California led the way with Obamacare, signing up more people for health insurance than any other state.
Now with a possibility that President-elect Donald Trump will repeal the law, as he has promised, the stakes are higher here than anywhere else.
“We’ve basically cut the number of uninsured in a little bit more than half, which is enormous progress,” said Dr. Gerald Kominski, head of the UCLA Center for Health Policy Research. But California’s huge gains also mean that if the Affordable Care Act is undone, “we have the most to lose.”
GOP leaders have said they’ll quickly repeal and replace President Obama’s signature healthcare law after Trump takes office in January. But experts say it’s unlikely the entire law would be immediately overturned, in part because that would leave more than 20 million Americans without health insurance.
Instead, lawmakers will probably opt to dismantle the law piece by piece while a replacement is devised, experts say. But it’s unclear which provisions will end up on the chopping block and what alternative GOP proposals would be.
“Until those conversations start, it’s really hard to predict what will happen,” said California state Sen. Ed Hernandez, who chairs that chamber’s health committee. “There are so many, so many outstanding questions.”
That uncertainty has many Californians on edge.
Lisa Moore of Glendale worries that she won’t be able to afford coverage for her son, Joe, if Obamacare is repealed. She pays $350 a month for his health plan through Covered California, the insurance exchange set up under the Affordable Care Act.
Joe, 26, sees multiple doctors a week to treat his schizophrenia and severe depression. Moore said that without constant medical care he wouldn’t be able to function, and without insurance she wouldn’t be able to afford his care. His medical bills typically total $1,000 a week.
“I don’t want to lose him,” said Moore, 63. “It’s a horrible situation, I’m terrified.”
Currently, 4.6 million Californians’ health coverage is funded by Obamacare. They either buy insurance plans through Covered California, or were able to join Medi-Cal, the state’s low-income health program, when the health law provided money to the state to expand the program in 2014.
Those Californians could face “life-or-death consequences” if funding for Obamacare dries up, said Anthony Wright, head of the consumer advocacy group Health Access California.
The state would lose $20 billion in federal funding if Congress votes to undo the exchanges and the Medicaid expansions, according to state data.
Officials in the heavily Democratic state say they will fight to keep the programs alive, but agree that the shortfall is far too great for the state to overcome on its own.
“California has a long and good tradition of going it alone, but there’s a limit to what California can do without federal framework and funding,” Wright said.
The Affordable Care Act, passed in 2010, has been highly controversial, and Trump repeatedly promised during his campaign to overturn it. Many have said that the health plans people are mandated to buy under the law aren’t affordable and that the law is an unsustainable expense for federal and state governments.
California, however, wholeheartedly embraced the Affordable Care Act.
“The ACA has not been perfect, there have been challenges,” said Sabrina Corlette, a senior research professor at Georgetown University's Center on Health Insurance Reforms. But “if there was one state where it was really working well ... it was California.”
The state enrolled millions in Medi-Cal, and 13.6 million people — one in every three state residents — is covered by the program. Insurance premiums have not increased here as much as they have elsewhere, and the exchange still offers many options so consumers can shop around.
The percentage of uninsured working-age adults in California had dropped by more than half to 11% last year, according to federal data. Beyond signing up large numbers for coverage, state officials had also started improving the way medical care is delivered to patients, Corlette said.
When considering what the Affordable Care Act could accomplish, she said, “California was held up as the gold standard.”
Trump told the Wall Street Journal on Friday that he might keep several provisions of Obamacare, such as barring insurance companies from denying coverage to people with pre-existing conditions. He also said he likes a provision in the law that allows young adults to remain on their parents’ health plans until they are 26.
But the rest is up in the air.
Lisa Selzer signed up for insurance through Medi-Cal when it was expanded under the Affordable Care Act. She works as a substitute teacher in San Diego and needs medicines for migraines and epilepsy.
She’s worried that if Obamacare is repealed she will lose her health coverage.
“There’s absolutely no way I can go off the meds,” she said. She can’t afford her medications on her own, and she’d likely start having seizures again if she went off them, she said.
She said her strategy for now is: “Hope for the best, plan for the worst.”
Hilary Haycock, president of Harbage Consulting, said she thinks the law has been in place for too long for legislators to make changes that would significantly roll back coverage.
“I’m going to dare to be optimistic and believe that when it comes down to it, it’s going to be really hard for members of Congress to vote to take something away from people without having a credible alternative,” said Haycock, whose national health policy consulting firm is based on Sacramento.
Many worry that the alternatives will not provide the same levels of coverage — what Corlette called a “6-foot rope in a 10-foot hole.”
The questions around Obamacare under a Trump presidency have cast a shadow on the law’s fourth open enrollment period, which began Nov. 1. Covered California officials said Thursday that they had already begun receiving calls from people asking about the future of their coverage.
Steve Halasz, who lives in North Hollywood, pays $278 a month for a Kaiser health plan through Covered California. He’s a comedian who had gone years without insurance before the Affordable Care Act went into effect.
He said that at a doctor’s appointment recently, “I was literally sitting there half-naked in a gown and I was emotional. It had been so long since I had real care.”
Halasz wants to keep his plan but isn’t sure whether he should fill out the renewal paperwork.
“Is this all for naught? I’m going to sign up for this and then after inauguration in January are they going to call for an immediate session and just eradicate it with the stroke of a pen?” he said. “It’s the not knowing that’s the worst.”
Covered California officials and consumer advocates urged people to choose plans for 2017.
In fact, more people purchased an Obamacare plan through the national insurance exchange HealthCare.gov the day after the election than any other day since this enrollment period.
“There’s no downside to signing up,” said Wright, with Health Access California. “If it gets ripped away, at least you had coverage for the X number of months until then.”