Moving Beyond the Affordable Care Act in California

Newswise — On March 24, House Republicans abruptly pulled legislation to repeal the Affordable Care Act (ACA) before it could reach the floor for a vote. The bill's failure was a triumph for supporters of President Obama's landmark health care reform act and a stunning defeat for President Donald Trump.

It was especially good news for Californians, says Shana Alex Charles, Ph.D., an assistant professor of health science at CSU Fullerton.

An expert on health care policy, Dr. Charles is the lead author of the recently released report, "The State of Health Insurance in California: Findings From the 2014 California Health Interview Survey."  The report finds that under the Affordable Care Act, the rate of uninsured people in California fell below 10 percent — an historic low.

We spoke to Dr. Charles about what the survival of Obamacare means to California and what might be next in extending health care to all.

Q: You predicted that the repeal bill would never make it through the House. Did anything about the way it went down surprise you?

Dr. Shana Alex Charles: One thing that did surprise me was the scope of the collapse. I thought it would be close, but more people defected from the right than I'd expected. I was also surprised by the immediate statement made by Republicans that they were going to move on to other things. They retracted the statement a few days later when they realized they never should have said it, but there hasn't been lot of indication that they will actually keep trying to repeal the ACA. That really feels like a complete victory for the Affordable Care Act. It put the wind in the sails of people on the left, that's for sure.

Q: Still, there are ways the Trump administration can undermine Obamacare without repeal.

Dr. Charles: Absolutely.

Q: President Trump has said they can just sit back and watch Obamacare explode.

Dr. Charles: That statement makes the underlying assumption that Obamacare is somehow exploding right now. It is not. It is very healthy and doing exactly what it was intended to do. In fact, in 2017 it's already achieved the goals that the Congressional Budget Office (CBO) projected it wouldn't reach until the end of 2023.

In 2013, the CBO estimated that with the full 10-year implementation of the ACA, the number of people without health insurance would be reduced by 25 million and we'd end up with 31 million people uninsured.

Well, according to estimates that the CBO prepared for the defeated American Health Care Act, we have 28 million uninsured people in the country, so we're already way ahead of the projections.

The ACA was never going to achieve full 100 percent enrollment — that was clear from the start — but what it has done is make a humongous dent in the number of uninsured and provide a good foundation to build on, while saving the country money.

If we just continue along where we are now, we're doing very well. With improvements, we could be doing even better.

On the other hand, the executive branch does have the ability to sabotage the gains that have been made by tweaking regulations and, through the Department of Health and Human Services, being less proactive in issuing subsidies, therefore putting up barriers to people buying insurance on the health care exchanges.

Q: In the days and weeks before the House was scheduled to vote, we saw people speaking out at town halls about what repeal would mean to them. Some said it would be a death sentence because they'd lose their insurance and with it ongoing treatment for cancer treatment or heart disease. Do you think these gatherings were effective?

Dr. Charles: I think they were very effective. We saw Republicans in the final two days change their vote from yes to no or undecided, specifically because of pressure from their constituents.

In my own district, Representative Ed Royce, a Republican, had voted over 50 times to repeal the Affordable Care Act during the Obama administration. He voted a straight party line every time. But this time, because our group, Indivisible CA 39 [Note: Dr. Charles is a co-chair of the group's Action Committee] was so active and so vocal in its pressure, he was one of the Congressmen who remained undecided. Royce refused to hold a town hall, so we were taking to the streets instead, holding rallies up until March 23, the night before the vote was set to take place. He never took a stand, never got to yes, which was a move to the left for him.

There wasn't any big national organization bussing people in and directing them to go protest. It was actual voters in hundreds of districts across the country, each deciding on their own that they needed to stand up and be very loud and clear about how important the Affordable Care Act was to them. 

Q: Are you feeling optimistic about the future of health insurance?

Dr. Charles: I'm feeling very optimistic. There are more people out there who are not going to be silent about how this good law benefits them. Another reason for optimism is that in California the implementation of the Affordable Care Act has been more successful than anywhere in the country — we've gone from having nearly seven million uninsured people in the state down to just over three million; that's through both the Covered California exchange and the expansion of Medi-Cal.

Now the energy is moving toward SB-562, the Healthy California Act, which is a measure that would establish a single-payer system … Just the fact that we have people in our legislature who are very knowledgeable about the health care system in California putting forward a plan that would benefit everybody, without co-pays, without deductibles, without premiums, is kind of amazing.

The bill, which is now in the state senate, is so radical, honestly, that I think it will be a fight to get it passed. If you're interested in that battle, call your own state senator and if you're someone who has the ability to access data to show why the bill would be good for California, put that in front of him or her.

It's important to do everything we can to demonstrate that under-insurance is still a big problem … Even when people have insurance there are still problems with delays in care and getting access to doctors. And even with insurance, medical bills can end up putting people in bankruptcy because of deductibles that are $10,000 a family.

I think a system where people didn't have to worry about these things is the next health care frontier in California.