“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same time the current law is repealed.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.
