GOP health care bill could drive even more North Coast patients to emergency rooms

June 25--Emergency rooms would once again become the main medical access point for low-income residents under the Republican Party's latest health care bill, which seeks to replace former President Barack Obama's Affordable Care Act, according to local and state health care experts.

Unveiled Thursday in the Senate, the Better Care Reconciliation Act would roll back Obamacare's massive expansion of Medicaid, which brought government-subsidized health coverage to 11 million low-income residents across the country, including 4 million in California and 35,000 in Sonoma County.

"People will go back to waiting until it's too late to access health care," said Dr. Michelle Quiogue, president of the California Academy of Family Physicians.

Quiogue said that means more people with high medical needs will appear in emergency rooms, including people suffering heart attacks, strokes and complications from chronic illnesses such as diabetes that require amputations or other expensive treatment. All of these illnesses can be preventable with primary care.

"It means we're taking a step back toward a 'sick care system' instead of a 'health care system,'" she said.

Under the Affordable Care Act, emergency departments in Sonoma County and across the country saw dramatic increases in hospital visits by those covered by Medicaid. Health care professionals said that increase was expected, given many of those patients were previously uninsured or underinsured and did not have a "medical home" or primary care doctor. As a result, they often sought care at the only place they knew -- the emergency room.

Quiogue said the shortage of primary care physicians, an ongoing national crisis, may also have left many of the newly insured under Obamacare with few options seeking primary and preventative care, leading to more emergency room visits. But since the expansion of Medicaid -- and by extension Medi-Cal, the equivalent program in California -- local health officials and medical providers have sought to connect Medi-Cal patients to a primary care doctor. County health officials point to declining rates of emergency room visits among local Medi-Cal patients as evidence this strategy is working.

Those improvements, however, could become meaningless under the GOP health care bill.

The Senate version would phase out the Medicaid expansion between 2020 and 2024. That segment of Medicaid is particularly expensive for the federal government, which paid 100 percent of the costs of expanding Medi-Cal between 2014 and 2016 before it began gradually scaling back its support, covering 90 percent of the costs by 2020. By comparison, the federal government pays only half of the cost of regular Medi-Cal.

Sonoma County would lose about $178 million in annual state and federal funding if the Medi-Cal expansion is eliminated, according to estimates by Partnership HealthPlan of California, the nonprofit that administers Medi-Cal benefits for some 112,000 people in Sonoma County.

On Friday, American College of Emergency Physicians President Dr. Rebecca Parker said the proposed Senate bill would likely lead to increases in patient loads and crowding at emergency departments, "which are already seeing record numbers of patients."

"This new legislation will create burdens on ERs that are unsustainable and dangerous," Parker said in a statement.

You can reach Staff Writer Martin Espinoza at 707-521-5213 or martin.espinoza@pressdemocrat.com. On Twitter @renofish.

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