Plans to Repeal Obamacare Continue

Congress Republicans Take Steps to Repeal Affordable Care Act

Republicans in Congress have advanced plans to repeal the Affordable Care Act, otherwise known as “Obamacare,” through  budgetary resolutions passed on Jan. 12 and 13.

Thirteen of California’s Republican representatives voted in favor of a resolution to repeal parts of the Affordable Care Act. Of the thirteen, four are based in Orange County: Ken Calvert (R-42), Mimi Walters (R-45), Dana Rohrabacher (R-48) and Darrell Issa (R-49). The only California Republican in the House not to vote in favor of the repeal was Tom McClintock. (R-4).

McClintock was one of nine Republicans in the House of Representatives that voted with Democrats against the measure, though the nine had varying reasons for voting against the resolution. Pennsylvania representative Charlie Dent rejected the resolution because he believed the that there was no clear plan to replace the ACA yet. Michigan representative Justin Amash rejected the resolution over concerns about government spending, as the resolution was a part of the broader budget guidelines for this fiscal year. Like Amash, Kentucky Senator Rand Paul voted against the resolution over spending concerns.

Still, by a vote of 51-48 in the Senate and 227-198 in the House of Representatives, both chambers of Congress passed budget resolutions that set the stage for large portions of the Affordable Care Act to be removed through a process known as “budget reconciliation.”

Budget reconciliation allows Congress to remove parts of the ACA that relate to government spending or taxation. This effectively ended portions of the Affordable Care Act, but not all of it.  

This initial process does not repeal the portion of the act which prevents companies from denying coverage to people with pre-existing conditions, or the portion that allows young people to remain on their parents’ insurance plans until the age of 26. Removing provisions like those would require that the Affordable Care Act be fully repealed by a vote.

A full repeal and replacement of the Affordable Care Act unrelated to the budget would require 60 votes in the Senate, meaning that Republicans would need to seek the support of some Democrats in the Senate given that Republicans only have a 52-seat majority.

The major issues facing Republicans now are the timing of a repeal and what a possible replacement would look like. The actual process of repealing could take weeks or months, while the implementation of a new plan could begin as early as next year, depending on how the repeal is written. Changes are unlikely to take effect this year because contracts have already been signed and regulations set in place.   

As of now, what the replacement of the Affordable Care Act would be, if it is removed, is unclear. Several different Republican lawmakers have put forward different plans and remain divided.

How Changes Might Affect Californians

According to a set of studies from the UC Berkeley Center for Labor Research and Education and the UCLA Center for Health Policy Research, millions of Californians would lose coverage and hundreds of thousands of jobs would be lost if the ACA is repealed.

Under the ACA, the rate of uninsured persons in California halved from 6.5 million in 2013 to 3.3 million in 2015. The two main reasons for the decline were the expansion of Medi-Cal and federal subsidies for people purchasing their own private insurance through Covered California, the state health marketplace.

Up to 3.7 million people insured in California’s Medicaid expansion and a further 1.2 million Californians receiving subsidies to buy affordable health insurance could potentially lose access to affordable coverage if the ACA is repealed.

“Fallout from Republican changes to the health care system could be even more harmful if the administration changes the way Medi-Cal benefits are calculated or if coverage features are reduced,” said Miranda Dietz, researcher at the UC Berkeley Labor Center and lead author of the study.

Young adults, low-income families and part-time workers stand to lose the most. Additionally, people of color made up 71 percent of those insured in the Medi-Cal expansion. Many of those people self-identified as Latino.

Under the Affordable Care Act, Orange County’s uninsured rate fell from 16.2 percent in 2013 to 8.7 percent in 2016. The approximately 230,000 residents who have gained coverage could lose it.

Another study from UC Berkeley estimates a “$20.5 billion annual loss in funding for Medi-Cal expansion and federal subsidies, $1.5 billion lost in state and local tax revenue, and 209,000 lost jobs, primarily in the healthcare industry,” in California if the ACA is repealed without an adequate replacement.

Many details of the repeal and replacement of the Affordable Care Act remain undetermined, and the effects are difficult to predict until concrete proposals are made.