Obamacare repeal could cost jobs in Ventura County

Jan. 13--Repealing the Affordable Care Act could take away 4,000 jobs from Ventura County and cost $331 million in lost goods and services, according to University of California, Berkeley, researchers.

Hospitals, clinics and other health entities that met the flood of 55,0000 uninsured Ventura County residents who gained coverage through the health care law would absorb more than 70 percent of the job loss.

Real estate firms, insurance agencies and restaurants could be hit too, partly because out-of-work health care employees would spend less.

The reduction would be driven by the possible loss of about $17 billion a year in federal funding that enabled the Medi-Cal government insurance program to stretch its reach and cover 3.6 million more people across California, including as many as 66,000 in Ventura County, according to Berkeley data.

About $4 billion in tax subsidies used on monthly insurance premiums bought through a Covered California marketplace spawned by the Affordable Care Act could disappear too.

"When the money stops, the health insurance stops," said Laurel Lucia, a UC Berkeley researcher, predicting demand for care in hospitals, doctors' offices, pharmacies and offices would diminish, triggering layoffs. "I think it will hurt a lot given that we're still recovering from the Great Recession."

Like every other aspect of the program known as Obamacare, the projections ignite fear, rebuttals and name-calling.

"Alarmist" is the word Sung Won Sohn chose for the Berkeley research and another study that predicts more dire consequences. The economist at CSU Channel Islands said that without knowing if and exactly how the health care law will be changed it is impossible to predict the impact on the economy.

"We might be pleasantly surprised at the end of the day," he said of the unknown replacement to Obamacare. "We may have a different system but the job impact may not be that great... I think those projections have done a disservice by providing alarm."

Others contend predictions of layoffs show an impact largely hidden in a fight focused on rising out-of-pocket costs, broken promises and access to care. They expect job cuts.

"It doesn't surprise me. It just appalls me," said Jo Hathon, medical office assistant at a county-affiliated outpatient center in Ventura. She mulled over the wave of newly insured patients and increases in staffing, worrying about what happens if the tide recedes.

"That will mean some unhappy things," she said.

If the ACA is repealed...

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Sources: UC Berkeley Center for Labor Research and Education, UCLA Center for Health Policy Research

$20 billion could be lost

The exact future of the Affordable Care Act dangles in limbo. President-elect Donald Trump and Republican lawmakers have promised to repeal the law in a process that began with a Senate budget vote at 1:30 a.m. Thursday. The House of Representatives approved the resolution on Friday in a move that could enable a speedy repeal.

Trump has suggested aspects of the current system could stay, including a ban on denying coverage to people with cancer or other pre-existing conditions and the clause that allows young adults to remain on their parents' coverage until age 26.

In his first press conference as president-elect, Trump said the repeal will come almost simultaneously with new legislation that will replace Obamacare. He has not offered details of that plan.

Lucia, co-author of the study that projected impacts of a repeal, said job loss across California could be reduced depending on the replacement plan. She said projections are based on factors including the likely elimination of the Medi-Cal expansion, premium subsidies and the mandate that people obtain insurance or pay tax fines.

The programs were targeted in a previous repeal effort in December 2015.

Unemployment rates and enrollment in Medi-Cal and Covered California factored into calculations that tracked how federal funds filter from the newly insured to health entities and the companies that provide services to them.

Without that money, about 209,000 jobs could be lost across California, researchers said. About $20 billion in goods and services would be lost.

"It will be very difficult for the state to make up that loss," Lucia said. "$20 billion is a huge share of the state budget."

Ventura County projections were not included in the original December study but were calculated by Lucia. The 4,000 jobs lost is slightly less than the projected 5,000 positions at jeopardy in neighboring Kern County and more than the 3,000 jobs in Tulare County.

To put the 4,000 jobs in context, Ventura County government employs about 9,000 people. The lost jobs projected in the Berkeley study would come from the private and public sector.

Health entities that serve low and middle-income people -- those covered by Medi-Cal and Covered California -- could be hurt worst but effects would spread, Lucia said.

"When health care workers lose their jobs, they will be spending less at restaurants, retail stores and other businesses," Lucia said, also suggesting real firms and insurance brokerages would feel the impact.

The predictions are not unique. A national study released by the Commonwealth Fund this month projected job loss would grow over time with as many as 2.6 million people pushed into unemployment lines in 2019.

