The ACA has provided almost twenty million Americans with health insurance who didn’t have it before, lowering the uncovered population from 14.4 percent to 8 percent. It is probably no accident that Senate Democratic Leader Senator Chuck Schumer and House Minority Leader Nancy Pelosi tapped former Kentucky Governor Steven Beshear to give the Democratic response to President Trump’s address to a Joint Session of Congress this Tuesday. Governor Beshear’s work in implementing healthcare and the Kynect exchange brought the percentage of uninsured Kentuckians from 20.4 percent in 2013 to 7.5 percent in 2015, and gained him national recognition in Democratic circles.
In California, under the ACA the number of uninsured residents has fallen to 7.1% of the population in 2016 from 17% in 2013. Our state system relies on $22 billion in Federal funds to cover insurance subsidies linked to plans purchased through the state health insurance exchange. This means that, in the health care arena as in so many others, we do not carry out a California policy model in complete isolation from the Federal Government. Governor Brown, our legislature, and our new Attorney General, Xavier Becerra, who has twelve terms of Washington Congressional experience, are involved in defending our California model. The state legislature is active in discussing legislation, and has retained former U.S. Attorney General Eric Holder to advise on how to defend California legal frameworks from the initiatives of a Trump Administration.
Here in Ventura County, the ACA has already had an important effect on health care treatment. Some 226,000 residents now participate in Medi-Cal, up from 112,658 in 2013. Medi-Cal now serves more than one-quarter of Ventura County’s residents. 44,000 residents have obtained an insurance plan through Covered California. Congresswoman Julia Brownley held a lively town hall meeting last week about health care at the Camarillo Library for a standing-room-only crowd, and people had a lot to say.
It was easy for the Republicans to take potshots at an imperfect ACA while it was being implemented and avoid working to perfect it. Reform of the health care sector, involving 17 percent of our GDP, is incredibly complex. Despite the fact that Americans spend more per capita and as a percentage of our GDP, we have not achieved a better outcome than other developed countries (many with single-payer systems). For the Obama Administration, working on health care reform through an unusually partisan and fractious national legislative process, even when based on a largely Republican framework, has not been a smooth process. It now seems a long time ago, when Governor Mitt Romney and Senator Ted Kennedy were able to come together in Boston on April 26, 2006, for the Governor’s signing of the Massachusetts health care legislation that came to be called “Romneycare,” and ultimately covered 97 percent of Massachusetts’ population. Now the new Administration wants to “repeal and replace,” but we do not yet have much sense of what the plans for “replacement” are. I fear we will begin to know very soon.
Whatever the Trump Administration wants to do in terms of health care reform should recognize the importance of the sector to the average citizen and the economy. If the Administration and Congress want to make changes that affect such a large portion of the public and the economy, they owe it to the American people to explain clearly their replacement proposals, hold careful, deliberative and constructive hearings, that are open to give and take with the public’s views. The public should insist on this. It is also fervently to be desired that people who currently have health care coverage don’t lose it, that citizens don’t suffer from lack of access to it, and that what comes out at the end does not leave medical bankruptcy as the leading cause of personal bankruptcy in the U.S. The American people are wise, and will be well able to judge the result of the process underway and who is responsible on their merits.