As President-elect Donald Trump prepares to take office after his victory Tuesday, some health care professionals are concerned about what a Trump presidency will mean for those in Contra Costa with federally funded health insurance.
“We’re in shock that this happened,” said Jane Garcia, CEO of La Clinica de la Raza, a community health care provider with clinics in Alameda, Contra Costa and Solano counties. “We haven’t had a chance to prepare for this.”
The Affordable Care Act (ACA), also known as Obamacare, was signed into law by President Barack Obama over six years ago. In the years since, calls for a repeal from the Republican Party have not ceased.
“It is the single worst piece of legislation among many bad pieces of legislation passed in the first two years of the Obama presidency,” said Senate Majority Leader Mitch McConnell at a press conference earlier this week.
Those who oppose the ACA cite several reasons repeal it: they say the act has led to increased insurance premiums and higher taxes, and contains an individual mandate which some claim is unconstitutional. President-elect Donald Trump called it “a disaster” during the second presidential debate.
Now, with Trump’s election and Republicans in control of Congress, a repeal of the act that has extended health care coverage to more than 20 million Americans may become a reality. In fact, as Trump told an audience in Pennsylvania in October, he plans to introduce legislation to repeal the ACA in his first 100 days in office.
The repeal of the ACA may be especially devastating in California, where 1 in 3 state residents are covered by Medi-Cal, which was expanded by the ACA to include almost five million people. According to Department of Health Care Services data, 275,008 people in Contra Costa County were covered by Medi-Cal as of this past June, which, given 2015 population figures, means about 1 in 4 in the county are covered through the program.
“We’re all concerned about what Trump will do with Obamacare,” said Marty Lynch, Executive Director of LifeLong Medical Care, a community health organization that provides services to residents of Alameda, Contra Costa and Marin counties.
But it’s unclear what a repeal of the ACA would mean for the county, said Alvaro Fuentes, Executive Director of the Contra Costa and Solano Counties Community Clinic Consortium.
“At this point it’s anyone’s guess as to what the fallout would be,” he said.
Some experts say a repeal could translate into loss of insurance coverage, economic decline and poorer health outcomes across the entire state.
Micah Weinberg, president of the Bay Area Council’s Economic Institute said that expanded Medi-Cal coverage has had “significant economic benefit for the state and the region.” Preventative health care leads to healthier workers, he said, and healthier workers are more productive.
Daniel Zingale, Senior Vice President of The California Endowment and leader of its Healthy California team, said that “a repeal of Obamacare would have a devastating impact on the health and economy in California,” specifically.
That’s because California has a particularly high rate of Medi-Cal coverage, said Zingale. In some counties, more than 50 percent of the population relies on Medi-Cal for health insurance, he said. Medi-Cal is also the primary health provider for half the children in the state.
California residents benefit from an estimated $20 billion worth of health insurance annually through federal programs, Zingale said. “The loss of that is almost unimaginable,” he said.
Some experts are concerned that a repeal of the ACA would mean a loss on investment, too. “For the last three, four years, we’ve been creating the infrastructure that was necessary to play and participate in the ACA,” said La Clinica’s Garcia. “This puts in question whether the same rules are going to apply.” A new health care system may require more trainings to learn about new legislation, different paperwork or procedures and even new computer software, among other changes. It could also mean the end of Covered California, the state’s online health insurance marketplace.
Lynch said he doubted that ACA would be entirely undone by a Trump administration. “Maybe I’m naïve,” he said, “but I don’t know if they’ll want to dismantle all the pieces.”
He may be right: many parts of the Affordable Care Act are popular, even across party lines. A 2013 article on Politifact, a political fact-checking website, stated that although only about 40 percent of Americans approve of the law as a whole, the majority of those surveyed viewed individual elements of Obamacare, such as coverage for pre-existing conditions or for children through their parents’ plans up until age 26, in a positive light.
Regardless of the uncertainty ahead, Fuentes said one thing is clear: health professionals have already shifted from planning to strengthen and expand coverage to planning to preserve it.
“We’re now having to think about contingencies,” he said.