"Hospitals will have to lay off staff or reduce wages or cut back on what they buy," said Leighton Ku, a George Washington University professor who helped lead the research.

Waiting for clarity

In Ventura County, the Affordable Care Act sent Medi-Cal enrollment skyrocketing.

A study from Berkeley and UCLA said the provisions in the law that expanded Medi-Cal in part by raising the income bar brought coverage to 65,669 people in Ventura County. Gold Coast Health Plan, the publicly funded organization that administers Medi-Cal in the county, said their number of enrollees from the expansion is 56,338.

The surge in members was accompanied by a surge in Gold Coast employees. The plan's full-time staff jumped from 57 people in January 2013 to a current level of 186. CEO Dale Villani said it's hard to know how much of the staff increase was triggered by Medi-Cal changes.

But the focus on repealing the Affordable Care Act in the presidential campaign triggered fears among some Gold Coast employees that their jobs could be affected by Trump's election.

"My message to everyone was and still is that we are looking ahead to an uncertain future and are taking our lead from the state while they are waiting to hear from Washington," said Villani in an email.

The Medi-Cal changes also brought about 45 jobs to Ventura County Human Services Agency where workers enroll people in Medi-Cal.

"It would be irresponsible for us to make any kind of projection about job loss given the uncertainty about federal and state changes," said agency spokeswoman Jennie Pittman.

Bad debt could rise

Leaders of the 2,700-employee Ventura County Health Care Agency said they're still analyzing the impact of the Affordable Care Act on a hospital and clinic system that focuses on the uninsured, Medi-Cal members and other lower income patients.

State records show that in 2013 -- before the Affordable Care Act -- the Ventura County Medical Center absorbed $47 million in uncompensated care and bad debt. About 16 percent of the hospital's operating expenses was spent covering unpaid bills from patients, according to the Office of Statewide Health Planning and Development.

In 2015, after two years of Obamacare, uncompensated care and bad debt fell to $21 million, or about 7 percent of operating expenses.

Health systems across the state watched their uncompensated care numbers fall, providing a financial boost that could be reversed in a repeal. Some systems have also seen an increase in outpatient primary care because the surge in insured patients means people don't have to delay care until they need emergency room treatment, said Johnson Gill, new director of the Ventura County Health Care Agency.

If a repeal comes and brings longer lines in emergency rooms -- a shift from what Gill called well care to sick care -- the county system may need to shift its work force to meet needs. Gill said he's optimistic there won't be job cuts.

But union members worry.

"Absolutely," said Coral Itzcalli, spokeswoman for SEIU Local 721, describing a forum where 5,000 union members talked about repeal efforts and the possibility of cutbacks that would push more responsibility on a shrinking workforce. "Some people may lose their jobs. For those who don't, they're left behind working in very stressful situations."

The union's reach includes about 1,500 workers at the Ventura County Health Care Agency. Hathon is one of them. Her job is to tell patients if they're covered by insurance.

"I'll be saying, 'You could be held responsible for this bill,'" she said of what could come with a repeal.

She's worked for the county for 21 years and thinks that tenure will provide job protection. She worries about other workers, patients and taxpayers.

"If they have insurance, we get paid for it," she said of the county. "If they don't have insurance, the taxpayers pay for it. Solely."

Carmela Castellano-Garcia leads a California Primary Care Association that represents community health centers across the state. The Affordable Care Act has brought money to expand community health centers and also increased patients' ability to pay for care.

"There will absolutely be job loss," she said of a possible repeal.

But the point is argued even among health centers.

Roberto Juarez, CEO of Clinicas del Camino Real, said before the budget votes in Congress that he does not think the Affordable Care Act will be repealed. If dramatic changes do come, he thinks it could mean a small cut in revenue to Clinicas' network of health centers but could also mean more uninsured patients falling into the safety net.

"We would have to employ more people," he said.

The final word belongs to Mike Osborn, chairman of the Ventura County Republican Party and a Donald Trump supporter. He wonders how researchers can figure out what new jobs in hospitals and clinics were directly created by the Affordable Care Act.

Tell him projections rely on a well-known software program used for research. He paused and thought of a Trump victory that defied poll projections.

"Is that the same one," he asked, "they used in the election?"

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