June 15, 2017

California’s counties continue to communicate significant concerns with current efforts underway in the U.S. Senate to repeal the fiscal underpinnings of the Affordable Care Act (ACA) and impose a new cap on federal Medicaid spending. Senate leadership has indicated that they hope to vote on the new plan, which builds off of the lower house’s American Health Care Act, the week of June 26. However, work on the proposal continues in secret and it is unclear whether counties will have a chance to weigh in before the vote.

In an effort to ensure that the county voice is part of the discussion, CSAC and county affiliates and organizations sent a joint letter last week that reiterated our concerns with the AHCA as passed by the House, including how it would shift almost $1 trillion over 10 years in health care costs to states – and ultimately to our counties, since counties retain the obligation for indigent health care in California.

But the repeal of the ACA’s Medicaid expansion is just the tip of the fiscal iceberg for California’s counties, as another provision to impose a per-person cap on Medicaid funding threatens to end the successful federal, state, and county partnership to serve the neediest among us. California estimates that by 2027, the funding reduction for the expansion population and the federal cap combined would cost the state $24 billion annually, and keep growing.

For the counties, the proposed per-capita cap on federal Medicaid spending will force our public health care systems to significantly reduce critical health services, curtailing our ability to provide even the most basic health and behavioral health services to our constituencies.

The new block grant or per-capita cap would also reduce funding for states and counties at the same time that our safety net of public health systems, including county systems, would be under further stress, with up to 23 million uninsured by 2026 under the AHCA and seeking care – often uncompensated – from these providers.

Additional provisions to eliminate retroactive eligibility, including reducing eligibility levels for children’s health coverage, would reduce care available to new program entrants and those in crisis, and force more of them into medical debt and bankruptcy.

CSAC is concerned that these massive proposed changes to how Medicaid is funded will force counties, health systems, health insurers, health care providers, hospitals, and other health care professionals to face the possibility of a dual disaster: Millions of newly uninsured Americans at the same time that federal Medicaid funding is arbitrarily and significantly reduced.

CSAC will continue efforts to raise our concerns directly to the Senate and through NACo as the date for a vote in the Senate moves closer.