LA, state politicians mull responses to Obamacare repeal

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California lawmakers are discussing how they will respond to a possible repeal of the Affordable Care Act, and Los Angeles County is poised to offer its own suggestions for how to deal with a cut in federal health care dollars.

Some state lawmakers "have legislative vehicles ready to respond" once Congress and the Trump administration take action on Obamacare, said Anthony Wright, executive director of Health Access California.

Wright said the bills are just placeholders right now, because "the range of what the federal government could do is so great... it's hard to know what an appropriate response is."

Meanwhile, Los Angeles County Supervisors Mark Ridley-Thomas and Sheila Kuehl introduced a motion Tuesday that would direct county staff to "develop options of how health insurance coverage could be maintained and/or extended" within the county and the state in case of repeal.

The motion does not specify what those options might be. But it acknowledges that states "have special powers and resources for creating insurance coverage," and notes that the state of Massachusetts created a state-run health insurance system in 2006. The Massachusetts approach served as a model for the Affordable Care Act.

"It is critical that Los Angeles County and the State of California are prepared to care for those who may lose insurance under threatened cuts to the [Affordable Care Act]," L.A. County Health Agency Director Dr. Mitch Katz said in a statement.

The motion notes that under Obamacare, about 900,000 county residents have obtained coverage through the expansion of Medi-Cal, and another 300,000 bought insurance through Covered California. Federal subsidies cut the cost of most policies purchased through the state exchange.

As the most populous county in the state, L.A. has an important role to play in fighting to preserve the health law and its benefits, the motion argues.

"Given the size of the uninsured population in the County, it is generally recognized that for any State of California plan to work, it must work in the County," it says.

The board could vote on the motion as soon as next week.

Kuehl has in the past been an advocate of a so-called single-payer system, in which a state agency would replace private insurance companies and handle all contributions and payments for health care. As a state senator, she introduced single-payer bills that won legislative approval in 2006 and 2008; Gov. Arnold Schwarzenegger vetoed both.

The Ridley-Thomas/Kuehl motion is "an important step," said Wright, but neither the county nor the state could make up the entire gap if Congress makes sweeping cuts to the Affordable Care Act and the funding it provides.

California receives more than $15 billion from the federal government to cover the Medi-Cal expansion and $5 billion in federal subsidies to offset the cost of insuring eligible Covered California enrollees, according to the state Senate Committee on Health.

While state and local politicians explore how they might respond to repeal of the Affordable Care Act, their more immediate focus seems to be on the effort to stop Congress from killing the health law. 

"My highest priority is to fight a repeal," State Sen. Ed Hernandez, chair of the Senate Health Committee, said in a statement. "I believe the momentum is on our side and am becoming more confident the [Affordable Care Act] will remain in place."

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