July 31 2017

With last week’s defeat of “repeal and replace,” “repeal and delay,” “skinny repeal,” and everything but Gluten-Free Repeal, a lot of Californians are wondering where this leaves them and their health care.

Obamacare lives on for now but Congress could try again and President Trump keeps making threats to “let Obamacare implode,” which is code for taking revenge on the American people.

So, let’s take a look at what could happen in the weeks and months ahead for Obamacare’s coverage elements, which we know as Covered California and the Medi-Cal coverage expansion.

First, the most immediate threat: In essence, what Trump could do is end federal dollars to insurance companies that help lower income individuals pay for deductibles and co-payments.  People who qualify for tax credits will get help to pay for premiums. But some people need additional help with out-of-pocket expenses, like deductibles and co-pays, and these subsidies help insurers offer these lower-cost plans.  Under federal law, if the subsidies end, insurers would still be required to provide this financial assistance, so they may be tempted to leave Obamacare exchanges like Covered California rather than suffer significant financial losses, or significantly increase premiums to make up for the lost revenue.

For Californians who received coverage for the first time through the Obamacare Medi-Cal expansion, their access to preventive and necessary health care appears safe for now.

There have now been many calls for Congress to work in a bipartisan way to fix some of the deficiencies in Obamacare, rather than repeal it.  This includes a group of moderate Republicans and Democrats in Congress that have recently found common ground on a bill that would stabilize the individual health insurance market.

Even Senate Majority Leader Mitch McConnell said in July that if repeal failed this year, Congress should take this route. The question remains if such a bill could pass and, even if it did, whether President Trump would sign a bill that strengthens a law that he despises.

We won’t know much until later this month or in September, when Congress will have to decide whether they want to move on to tax reform, which they’ve been eager to do, continue to remain focused on efforts to repeal the ACA, or separately attempt to reduce Medi-Cal, this time through the federal budget process.

In the meantime, Obamacare lives and millions of Californians who became recently insured will continue getting coverage through Covered California and Medi-Cal.

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