Lessons from CA: Amended ACA Repeal Bill’s Medicaid Cuts Still Disastrous for California

Lessons from CA: Amended ACA Repeal Bill’s Medicaid Cuts Still Disastrous for California

The House Republicans are still at it – with another version of the American Health Care Act (AHCA) to repeal the Affordable Care Act (ACA) and radically cut Medicaid. This week the bill was amended again and it is only getting worse for low-income people across the country.  California, which fully implemented the ACA to cover millions more people through Medi-Cal and the marketplace, has a lot to lose.

The amended House bill still includes costly cuts to Medicaid – $880 billion over ten years –  and repeals integral provisions of the ACA that would cause 24 million people to lose health care coverage and hike premiums for everyone else. And the amended version still would result in dire consequences for Californians.  The 4.1 million people enrolled in the Medicaid Expansion could lose their coverage.  In addition, California stands to lose billions in federal funding for Medi-Cal.  The State’s own analysis concludes that the federal proposal would dramatically shift healthcare costs from the federal government resulting in nearly $6 billion in costs to California in 2020, growing to $24.3 billion by 2027.

Below are ten major changes to Medicaid that the amended repeal bill could mean to California:

  • Cuts to Medi-Cal by capping federal funds to provide coverage and services to 14 million people
  • Repealing Medi-Cal coverage for up to 4 million Californians made eligible for coverage by the ACA
  • Jeopardizing Medi-Cal coverage for children ages 6-19
  • Eliminating immediate coverage in Medi-Cal through admissions to hospitals or emergency rooms
  • Removing Medi-Cal coverage for bills from the three months before  a person applies for coverage
  • Requiring adults to work as a condition of being eligible for Medi-Cal
  • Jeopardizing funding for Medi-Cal waivers used to transform and improve quality and access to care
  • Eliminating essential health benefits such as mental health and substance use disorder services
  • Cutting funds for in-home supportive services being provided for to up to 500,000 individuals
  • Cutting eligibility for long term care services for people who own a home with too much value

While it remains unclear how California policymakers would implement these proposals or pay for coverage and services with the loss of billions of federal Medicaid dollars, it is clear that fundamentally altering the financing of Medi-Cal from a guarantee (or “entitlement”) to a capped program, along with other proposed changes to Medicaid outlined above, threatens not only the 13.5 million Medi-Cal enrollees, but the entire state and its economy. With the state’s already low Medi-Cal per enrollee spending (and low provider reimbursements rates), and given the state’s growing low-income aging population, the House’s amended repeal bill will hit California harder than many other states.

See our recently updated Issue Brief that provides a “deeper dive” into the details of how this new attempt to repeal the ACA still targets low-income people who rely on Medi-Cal for their health care. We encourage advocates and stakeholders in other states to educate their communities about the harms that would result if this proposal were to become law.

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