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As the Republican-controlled Congress and President-elect Donald Trump declare the end of Obamacare, local health care officials and providers are taking a “wait and see” approach, some of them skeptical that Washington could so easily and quickly unravel a massive law that has been in effect for six years.

Since the beginning of its implementation in 2010, tens of thousands of Sonoma County residents have taken advantage of the federal Affordable Care Act, which included a dramatic expansion of Medicaid eligibility that nearly doubled the number of local residents eligible to receive health coverage through Medi-Cal, the state’s Medicaid program.

The county’s community health centers greatly expanded their services, built new facilities and hired doctors, nurses and social workers. Hospitals, physicians groups and health care giants such as Kaiser Permanente adapted to significant shifts in how medical care is provided and paid for, with a focus on quality and health outcomes.

“This law is not going to be unwoven or dismantled overnight,” said Shirlee Zane, Sonoma County’s 3rd District Supervisor. “If the president-elect thinks that he can eliminate some things while retaining others easily, he is naive... It’s much harder to fill that incredible void with substantial health care coverage for millions of Americans.”

Zane said that for every person who complains about rising health insurance premiums, there are others who have benefited from Obamacare’s provisions, including expanding Medi-Cal, allowing adult children to remain on their parents’ health insurance until age 26, prohibiting health plans from refusing to cover people with preexisting conditions and subsidizing medical coverage purchased through state health exchanges.

It’s unclear exactly what President-elect Trump proposes for a replacement, officials said. What is clear is the footprint that the 6-year-old law has left.

Across the country, some 20 million people have received health insurance either through state or federal health exchanges and the expansion of Medicaid. In California, 3.5 million residents gained Medi-Cal coverage and between 85 and 90 percent of the 1.3 million people who purchased insurance through Covered California, the state’s health exchange, receive a federal subsidy, said Anthony Wright, executive director of Health Access California, a health care consumer advocacy coalition.

“People should be concerned and active about these proposals for eliminating, capping or rolling back Medicaid,” Wright said, adding that eliminating the expansion of the federal Medicaid program would cost the state $16 billion. “That’s not including additional money our health system would lose to provide subsidies to people,”

But conservatives in Washington have argued that such expenditures cannot be sustained and that Obamacare will eventually cause more damage than good to the health care industry. Some point to dramatic increases in premiums in some states’ health exchanges.

In Sonoma County, as of last summer almost 23,000 people purchase health insurance through Covered California, with Kaiser Permanente coverage making up nearly 50 percent of that total, according to Covered California’s latest member profile.

There are currently about 128,000 Sonoma County residents enrolled in Medi-Cal, said Karen Fies, director of the county’s Human Services Department.

Medi-Cal enrollment through that department has increased dramatically, she said, adding that as of September 2016, there were about 112,000 enrolled in Medi-Cal through human services, compared to 64,000 in 2012. Fies said that its too early to say what is going to happen to Obamacare coverage under a Trump presidency.

“We can’t even speculate what’s going to happen,” she said. “We just have to wait and see.”

Roseland Pediatrics, a 4-year-old clinic located in a west Santa Rosa shopping center that is operated by Santa Rosa Community Health Centers, is one of countless health centers that provide medical services to the county’s Medi-Cal population.

The clinic’s construction was made possible by a $500,000 Obamacare grant, as well as significant contributions by the Santa Rosa East and Santa Rosa West Rotary clubs, First Five and Kaiser Permanente.

“More than 10,000 of our patients that were previously uninsured now have full-scope Medi-Cal coverage for all of their medical, mental health and dental needs,” said Naomi Fuchs, CEO of Santa Rosa Community Health Centers.

Fuchs said that if those people lost Medi-Cal coverage, the overall health of the local community would suffer.

“The cost of health care would increase dramatically as people delay treatment until they have an emergency,” she said, adding that some would likely forgo preventive measures such as cancer, diabetes, hypertension and oral health screenings.

“Our county would suffer tremendously,” she said.

With Congress warning that it plans to act quickly on Obamacare, Zane said county officials are going to remain vigilant.

“I don’t want a lot of people to lose sleep over this — we’re going be watchful,” she said. “But I feel hopeful at this point that (Trump’s) administration is not going to do something that would render them hugely unpopular with Americans who did not have health care coverage before.”

You can reach Staff Writer Martin Espinoza at 707-521-5213 or martin.espinoza@pressdemocrat.com. On Twitter @renofish.

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