Health Care Bill Will Hurt Low-Income People of Color and Children, Advocates Say

People line up for free dental care in Salinas. Photo: Lily Dayton/CHR

Senate Republicans’ proposed health bill to overturn Obama’s Affordable Care Act is worse for low-income Californians than the House bill approved last month, health advocates say.

The Senate’s draft “Better Care Reconciliation Act” caps and cuts funding for the federal low-income health insurance program Medicaid at an even greater amount than the House’s “American Health Care Act,” which cut $880 billion from the program. About 13.5 million people or a third of California’s population is enrolled in Medicaid, known as Medi-Cal in the state.

“There is no state for which this is good, but for California, it’s particularly bad,” said Anthony Wright, executive director of Health Access California, a consumer advocacy organization. He said that if approved, the bill would amount to “health care Armageddon.”

Senate Republicans are hoping for a vote before the July 4 recess. The bill would that have to go back to the House for approval before it could be signed by President Trump and go into effect.

Wright is most alarmed about the proposal in both the Senate and House bills to end open-ended funding in Medicaid. Since its beginning in 1965, Medicaid has provided states $1 in federal funding for every $1 they spend. Under the Senate and House proposals, the federal money would be capped through block grants or fixed per capita amounts.

“Never in the history of Medicaid has the federal government refused to pay its share of the cost of providing care,” said the Western Center on Law and Poverty in a statement. “If this bill passes millions of low-income Californians will lose coverage.”

Medi-Cal would be challenged to offer the same level of coverage for pregnancy, mental health and oral care and care for persons with disabilities, according to a statement issued by the California Pan-Ethnic Health Network.

Minorities would be particularly affected. According to the Medi-Cal Monthly Enrollment Fast Facts report in January, 48 percent of Medi-Cal recipients are Hispanic, 13 percent are Asian/Pacific Islander and 8 percent are African-American. Twenty percent are white and 12 percent didn’t report a race.

Children would also be affected.  About half of all births in California are covered by Medi-Cal (that was about 250,000 in 2014). About half of all the state’s children are covered by Medi-Cal.

“Some of the provisions of the senate bill are disastrous from any perspective,” said Mike Odeh, director of health policy for advocacy group Children Now.

There is a provision in the Senate bill that exempts “medically complex” children from the Medicaid caps, but that didn’t impress Jennifer Kent, director of the California Department of Health Services. “Medi-Cal covers 5.6 million children but only 180,000 are ‘medically complex,’” she said in a tweet on social media site Twitter. “All kids deserve healthy start.”

Fernando Stein, M.D., president of the American Academy of Pediatrics, said he doesn’t see how the protection would work. “A ‘carve-out’ for children with ‘medically complex’ health issues does little to protect their coverage when the base program providing the coverage is stripped of its funding.

In a column published in the Cincinnati Enquirer, Senate Majority Leader Mitch McConnell explained  the Senate bill is necessary to correct high premiums and lack of health insurer choice caused by the Affordable Care Act.   He said the bill will stabilize America’s insurance markets giving people more options.

Bernard J. Tyson, chairman and CEO of managed care consortium Kaiser Permanente issued a statement saying the provisions to stabilize the market are needed but are outweighed by other concerns. “The draft bill does not expand coverage; it does not do enough to protect people in need of care, nor does it provide enough assistance to those who need help in paying for health care and coverage.”

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