Health Equity Forum: Federal Update – September 2017

Your Organizing Saved Health Care Again!

Citing a lack of votes, Senate Republicans declared on Tuesday they will not hold a vote on the partisan Graham-Cassidy bill. This last-ditch effort to repeal the Affordable Care Act (ACA) would have made even deeper cuts to Medicaid than previous repeal efforts, and would have ended funding for the ACA’s financial assistance for consumers and the Medicaid expansion threatening health coverage for 6.7 million Californians, of which a majority are communities of color.[1] The cuts were purposefully and maliciously targeted at California and other densely populated, diverse states that have embraced the ACA and enrolled millions in health care. The bill would have cut $80 billion from Medicaid by 2026, over a third of which would be taken from California alone. In 2027 and beyond, California would have lost $53 billion a year in Medicaid funding, most of the funds we receive from the federal government for this purpose, according to an analysis by the Department of Health Care Services. Earlier this week, the Congressional Budget Office (CBO) estimated that “millions” would lose coverage and Medicaid would have been cut by as much as $1 trillion over a ten year period under the plan.

More specifically the Graham-Cassidy bill:

• Eliminates financial assistance for 1.3 million Covered California enrollees
• Ends expanded Medicaid coverage for 4 million low-income Californian adults
• Guts Medicaid through deep, permanent cuts that would grow over time and threaten care for at least 1.3 million low-income seniors, children, and people living with disabilities
• Jeopardizes access to life-saving behavioral health care and effective treatments for addiction and weakens states’ efforts to address the current crisis of drug overdose deaths
• Undermines essential protections for millions of Californians with pre-existing conditions
• Defunds Planned Parenthood, jeopardizing women’s health for the more than 600,000 Medi-Cal and Family PACT beneficiaries in California who are receiving services
• Eliminates critical funds for prevention and public health including efforts to promote more equitable care

What about mental health?

Graham-Cassidy, like previous repeal proposals, would have devastated California’s public mental health system, and eliminated coverage for millions of consumers with mental health conditions. 30% of people newly eligible for coverage as a result of the Medicaid expansion are living with a mental health or substance use condition. The bill would also have allowed states to waive the Essential Health Benefits, including mental health and substance use treatment, and would have jeopardized crucial protections with people with pre-existing mental health and substance use conditions.

What’s next?

The fight is not over! We must remain vigilant. As we’ve seen time and again, Republicans continue to be determined to rip healthcare from millions and repeal efforts never seem to stay dead for long. September 30 is the deadline for Congress to use the current budget reconciliation process, which allows the Senate to pass a bill on a majority vote rather than 60 votes. Even after this deadline and as Congress moves on to tax reform, the threat is not over. We renew our calls to California’s Congressional leaders to protect Medicaid and Medicare from devastating cuts as part of upcoming tax reform and federal budget proposals. With the failure of this latest repeal attempt, we echo calls for a return to bipartisan efforts to strengthen and fix the ACA by working jointly on proposals to make insurance affordable and to shore up the insurance marketplace. We need stability and certainty, not unpredictability and sabotage.

In other news:

Future of Cost Sharing Reductions Unclear: The Administration continues to threaten insurance markets nationwide by providing no assurances that federal consumer assistance to purchase coverage through ACA marketplaces (called Cost Sharing Reduction Subsidies) will continue. Currently, the Administration is only opting to fund this month by month.

Reductions to Enrollment Already in Place:  The federal Health and Human Services Agency is slashing the budget for outreach and advertising by 90 percent, which could cause confusion especially with a shorter enrollment period — running from Nov. 1 to Dec. 15. Fortunately, Covered California took steps to prepare for such a change by increasing funding for marketing efforts and extending the open enrollment period to January 15^th, 2018.

Funding for Children’s Health Care up for Discussion: The popular Children’s Health Insurance Program (CHIP) which provides more than $2 billion to cover California’s poorest children expires on September 30. There appears to be bipartisan support for the program’s reauthorization as evidenced during a September 12^th Senate Finance Committee hearing. However a final reauthorization vote has yet to take place.

Universal Coverage proposals in California: California’s single payer bill, SB 562 failed to advance this year. Despite this, the State Assembly announced plans in August to hold ongoing hearings beginning this fall to achieve universal health care in California. The hearings will be presided over by the chairs of the Assembly Select Committee on Health Care Delivery Systems and Universal Coverage, Dr. Joaquin Arambula (D-Fresno) and Dr. Jim Wood (D-Healdsburg) and will provide a new opportunity to explore different approaches to achieving universal coverage from single payer to hybrid systems and more modest proposals that build off of the success of the ACA. California has cut its uninsurance rate to just 7% under the ACA. As a result, California is within striking distance of achieving universal coverage for all.

Open Enrollment: Covered California is gearing up for its 2018 open enrollment period. Despite federal attempts to sabotage ACA enrollment by shortening enrollment times, Covered California’s open enrollment period remains unchanged and will run from Nov. 1, 2017 to Jan. 31, 2018. Legislation is pending on the Governor’s desk to maintain in state law the existing three-month open enrollment period for Covered California and the individual market in 2019 and beyond.