L.A. will suf­fer in GOP plan

Los Angeles Times - - OPINION -

Con­gres­sional Repub­li­can pro­pos­als to “re­peal and re­place” Oba­macare would slash Med­i­caid, the na­tion’s health in­sur­ance pro­gram for the poor. In so do­ing, they would dev­as­tate Los An­ge­les in ways that may not yet be fully ap­pre­ci­ated.

One in 20 of the na­tion’s Med­i­caid re­cip­i­ents lives in L.A. County and re­lies on the pro­gram for their health­care. About 4 mil­lion strong, they make up about 40% of the county’s pop­u­la­tion. Many would be at grave risk of los­ing their health cov­er­age, and con­se­quently all but emer­gency med­i­cal treat­ment, un­der the Repub­li­cans’ plan. Cur­rent pro­grams to pro­vide hous­ing and treat­ment to thou­sands of peo­ple liv­ing on the streets, or head­ing there after their dis­charge from hos­pi­tals or re­lease from jails and pris­ons, would be deeply cut.

Se­nate GOP leaders post­poned a planned vote on the mea­sure this week after sev­eral Repub­li­cans balked. But the ef­forts to drum up sup­port for it con­tinue, and a vote could hap­pen in mid-July.

Los An­ge­les County has more peo­ple on Med­i­caid than 45 states do. It has about as many peo­ple on Med­i­caid as the en­tire pop­u­la­tion of Ken­tucky, Se­nate Ma­jor­ity Leader Mitch McConnell’s home state.

Why are so many L.A. res­i­dents on Med­i­Cal (Cal­i­for­nia’s name for its Med­i­caid pro­grams)? Two pri­mary rea­sons.

First, de­spite its pock­ets of fab­u­lous wealth, the re­gion is also be­set with intense poverty. The poor never had it easy, but at least in the past they had a fight­ing chance to make ends meet in Los An­ge­les, where man­u­fac­tur­ing and low-skill jobs were plen­ti­ful and the cost of liv­ing was rel­a­tively low. But now far fewer jobs pay enough to meet the sky­rock­et­ing cost of get­ting by. Mil­lions of peo­ple who once could save up enough money for an­nual check-ups for ev­ery mem­ber of the fam­ily, plus the oc­ca­sional doc­tor visit to deal with bro­ken bones or se­ri­ous ill­ness, now need as­sis­tance to stay healthy and, by the way, to keep sick­ness suf­fi­ciently un­der con­trol so that it does not turn into an epi­demic and does not sap the work­force, poorly paid though much of it may be.

And sec­ond, one of the most valu­able com­po­nents of Oba­macare was Med­i­caid ex­pan­sion, un­der which far more peo­ple be­came el­i­gi­ble to par­tic­i­pate in the pro­gram in states, like Cal­i­for­nia, that opted in. That in­cludes an ad­di­tional 1.2 mil­lion adults in Los An­ge­les County who earned less than $15,400 an­nu­ally.

So while the large num­ber of L.A. Med­i­Cal re­cip­i­ents was never a sign of eco­nomic good health, the ex­pan­sion was a very good de­vel­op­ment. It helped the county fi­nally take care of its poor by keep­ing more of them healthy, work­ing, go­ing to school and car­ing for their fam­i­lies — and shift­ing rou­tine care out of costly emer­gency rooms.

Medi-Cal is man­aged care, and as such it’s a much bet­ter ap­proach to cost con­trol than hav­ing unin­sured peo­ple show up in ERs. Mak­ing sure that ev­ery­one has some form of cov­er­age, from the gov­ern­ment or private in­sur­ers, is cru­cial to slow­ing the growth of spend­ing. Oth­er­wise, it will be dif­fi­cult to change the in­cen­tives that are driv­ing health­care costs ever sky­ward.

If the Se­nate bill or sim­i­lar deep cuts to Med­i­caid are adopted, more than a mil­lion adults in L.A. will ul­ti­mately lose the cov­er­age they cur­rently en­joy un­der the ex­pan­sion. In ad­di­tion, the county es­ti­mates that about 323,000 adults will lose the sub­si­dies that cur­rently en­able them to af­ford cov­er­age from private in­sur­ers.

In­no­va­tive L.A. County pro­grams like Hous­ing for Health, which lever­ages Med­i­Cal dol­lars to fund shelter for peo­ple whose men­tal health or sub­stance treat­ment re­quires the se­cu­rity of a roof, a door and a key as much as medicine and other ther­apy, would be crip­pled. County of­fi­cials would have to de­cide whether to re­duce the hous­ing and ser­vices, or raid other pro­grams for fund­ing. But there are few to raid, be­cause most are non-dis­cre­tionary. The Board of Su­per­vi­sors has no choice but to fund them.

The ef­fort to com­bat home­less­ness would con­tinue be­cause of the fund­ing for hous­ing that city vot­ers ap­proved with Mea­sure HHH and for ser­vices in the county’s Mea­sure H. But the im­pact of that money would be far less with no Medi-Cal fund­ing to lever­age.

Ef­forts to move peo­ple away from emer­gency rooms to pri­mary med­i­cal treat­ment would likely evap­o­rate. So would the dis­pos­able in­come of peo­ple cur­rently cov­ered un­der ex­panded Medi-Cal who, for now, do not have to choose be­tween a doc­tor visit and a trip to the gro­cery store. So would thou­sands of health­care jobs.

Didn’t L.A. County cover all th­ese peo­ple be­fore Oba­macare? It tried — and we see the re­sults to­day on our streets.

With ex­panded Med­i­caid, there was fi­nally a map­pable route to vi­a­bil­ity and per­haps ad­mis­sion to the ranks of the mid­dle class for L.A. County’s poor, sick, men­tally ill, ad­dicted and oth­ers liv­ing on the mar­gins — and a route to a higher qual­ity of life for the rest of us, who are at times over­whelmed by the misery we see on our streets and an­gry that the gov­ern­ment that we fund has done so lit­tle about it. With­out it — and with the Repub­li­can pre­scrip­tion for health­care, home­less­ness and public safety — we can ex­pect our poor neigh­bors to be­come poorer. And more nu­mer­ous.

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