Last week, I went looking for the real Obamacare. Not the one that's been vilified by President Trump and House Speaker Paul D. Ryan, but the Obamacare that's otherwise known as the Affordable Care Act, the one providing health coverage to more than 5 million people in California.
I found it in the southern San Joaquin Valley, where the air quality ranks as the worst in the nation, where diabetes is common, where the opioid epidemic rages, where work in the agricultural fields breaks down a body before its time. I found it in the voices of patients, doctors, nurses, clinic directors and hospital administrators.
I and colleagues from the California Senate Health Committee traveled to Bakersfield last week to hold a hearing with a simple purpose: to learn how the ACA has changed lives in one of the most distressed regions in America.
Bakersfield is one of the reddest areas of the state, and it's represented in Congress by House Majority Leader Kevin McCarthy, who is among the Republicans attempting to repeal the ACA. But we weren't there to point fingers or underscore an irony. We chose the location for the simple reason that, before the ACA, few regions in the country had more gaps in healthcare than Fresno, Tulare, Kings and Kern counties.
Was the ACA making a difference? And what was at stake if "repeal and replace" became a reality?
At the hearing, the experts laid out the numbers. In Kern County alone, 95,679 low-income adults who enrolled in an expanded Medi-Cal under the ACA would lose their insurance. Another 16,170 low- and middle-income residents would lose federal subsidies that help fund their private insurance purchased through Covered California. According to a recent study by the Center for Labor Research and Education at UC Berkeley, repealing the ACA would strike a $359-million blow to the local economy through the loss of jobs and federal funding to local hospitals.
Then the faces representing those statistics came forward.
Julie Otero, who suffers from two lung diseases, had a breathing tube attached to her nose. "I have never in my life smoked," she said. She had a good idea what had caused her condition: years of breathing Kern County's polluted air.
Otero, 53, is a domestic worker who cares for her 85-year-old mother. Inhalers and medication would cost her $4,000 a month if she didn't have Medi-Cal coverage under the ACA. "I work every day, but I don't make enough," she said. The replacement plans being discussed by Republicans are not likely to fund the key provisions of her plan. She fears she'll be left with no means to fight a disease that will suffocate her.
Andrew Miskiwicz, a 52-year-old diagnosed with mental illness, told us he'd been living on and off the streets for 12 years. With expanded Medi-Cal coverage funded by the ACA, he's been holding it together for longer periods, and he's ready to enroll in a job training program. Without insurance, he has no way to pay for the medication that is now keeping him stable. "It's scary to think that the rug could be pulled out from under me," he said.
Jimmy Cruz, 51, has Type 2 diabetes and works in a convalescent hospital, making $10.25 an hour. His monthly earnings are not nearly enough to cover the costs of his medication and care. Under the ACA, he pays only $78.33 a month for his medical plan and $10.50 a month for dental coverage. "What am I going to do without this insurance?" he said. "Am I going to get an arm cut off, a foot, go into a diabetic coma, lose my sight?"
Dr. Tony B. Iton, a physician with the California Endowment, which is trying to expand healthcare in underserved communities, told us about a truly alarming trend in the valley: Latinos and blacks are suffering disproportionately from heart disease, diabetes and obesity, a disparity linked not to their genetic codes, but to their ZIP codes.
But it's middle-aged whites who are dying prematurely at unprecedented rates in these four counties. An 11% jump in their mortality rate since 1995 is all the more striking because many of the deaths were preventable. "Deaths of despair," Iton called them, "an invisible crisis" caused by drug overdose, chronic alcohol abuse and suicide.
"These are people who feel they have lost a shot at the American Dream," he said. "This is the worst possible moment to be withdrawing access to healthcare for people in the valley."
Few regions have benefited more from the Affordable Care Act than these four counties. The law brought coverage to 331,000 people here, along with 15,000 new healthcare-related jobs.
As I drove up and over the Tehachapi Mountains to my valley — the San Gabriel — I couldn't get one of Otero's statements out of my head. "We are not asking for much," she said. "Decent healthcare. Don't take it away. Make it better."
State Sen. Ed Hernandez (D-West Covina) is an optometrist and chairman of the Senate Health Committee.