More than 2.5 million Southern Californians may lose health insurance under GOP plan
24 million nationally could lose their health insurance by 2026 under the proposed draconian cuts to subsidies and Medicaid. More than 1.4 million Californians already receive subsidies -- subsidies that would be slashed or eliminated under the proposed revisions to Obamacare.
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March 16--Many of the 2.5 million Southern California residents insured by Obamacare could lose coverage under the Republican replacement plan, local health experts say.
The uninsured rate in California has reached a record low of 7 percent since the passage of the Affordable Care Act, or Obamacare. In Los Angeles, Orange, Riverside and San Bernardino counties, about 674,025 people receive subsidized plans through Covered California, the state exchange, and 1.8 million through expanded Medi-Cal, known nationally as Medicaid.
The Congressional Budget Office this week released estimates that 24 million nationally could lose insurance coverage by 2026 through reduced subsidies and cuts to Medicaid, the insurance program for the poor. That projection has not been extrapolated regionally, but health policy experts say that coverage would be in jeopardy for many of the roughly 5 million Californians whose plans are funded by the ACA.
"We are confident, sadly, that it would be millions," said Peter Lee, executive director of Covered California. "Exactly how many, and where, is going to take further analysis."
According to the state's exchange, last year 1,484,537 Californians received $4.2 billion in tax subsidies to help pay for their coverage. The GOP proposal would offer a flat tax credit based on age, while the Affordable Care Act also considers income, family size and local insurance costs when calculating the amount of assistance.
Taylor Reichelt, 28, of Costa Mesa earns about $24,000 a year working full-time at the drug rehab center where he kicked his own addiction. He pays $114 a month for his Covered California plan and receives a subsidy of $293 a month. With the replacement legislation, he would receive an annual tax credit of $2,000, or about $1,500 less than what he gets now.
"I wouldn't be able to afford health insurance at all," Reichelt said. "I like having health insurance. I don't go to the doctor super often, but there are times when I need to."
Reichelt went eight stressful months last year without coverage before enrolling in a Molina Healthcare plan for 2017. During that time, he ran up an $800 emergency room bill and turned down friends' offers to go snowboarding because he couldn't risk an injury.
"I think we're all entitled to the rights of health insurance," Reichelt said. "I don't think we should be penalized if we don't have it. Being one of those people getting help from the government at the moment, I guess I'm kind of biased."
For the four-county region, younger adults and higher earners would fare best under the Republican tax credit proposal.
A 25-year-old earning $75,000 would not qualify for a subsidy under Obamacare but would receive $2,000 a year in tax credits from the GOP plan. A 60-year-old making $75,000 would get a $4,000 tax credit but nothing under the ACA.
The toughest squeeze would be on older, low-wage earners. Under the Republican plan, a 60-year-old making $20,000 a year would receive a $4,000 tax credit. But the ACA subsidies are much larger, ranging from $6,800 in Los Angeles and San Bernardino counties to $7,080 in Riverside County and $8,030 in Orange County, according to a Kaiser Family Foundation analysis.
Lee said the GOP's proposed tax credits, available for single incomes up to $75,000, fail to take into account the wide regional variations in the price of coverage. He noted that insurance costs are 30 to 40 percent higher in Northern California than the Los Angeles area, but that the tax credits would be the same.
"Those changes would greatly affect the ability of California consumers to afford their coverage and care, especially those at the lowest end of the economic ladder," Lee said.
He added that even the privately insured would suffer because more uninsured residents will show up in hospital ERs, unable to pay.
"Those costs are borne by employers and all Americans," Lee said.
Dr. J. Mario Molina, CEO of Long Beach-based Molina Healthcare, which offers Covered California plans in Los Angeles, Orange, Riverside and San Bernardino counties, said without adequate subsidies, most of his members won't be able to afford coverage.
"Before the ACA passed, the biggest reason for personal bankruptcies was medical bills," Molina said. "That's almost died. After this bill is passed, it's going to come right back."
Molina said medical expenditures increased in December, which appears to be a result of patients worried about losing coverage in the new year.
"They're saying, 'Whatever needs to be done, let's do it now because I may not have insurance coverage in the future,'" Molina said.
Expanded Medi-Cal access
With California's expansion of Medi-Cal through Obamacare, single residents qualify if they earn $16,395 a year or less. The coverage is free.
Cassondra Sells of Irvine lost insurance last year when she was laid off from her job. She's now working several part-time jobs and qualifies for expanded Medi-Cal.
Sells, 27, said the coverage has allowed her to remain on anti-depressants that she said are vital to living a normal, productive life. She quickly saw a doctor and received a prescription that was fully covered at the pharmacy.
"That was a peace of mind," Sells said. "I'm honestly relying on it. If it's cut and I don't qualify, I'm going to have to do the health insurance application again and see how much it's going to cost. It would be an added stress if I were to lose it."
But while Sells says Obamacare has been good to her, as a Republican she supports giving the proposed replacement law a chance.
"It's going to create new solutions," Sells said. "Who knows it if will help where Obamacare was lacking."
Dr. Ilan Shapiro, medical director for health education and wellness for Alta Med, a chain of nonprofit clinics in Los Angeles and Orange counties, treats a large number of Medi-Cal patients. He said he's seen how families have benefited from expanded Medi-Cal, especially those with chronic conditions such as diabetes and asthma.
"It's way cheaper and better for everybody to prevent problems or manage problems instead of waiting and going to the hospital," said Shapiro, who also works as a pediatrician at an Alta Med clinic in East Los Angeles. "I'm worried if you take out insurance for people that need services, it will be a ticking time bomb."
At Riverside University Health System, Dr. Geoffrey Leung, chief medical officer for federally qualified clinical services, said deteriorating health strains all parts of people's lives, including work, self-confidence, family and other relationships.
"We've seen many cases in the past where, if you can help someone with their physical health, then other parts of their life start to get better as well," Leung said.
Staff writer Suzanne Hurt contributed to this report.
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