California county organizations warn on ACA repeal without replacement

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Billions of dollars and services to more than 14 million Californians are at stake if the Affordable Care Act (ACA) is repealed without a “suitable comprehensive replacement.” That’s the message six California county organizations with direct involvement with the ACA have sent in a letter to the state’s congressional delegation last month.

“The repeal of the Affordable Care Act — without a suitable replacement — would create an incredibly destructive impact on California Counties and the 39 million people we serve,” said Matt Cate, Executive Director of the California State Association of Counties (CAS). “We urge Congress not to move ahead with any plans to repeal until a workable, comprehensive plan that maintains existing levels of Medicaid coverage is in place.”

The letter was signed by the CASC, California Association of Public Hospitals and Health Systems, County Behavioral Health Directors Association, County Health Executives Association of California, County Medical Service Program and Child Welfare Directors Association. It states, “California’s counties seek the development of such a replacement framework, but we write to share with you the destructive impact the loss of the ACA will have on our members and the 38 million people we serve.”

According to the signors, the loss of the ACA will impact the following:

County-Administered Health care

Since ACA went into effect, the number of the state’s uninsured adults have been significantly reduced.

Mental health and Substance Use Disorder Treatment

The ACA established that mental health and substance use disorders can be covered under Essential Health Benefits (EHB). That allowed millions Medi-Cal enrollees to access those services.

Public Hospitals and Health Systems

Through the ACA, low-income Californians were offered an unprecedented expansion of insurance coverage. This shifted the focus from emergency care to preventative care, which is must less expensive.

Medicaid Eligibility

Since 2013, Medicaid has received three million new beneficiaries. The ACA matching funds allowed counties to increase its workforce, improve systems and innovate solutions for better outcomes.

Public Safety

Many counties are using the ACA Medicaid Expansion to address issues such as criminal justice recidivism and chronic homelessness.

Two counties, San Mateo and Riverside began using ACA funds last week through the California Section 1115 Waivers. Riverside County has expanded and improved treatment for low-income residents struggling with substance use disorder. Set to go into effect this month, Medi-Cal patients will be covered for a wider range of drug and alcohol treatment options not previously allowed under federal law.

According to CA Fwd Policy Consultant Kathy Jett, the repeal of the ACA without a robust replacement will have far reaching effects beyond basic healthcare. “It’s important to know that counties are using funds from the ACA to reduce the impact specific populations have on the criminal justice system, such as the mentally ill and those with substance abuse disorders,” said Jett.

CA Fwd’s Justice System Change Initiative (J-SCI) is working with four California counties, including Riverside County, to lower jail populations. Through its jail studies, J-SCI has found that the mentally ill generally stay in jail longer and are booked more often for lesser crimes.

The leaders of the six organizations have offered to work with the Congressional delegation to seek solutions to maintain the state’s safety net and ensure healthcare for millions of Californians.


Nadine Ono

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