Latest Obamacare repeal bill would hit California hard

If Congress passes the latest effort to repeal the Affordable Care Act, California stands to lose tens of billions of dollars over the next 10 years, according to separate analyses of the legislation.

The left-leaning Center on Budget and Policy Priorities was the first to crunch the numbers on the bill sponsored by Sens. Lindsey Graham (R-South Carolina) and Bill Cassidy (R-Louisiana). It determined that the state would lose nearly $58 billion in 2027. A Kaiser Family Foundation analysis estimates California would lose nearly $46 billion that year, and nearly $62 billion from 2020-26.

The Congressional Budget Office says it doesn't have enough time to conduct a complete analysis of the bill by the time the U.S. Senate must vote on it next week.

The Senate Parliamentarian has ruled that the chamber only has until Sept. 30 to try to pass the legislation with 51 votes under budget reconciliation rules. After that, Republicans would need 60 votes to overcome a Democratic filibuster.

The legislation would roll back funding for expanded Medi-Cal and the subsidies that help people buy private individual insurance policies through Covered California. Those dollars would be replaced with block grants to states. Graham and Cassidy argue that states are better positioned than the federal government to decide how best to serve their populations' health care needs.

Switching to block grants would be a boon to states that never expanded Medicaid under Obamacare. It would mean a financial hit for those that did, like California. In the Golden State, that could amount to a loss of more than $1,500 a person, according to the Center on Budget and Policy Priorities.

Analysts say the loss of funding could force the state to make deep cuts to Medi-Cal, which covers one out of every three Californians.

The UC Berkeley Center for Labor Research and Education estimates that 6.7 million Californians could lose coverage in 2027, based on a scenario in which the state cut Medi-Cal eligibility or capped enrollment for certain groups. 

"The biggest group would be the people in the Medi-Cal expansion, but also people with covered California subsidies would lose those subsidies, and children, and seniors, and individuals with disabilities in Medi-Cal are also at risk of coverage losses," said Laurel Lucia, director of the Center’s Health Care Program.

Health organizations with a majority of their patients on Medi-Cal expect to be hit hard if the Republican bill becomes law.

"When states get block-granted they have to make really tough choices," said Louise McCarthy, president of the Community Clinic Association of Los Angeles County. "They either cut the eligibility, they cut the services, or they cut the payments. Or they cut all three."

Those cuts would mean health care providers would, in turn, be making their own tough decisions on where to tighten their belts, meaning fewer services and potentially fewer jobs, she said.

"At this point in the Affordable Care Act debate, it feels like we are in hurricane season," said McCarthy. "We’ve been dodging hurricane after hurricane of repeal attempts. Now with Graham-Cassidy, we are right back where we started fighting a storm that is even worse than those that preceded it."

This story has been updated.