The GOP Proposal to Replace Obamacare: What Does It Mean for L.A. County Families?

Last week began with House GOP leaders unveiling their plan – the American Health Care Act – to replace the Affordable Care Act (Obamacare). LA Best Babies Network is not a political advocacy organization, so we’re not urging you to support or oppose legislation. But, because the Family Strengthening Network (Welcome Baby and its partner home visiting programs in Los Angeles County) helps families navigate the vicissitudes of insurance coverage, we wanted to provide a brief update.

What does this mean for the families you serve?

Nothing – yet. The newly proposed plan continues to undergo changes before it faces a vote in Congress. And passage in Congress is not assured, so it may never reach the president’s desk. As the LA Times notes, it is “getting blasted from all sides, with conservativesliberals and libertarians all trashing it.” The list of groups opposing the bill now includes AARP, the American Medical Association, the American Hospital Association, the American Nurses Association, the Association of American Medical Colleges, the Catholic Health Association of the United States, and the Children’s Hospital Association.

But last week two House committees swiftly advanced the bills that would comprise the new health care law (before the nonpartisan Congressional Budget Office could give its cost/impact estimates). The Wall Street Journal reports that “people across the country who have benefited from the ACA, concerned about Republican efforts to topple the law, are now rushing to get treatments, visit doctors and find alternative ways to pay for their medical costs.”

What could this mean for the families you serve?

On March 16, 10:00 am – 12:00 pm, our partner Maternal and Child Health Access will host a meeting on “The GOP American Health Care Act; Impact on MCH.” RSVP here.

For details on the proposed plan, here are some helpful articles:

At this stage, lots of details are still being sorted out — “it’s a work in progress,” and this is just the first phase, says HHS Secretary Tom Price — but here are a few key points:

Medi-Cal: California’s version of Medicaid, this program now covers 13.4 million low-income and poor Californians (over a third of the state’s population), up from 8.6 million people three years ago. Half of all pregnancies are covered by Medi-Cal. The GOP proposal would continue Medicaid expansion through January 1, 2020, after which it would convert Medicaid to a “per capita cap” system that could result in massive cuts in Medi-Cal eligibility and benefits, leaving millions with little or no coverage.

Low-income working families who are still covered would have to pay more for fewer benefits. As Maternal and Child Health Access explains, this would happen because subsidies would be based on age, not income, and no longer have the “cost-sharing reduction” that helps pay co-pays and deductibles.

Tax credits for middle-income young people in L.A. County who have insurance under Covered California might not change significantly, according to a Kaiser Family Foundation analysis. Those who stand to lose the most in terms of tax credits would be low-income older Americans in rural parts of the country where health premiums are high.

More help for the wealthy: The plan would repeal almost all of the taxes that were increased by the ACA to pay for health coverage expansion. It would also provide new tax advantages for those who can afford to save, including allowing more money to be deposited into health savings accounts.

Prenatal and maternity care are essential benefits under the Affordable Care Act, but the new plan proposes to cut these benefits to Medicaid recipients. The ACA requires insurance plans to include maternity coverage, but, as CNN reports: “Republicans say they want to jettison the maternity coverage requirement … [but] removing it outright won’t be easy since it would take complicated maneuvering in the Senate to do so. It remains intact in the bill moving through Congress, but that is due to budget rules, not because Republicans want to keep it.”

Family planning and abortion: The plan’s tax credits could not be spent on any health care plan that covers abortion. As NPR reports, while health care plans can cover abortion, very few people may be able to purchase those sorts of plans, as they wouldn’t be able to use their tax credits on them. The bill also includes a ban on federal funds for Planned Parenthood, which offers primary care services to support healthy pregnancies.

L.A. County’s 350 community clinic sites treated 23% more patients in 2015 than they did in 2010 — serving 1.5 million people each year, according to Louise McCarthy, head of the Community Clinic Association of L.A. County. The LA Times looks at how these clinics have expanded under Obamacare, with a focus on the Antelope Valley. The AV Community Clinic, which was a mobile van that offered check-ups and employed fewer than 10 people, is now a health system with two clinics, two vans and 235 employees, and treats 500 patients a day. But CEO James Cook worries that the new healthcare law will cut funding for his clinic and others like it that serve some of L.A. County’s poorest and sickest residents: “Those are thousands and thousands of patients who would go back to not having any healthcare,” Cook said. “We’ll return to where we were 10 years ago.”

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