Aaron Reyes David Becerra ACA Repeal Replace Aaron Reyes David Becerra

Overview of ACA Gains Increasing and improving coverage Source: • The rate of uninsured has fallen 37% since the beginning of 2014 • In the first quarter of 2016, the uninsured rate fell to 8.6% - the lowest rate in our nation’s history • 20 million Americans have gained coverage under the ACA • 129 million Americans with pre-existing conditions don’t have to worry about losing coverage; 105 million Americans no longer have lifetime or annual limits • Nearly 3 million Americans remain uninsured in the “Medicaid gap” Source: Wendell Primus, Senior Health Policy Advisor to House Minority Leader Nancy Pelosi. Presentation given 12/8/2016, Washington D.C.

Overview of ACA Gains Source: Restraining Health Care Costs • Since the ACA passed, health costs have grown at their slowest rate in 50 years • Premiums for employer-sponsored coverage grew just 4.2% in 2015, compared to an average of 7.9% from 2000-2010 Improving Health Care Quality • 565,000 fewer hospital readmissions in Medicare • 17% reduction in hospital-acquired conditions • Promising results for early innovation models Source: Wendell Primus, Senior Health Policy Advisor to House Minority Leader Nancy Pelosi. Presentation given 12/8/2016, Washington D.C.

Trump Administration Plan To Replace Affordable Care Act Step 1: Pass Legislation i.e. American Health Care Act Step 2: Director of Health & Human Services will use power to deregulate insurance marketplace to in increase choice and competition Step 3: Rebuild Healthcare System: Regulate medical liability, increase provider reimbursement, become more cost effective with government sponsored/ health related spending, allow health insurance policies to be sold across state lines and provide tax credits to help alleviate the cost of health insurance.

Identify The Players: The 115th Congress House Speaker of the House: Paul Ryan 237 Republicans 193 Democrats Freedom Caucus Moderates Senate Vice President: Mike Pence 52 Republicans 46 Democrats 2 Independents

Budget Reconciliation Provisions under threat: 1. Medicaid (Medi-Cal) expansion (MAGI Medi-Cal) 2. Market place financial assistance (APTC, CSR) 3. Individual and employer mandates* Provisions Not Under Threat 1. Guaranteed issue 2. Modified community ratings 3. Essential health benefits 4. Actuarial value standards (Metal Tiers)

American Health Care Act What would the new plan to replace the ACA include? Officially introduced on March 20, 2017. Government will no longer penalize Americans for not having health insurance However, the government would encourage people to maintain coverage by allowing insures to impose a surge of 30% for those who have a gap between health plans. The Legislation would preserve two of the most popular features of the 2010 health-care law: Young adults can stay on their parent’s health plan until age 26 Health insurers cannot deny coverage or charge more to people with preexisting medical problems.

Changes to Medicaid • Medicaid would be converted from its current form of entitlement to anyone eligible into a per capita cap on funding to states, depending on how many people they had enrolled • In states that expanded Medicaid under the ACA, the government for now would continue paying for virtually the entire cost of the expansion. - Increase State Taxes - Cut to Benefits - Decrease in eligible medicaid recipients • For the other 19 states that did not expand Medicaid, the legislation would provide $10,billion spread over five years.

CBO Projections on Repeal • The number of uninsured would increase by 18 million in the first new plan year following repeal. • After the elimination of the Medicaid expansion, the number of uninsured would increase to 27 MM in the first year and to 32 MM by 2026 • Premiums in the non group market would increase by 20-25% relative to current projections • Premium increases would reach 50% in the year following repeal • Premiums would almost double by 2026 Source: CBO Report: How Repealing Portions of the Affordable Care Act Would Affect Health Insurance Coverage and Premiums. January 17, 2017

CBO’s Highlights for Medicaid • $880 billion drop in federal Medicaid spending over the decade • 14 million fewer Medicaid enrollees by 2026 • 95 percent of people who are getting Medicaid through the health law’s expansion would lose that enhanced federal funding • 15 percent of Planned Parenthood clinic patients would “lose access to care.”

Impact on California Health Insurance at Risk • 4.9 MM Californians are at risk of losing coverage through ACA repeal • 1.2 MM will lose subsidies through Covered CA • The uninsured rate in California is projected to spike 146% through 2019 California Economy • California stands to lose $160 BN in federal funding for Medicaid, CHIP and premium assistance • 20.5 BN annual federal funding for the Medicaid expansion Sources Implications of Partial Repeal of the ACA through Reconciliation (Washington, DC: Urban Institute, December2016), available online at http://www.urban.org/research/publication/implications-partial-repeal-aca-through-reconciliation (last accessed Dec. 7, 2016).

Impact on Orange County Health Insurance at Risk • 260,086 OC residents are at risk of losing coverage (Medicaid expansion). This constitutes 8.3% of the counties population • 117,170 OC residents will lose federal subsidies for purchasing insurance Economic Loses • 15,000 health sector jobs are at risk of being lost due to ACA repeal • $1.4 BN in GDP would be eliminated from the county economy Sources Dietz M, Lucia L, Kominski GF, and Jacobs K, ACA Repeal in California: Who Stands to Lose?, UC Berkeley Center for Labor Research and Education and UCLA Center for Health Policy Research, December 2016. Lucia L and Jacobs K, California’s Projected Economic Losses Under ACA Repeal, UC Berkeley Center for Labor Research and Education, December 2016.

Healthcare Reform Comes to a Halt On March 24th, Speaker Paul Ryan announced the bill has been pulled and would not be put up for a floor vote. President Trump continually vows to push through healthcare reform in the near future. Freedom Caucus remains firm in their stance. The proposed plan is not conservative enough. President Trump extends an Olive branch to Democrats. Speaker Ryan condemns this action.

The Compounding Variables: Why Did It Fail? Dagger: Congressional Budget Projections Republican Governors: Medicaid Funding Political Party Ideological Disparities: Freedom Caucus vs. Moderates Health Plans Needed To Release New Rates Individual State Exchanges Lobbying: Covered CA State, Regional & County Associations Lobbying Advocation Center of Education (ACE) Community Based Organizations & Grassroot Effort: Sit ins, marches, phone calls and lobbying #Fight4OurHealth #ValueCHCs No Victory. Reprieved, Not Relieved! Become an advocate!

Things that can be done administratively • U.S. House of Representatives v. Price (Burwell) • CMS regulatory change/interpretations • Enforcement of tax code

Republican Plan for Tax credits • Tax credits may range from $2,000 per year for those under 30 to $4,000 per year for those over 60 • The full credit would be available for individuals earning up to $75,000 and up to $150,000 for married couples filing jointly • Tax Credits will phase out for individuals earning more • Ex. For each $1,000 in additional income, a person would be entitled to $100 less in credit • Meaning a 61- year old could make up to $115,000 and still receive some credit.