President Trump’s repeated efforts to derail Obamacare worries Sonoma County health care leaders

Jan. 20--Gov. Gavin Newsom has called President Trump's two-year barrage to undermine the Affordable Care Act "vandalism," while other state and national health care experts have described it as "sabotage," a "slow bleed," or even "death by a thousand cuts."

Local and state health officials, and now the newly sworn-in California governor, have sought to blunt the continuing onslaught from Trump and congressional Republicans to repeal or undermine the nation's health care law.

Sonoma County health care leaders say the stakes are in the millions of dollars for hospitals and community clinics that have benefited from the law since it was fully implemented in 2014.

Unless more steps are taken to protect the Affordable Care Act, area medical providers say they could begin to see an increasing number of uninsured patients and multimillion dollar annual losses because of unpaid patient medical bills and charity care.

"It's a game of whack-a-mole; we're trying to make the law work in California, but every time we turn around there's another attack by the federal government," said Anthony Wright, executive director of Health Access, a statewide health consumer advocacy group.

Wright and others say the effects of President Trump's repeated attempts to derail his predecessor's signature health care law largely have been deflected in California. There are some local signs, though, the law may be starting to weaken.

According to Covered California, the state's health insurance exchange, the number of new enrollees statewide has declined slightly, even as the tally of people renewing their medical coverage plans through Covered California has remained high. That may change, however, because the agency said late last week it was still processing last-minute enrollees who had until Friday to complete application forms.

"We are seeing strong renewal numbers, but we're seeing a slight decrease in the number of new consumers signing up," said James Scullary, a Covered California spokesman.

Scullary said any drop in enrollment could affect the "risk pool," especially if those who are opting out are younger people. "If it's determined that primarily healthy people left, that could have an impact on premiums," he said.

Another sign the health care law could be weakening is a recent drop in the number of people who are enrolled in Medi-Cal, the state's version of the federal Medicaid program to expand coverage for low-income people and those with disabilities. Aside from creating federal health exchanges and allowing states such as California to create their own, the statute greatly expanded Medicaid to low-income residents who were previously ineligible.

The president's actions against the Affordable Care Act include: the creation of short-term, low-cost individual health plans critics say would destabilize the law; the elimination of the individual mandate, making it easier for people to avoid the federal tax penalty for going without health insurance; and ending federal cost-sharing reduction payments to insurance companies who offer affordable plans to low-income Americans.

In response, last year the California Legislature banned short-term, low-cost health plans. And Gov. Newsom has proposed a sweeping health care plan that would create a statewide individual mandate and expand coverage to undocumented immigrants who were left out of the Affordable Care Act.

In December, a Texas judge cited the elimination of the individual mandate in his decision to render the entire Affordable Care Act unconstitutional. The law still stands while the decision is being appealed to a higher court.

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