CSAC Bulletin Article

Uncertainty for California Counties Over ACA Repeal

January 26, 2017

“Uncertainty” was the word of the day at CSAC’s presentation about the effects that repealing the Affordable Care Act would have on counties.

Tom Joseph from Waterman & Associates, CSAC’s federal lobbyists, summarized the current climate in Washington, D.C., and the procedures Congress would use in their attempts to repeal the landmark healthcare law. Congressional Republicans are meeting this week in Philadelphia to finalize their plans, and while they are not on track to meet their original deadline of January 27, a mid-February deal still seems possible.

One difficulty they face is that several Republicans in the Senate are pushing for a replacement plan to be enacted at the same time the current law is repealed. As those negotiations continue, CSAC and Waterman & Associates will continue to update counties through this Bulletin and through other channels.

Given that the shape of the federal repeal and replacement is still unknown, it’s no surprise that the other panelists—Farrah McDaid Ting of CSAC and Michelle Gibbons from the county health executives’ association—were unable to give specifics about the effects on counties. However, they discussed both the fiscal uncertainties and the potential increase in the number of residents that will need indigent care if the Medicaid expansion is rolled back.

Currently, the ACA allows for single, childless adults to be eligible for Medicaid. If these individuals were to lose their Medicaid eligibility, they are likely to return to county public health systems for their care. The difficulty for counties is that many clinics have closed over the past few years as the need for indigent healthcare has declined. Furthermore, people with health insurance have now become accustomed to receive preventative and standard medical care instead of waiting until their situation became an emergency.

One major factors for counties in California is how the state reacts to repeal. California is currently receiving large amounts of federal funding to implement the Medicaid expansion and other aspects of the Affordable Care Act that the state would have difficulty should the federal government repeal the ACA. And state funding that previously paid for indigent care has since been shifted to pay for CalWORKS grant increases and other priorities.

A recording of their conversation is available to those where were unable to attend. Stay tuned for more updates by following CSAC and the CSAC HHS team on Twitter.

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