EDITORIAL: A GOP plan to make America uninsured again

July 02--The Obamacare replacement plan now being debated in the U.S. Senate, would work out fine -- if there are no more poor or sick people in America by 2025. That's when the rollback of the Medicaid expansion that occurred under the Affordable Care Act would nearly be complete and the caps on spending for the overall program would start to kick in. In all, the bill, as drafted, would cut $772 billion from the nation's Medicaid program on which some 73 million Americans depend. That would go along with roughly $541 billion in tax cuts handed down to wealthy Americans and businesses.

But in the likely event there are still poor and sick people around in eight years, they are, by and large, going to be in a world of hurt.

As the Congressional Budget Office pointed out in its analysis last week, this bill, as drafted, goes farther than just repealing Obamacare. It makes America largely uninsured again, pushing the country back to a time where millions were losing coverage and were turning to emergency rooms for having their health care needs met. Based on the CBO's estimates, if the bill succeeds, some 15 million fewer people would have health insurance by the end of 2018. By 2026, that number will have swelled to 22 million.

That is just one of the reasons to dislike what Senate Majority Leader Mitch McCon- nell and others have crafted and continue to massage behind closed doors in hopes of attracting the 50 votes needed to push the legislation through before the Senate adjourns for its month-long August recess.

In California, the impacts of the GOP legislation would be particularly harsh, starting with a $3 billion increase in costs in 2020 increasing to $30 billion a year by 2027. The state Department of Health Services has concluded that overall the legislation would mean a $114 billion reduction in funding, most of it in cuts to Medi-Cal, the state's Medicaid program.

Given that the state would be hard-pressed to make up that gap, it likely means that most of the 3.8 million Californians who were able to obtain health coverage under the Affordable Care Act would be back in the ranks of the uninsured. And, once again, local emergency rooms would feel the impacts the most.

As Staff Writer Martin Espinoza reported last week ("GOP bill may put more pressure on system," Sunday), emergency departments in the county have seen a 67 percent increase in visits by Medi-Cal patients in the past three years. That was somewhat to be expected as many of these are individuals who were previously uninsured and lacked a primary care physician. Thankfully, those numbers are on the decline as county and health officials have helped connect many of these patients with a "medical home" where their basic health care needs can better be addressed than in high-cost emergency rooms. Unfortunately, under both the House version of "repeal and replace" legislation and the draft Senate version, those gains would likely disappear as local hospitals see a resurgence in uninsured patients. The result is more pressure on local hospitals to make ends meet in order to stay in business.

As we have stated before, the Affordable Care Act is in dire need of repair. But what congressional Republicans are pushing through represents neither repair work nor replacement legislation. It just represents regression -- and the nation's most vulnerable residents stand the most to lose.

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