Locals react to GOP’s health care plan

While Republican leadership is advocating for their replacement for the Affordable Care Act, local officials have already begun to imagine what health care will soon look like.

California Hospital Association CEO C. Duane Dauner wrote last week the proposed replacement plan could have negative impacts on state hospitals and its patients.

“California leads the nation in expanding health care coverage, with 91 percent of all Californi- ans now being covered,” Dauner said. “The plan’s proposal to restructure Medicaid will likely undo the important gains in coverage that have been made over the past few years. California has the highest poverty rate in the nation. An estimated 6.3 million Californians, including 1.9 million children, live in poverty. CHA is disheartened by the failure of this plan to restore funding for the Medicare program.”

Dauner also wrote that currently under the ACA, Medicare funding to state hospitals is being cut by more than $26 billion through 2026 in exchange for the promise of expanded coverage.

“Unless these payments are restored, California hospitals and the patients they serve will likely face a diminution of available health care services,” he

wrote. “As the effort to repeal and replace the ACA continues to unfold, CHA looks forward to working with members of the California congressional delegation to maintain optimal coverage for all Californians.”

Gino Patrizio, CEO of Rideout Health, said the proposal gets more complicated because it puts more authority, flexibility and financial pressure on individual states to manage their Medicaid programs.

“The landscape is evolving right before our eyes,” Patrizio said.

He said one of the criticisms of the ACA was that giving people insurance doesn’t necessarily give them access to coverage.

“Many physicians (in out-patient settings) elect not to accept MediCal as a payer source because reimbursement is so low,” Patrizio said Friday. “It is absolutely not the fault of patients, nor is it the fault of insurance companies.”

Patrizio said that’s due to the fact Medicaid, across the country, covers so many people, and there is a limited amount of financial support available. He said low reimbursement is an issue faced by all hospitals.

“We’re getting paid, but not enough to cover the cost to that patient,” Patrizio said. “It affects us at each interaction, at each episode of care.”

He said with the ACA, Rideout saw an increase in volume at the Emergency Department – reflective of the challenges that Medi-Cal patients have with access to care.

“They are (motivated) because they had insurance but they often find it difficult to identify a provider,” Patrizio said. “As a result, they seek care often times in our emergency department.”

Patrizio said no Rideout physicians turn down ACA patients because of low reimbursement.

“The fact that it does not cover the care against the backdrop of our commitment to continue taking care of those patients is reflective of Rideout’s core mission,” he said.

The proposed plan for repealing and replacing the ACA is still new, so how the Republican Congress plans to insure adequate coverage for uninsured patients is still unclear, Patrizio said.

“One thing that is clear is the intention to provide more flexibility and therefore more responsibility at the state level to create a program to cover the Medi-Cal or Medicaid population. What is unclear is whether the same level of funding will be available to every state that has already been available,” Patrizio said. “California’s Legislature has expressed the intention to maintain the same level and scope of coverage for the Medi-Cal population. The big question for all of us is how all these dynamics are going to (mesh) together.”

Congressman John Garamendi, D-Fairfield, strongly opposes the Republican replacement plan, saying it is wrong to gut the health security of average Americans to line the pockets of the wealthy elite.

“The Republican ‘ replacement’ plan is a cheap knock-off of Obamacare that will increase costs, provide less coverage, and give a massive tax break to the wealthy,” Garamendi said in an email Thursday. “It will allow insurers to charge older Americans five times as much as they would for someone in their 20s. And if you’re 55 years old earning an average income, your subsidy could be reduced by over $4,000 a year. There’s a reason that the AARP, the American Medical Association and the American Hospital Association oppose it.”

Curtis Grima, chief of staff for Assemblyman James Gallagher, said Gallagher has been busy with the Oroville spillway situation and hasn’t had a chance to review the proposal in as much depth as he would like to.

He referred the Appeal-Democrat to talk to Garamendi and Congressman Doug LaMalfa.

LaMalfa said in a written statement the plan is a good start for the discussion.

“This is only the first part in a three-pronged process to provide better and more affordable health care options for Americans,” LaMalfa said. “While we will still suffer through the effects of the ACAs momentum for a few more years, this proposal is intended to significantly lower premiums and to lower the deficit by $337 billion. We cannot sustain the current projection that we are on, and the Republican plan intends to provide much-needed relief and freedom of choice to millions of Americans.”

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