SANTA ANA, Calif. – Amidst fear that congressional Republicans were about to pull the plug on Obamacare and replace it with a bill that would leave millions of Americans with inadequate health insurance or none at all, nearly four dozen health care and immigration advocates, stakeholders and reporters convened here March 24 to discuss whether Orange County’s safety nets could support the resulting impact.
Half way into the convening came the news that the GOP leaders had failed in their quest to gut Obamacare, aka the Affordable Care Act (ACA), and replace it with the American Health Care Act (AHCA) put forth by House Speaker Paul Ryan. The new law would have caused California to lose $24 billion in federal health care funding over the next decade, forcing it to cut health care services and reimbursement rates to providers.
Even as they cheered the defeat, those who had gathered here were reminded by panelists that the Republican-controlled chambers could still jeopardize Obamacare.
“The noise that we are making must continue,” said Mayra Alvarez, president of The Children’s Partnership, characterizing the Republican efforts to dismantle the ACA as nothing more than “politics.” Her agency, along with Advancing Justice – Orange County, and the Coalition of Orange County Community Health Centers (COCCHC), co-hosted the convening.
She said that Congress was trying to gut the Medi-Cal (known as Medicaid in the rest of the nation) program even though it “has been a lifeline for many of our most vulnerable” people in Orange County.
The program provides coverage for the poor, the disabled and elderly people in need of long-term care. Last May, California launched the Health for All Kids (even those undocumented) law, expanding coverage to 180,000 kids. About 14,000 children in Orange County enrolled under the program, noted panelist Doreena Wong, project director for Advancing Justice – LA’s Health Access Project.
When Medi-Cal expanded under the ACA in 2014, it allowed around 3.5 million more people to enroll in it, thanks in large part to making single childless adults eligible and raising the income level of enrollees to 138 percent of the federal poverty level (about $16,400 for a single adult). In Orange County, 260,000 adults took advantage of the expansion, according to Wong.
Panelist Daniela Ojeda, a policy analyst with AltaMed, which provides affordable health care services to people in Los Angeles and Orange County, the uninsured rate in Orange County dropped to 8.7 percent.
“We have been able to provide preventative health care for people who don’t have to wait until they face a life-and-death situation and go to the emergency room, said Ojeda, whose organization works through nine centers in Orange County. Since Medi-Cal expansion, AltaMed’s population in the two counties has tripled, she said, noting: “If the ACA is repealed, we’ll be forced to reduce our services,” she said.
Health care advocates worry that Trump could still undermine Obamacare both legislatively and administratively – and without congressional approval. For instance, the ACA provides $900 million to help low-income people with a Covered California (the state-run online marketplace for private insurance) plan to pay for deductibles and co-pays.
“They could sabotage that,” said Anthony Wright, executive director of the non-profit Health-Access California.
Esen Kordoglu with the COHCCC, a consortium of safety net providers that caters to nearly one million patients each year, said the role of health clinics cannot be overestimated, especially in a place like Orange County that doesn’t have a county hospital. They will be forced to play an even greater role if the ACA is dismantled.
Panelist Dannie Cesena, the Transitions Services Coordinator with the LGBTQ Center of Orange County, worries about the future of mental health services for LGBTQ should Republicans succeed in their efforts to cut back the “10 essential benefits” the ACA mandates for insurers. The AHCA would allow insurers to provide limited benefits.
“The AHCA is bad for LGBTQ youth,” Cesena said.
For many minority communities, including the Korean, where mental health issues have always been a “taboo” subject, the programs in the ACA have made it less so, said Catarina Oh, program coordinator with the Korean Community Services in Buena Park, Orange County.
Oh said that despite the stigma attached to mental illness among many Koreans, 60 percent of her clients currently seek mental health care.
“We are seeing a growing acceptance” of the illness, she said.
Jenny Rejeske, health policy analyst with the National Immigrant Law Center, said that fear of outing themselves or of becoming a public charge should not keep parents from enrolling their children in Medi-Cal or from using the program.
“Under existing [state law] information won’t be shared,” with federal officials, she said.
Orange County resident Daisy, who hails from Columbia and who didn’t want her last name to be used, said she chose “to fight” publicly for her daughter, now 11, who was diagnosed with cerebral palsy as a young child.
The girl was able to get medical care and surgeries through the Kaiser Child Health Plan she had, allowing her to live a near normal life. She transitioned last year to full-scope Medi-Cal under the now nearly year-old Health For All Kids law.
“I am not only speaking for myself, but I represent all mothers when I say having health insurance betters the lives of all children,” she said through an interpreter.