GOP delays vote on Obamacare replacement bill; local impacts come into sharper focus

Ken Carlson, The Modesto Bee, March 23

As the nation waited Thursday for a House of Representatives vote on health care legislation, Astrid Zuniga joined about 60 demonstrators outside Congressman Jeff Denham’s office in Modesto.

Zuniga’s family could get hurt in a number of ways by the Republican health plan that would replace the Affordable Care Act, phase out a Medicaid expansion and cap federal funding to states for Medicaid services.

Zuniga’s 18-year-old son has autism and receives services from a regional center. She’s an in-home support services worker, and Medi-Cal pays for her husband’s hepatitis C medication, costing $600 to $1,000 per month. Funding for Medi-Cal, the name for the Medicaid program in California, is intertwined with all of that assistance for Zuniga’s family.

She and her husband became eligible for Medi-Cal health benefits when the state opted to raise the program’s income eligibility under the ACA. “I fear for my family if I have to go out and buy insurance,” said Zuniga, a Modesto woman who works three jobs. “The Medi-Cal expansion is super-important for people living at the poverty level.”

GOP House leaders delayed their planned vote Thursday on a long-promised bill to repeal and replace “Obamacare,” in a stinging setback for House Speaker Paul Ryan and President Donald Trump in their first major legislative test.

The decision came after Trump, who ran as a master dealmaker, failed to reach agreement with a bloc of rebellious conservatives. Moderate-leaning Republican lawmakers were also bailing on the legislation, leaving it short of votes.

The bill could still come to a vote in coming days, but canceling Thursday’s vote was a significant defeat. It came on the seven-year anniversary of President Barack Obama signing the Affordable Care Act, years that Republicans have devoted to promising repeal.

The Republican legislation would halt Obama’s tax penalties against people who don’t buy coverage and cut the federal-state Medicaid program for low earners, which the Obama statute had expanded. It would provide tax credits to help people pay medical bills, though generally skimpier than Obama’s statute provides. It also would allow insurers to charge older Americans more and repeal tax boosts the law imposed on high-income people and health industry companies.

In a count by The Associated Press, at least 30 Republicans said they opposed the bill, enough to defeat the measure. But the number was in constant flux amid the eleventh-hour lobbying.

Including vacancies and expected absentees, the bill would be defeated if 23 Republicans join all Democrats in voting “no.” Denham, a Republican from Turlock, has not formally said how he would vote on the bill.

$24 billion in Medi-Cal losses

State officials provided more clarity on what’s at stake for California, predicting Wednesday that annual losses in Medi-Cal funding would amount to $24 billion by 2027 under the Republican plan. The analysis was done by the state Department of Health Care Services and Department of Finance.

The state could lose an estimated $400 million in annual funding for the In-Home Supportive Services program. Stanislaus County officials were already upset about a recent state plan to shift more costs for the IHSS program to counties in the next budget year.

Anthony Wright, director of the consumer advocacy group Health Access, said people have mistakenly assumed the GOP plan only affects specific programs created by the ACA. “It’s an $880 billion cut to the Medicaid program,” Wright said. “This affects the whole population – children, seniors, nursing homes, people who depend on regional centers, children’s hospitals.

Some have criticized Republicans for rushing a vote on such momentous legislation only 18 days after it was introduced. Stanislaus County has 240,300 residents. or 45 percent of its population, in the Medi-Cal program.

While failures in other states created momentum for President Donald Trump’s election victory last year, California has been a model of success for the Affordable Care Act.

Anthony Castillo of Turlock said that Medi-Cal covered his family for two years after he was laid off during the recession. Castillo said insurance through the Covered California exchange later covered the family with subsidized rates and paid for $2,000-per-dose medication to treat his wife’s Crohn’s disease.

Castillo, who married his high-school sweetheart, said she calls it a miracle drug for relieving the debilitating symptoms of the chronic inflammatory illness.

“I know a lot of people who are at risk” and could lose access to care if the ACA is repealed, Castillo said. “It kills me to see them suffer.”

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