on immigration and environmental issues than health care," Wright said, adding that if Trump moves to repeal the act without Congress' blessing, Holder's role may be more helpful.

Holder was retained by state legislators because they expect "extraordinary challenges for California in the uncertain times ahead," citing immigration, climate change and health care, state Senate President Pro Tem Kevin de León, D-Los Angeles, and California Assembly Speaker Anthony Rendon, D-Paramount, announced in a joint statement early Wednesday.

Los Angeles County could feel the ripple effects most, he added.

Meanwhile Assembly Republican Leader Chad Mayes, R-Yucca Valley, said in a statement Wednesday that retaining Holder was a distraction from the other problems in California.

"Donald Trump did not cause California's transportation crisis, nor did he play a role in our state's sky-high housing costs," he said in the statement. "Democrats should focus on solving these real-world problems instead of wasting taxpayer money to score political points before the president-elect even takes office."

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