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Guerneville resident Alicia Tighe had no health insurance in late 2013 when she fell seriously ill and was hospitalized for about a month.

Tighe, now 26, lost coverage after leaving her retail job to focus on classes at Empire College in Santa Rosa, where she was studying to become a medical assistant. But Tighe said she was able to receive quality care through Medi-Cal coverage she secured because of an expansion of eligibility requirements allowed by the Affordable Care Act, President Barack Obama’s landmark health care law.

“If Obamacare wasn’t around, I don’t know what would have happened to me, or the type of care I would have received,” Tighe said. “I’m just really thankful that it’s there.”

But it may not stay there much longer. The federal health care law has once again come into the crosshairs of Republican lawmakers, who have long sought to repeal the legislation and now have a qualified endorsement from President-elect Donald Trump.

On Friday, the House of Representatives gave final approval to a budget blueprint that will speed Republicans’ plans for repeal.

If lawmakers successfully sink the law, they could eliminate a source of health insurance for more than 35,000 Sonoma County residents — like Tighe — cost the county 2,000 jobs and saddle it with an economic loss of nearly $200 million, according to University of California health care researchers.

Patients would lose access to preventive care, treatment for acute and chronic conditions, as well as mental health services and dental care, local public health officials said.

“Most likely, many would go back to using the emergency room when they were in crisis,” said Naomi Fuchs, chief executive officer of Santa Rosa Community Health Centers, one of the largest primary care providers for Medi-Cal patients in the county.

Medi-Cal benefits

The Affordable Care Act included an expansion of Medi-Cal benefits that enabled 3.7 million low-income adults to gain government-sponsored health benefits, cutting in half the number of uninsured California residents from 6.5 million in 2013 to 3.3 million in 2015, according to researchers at UC Berkeley and UCLA.

Santa Rosa Community Health Centers, which operates eight facilities, got 14,000 people covered under the Medi-Cal expansion, generating about $4 million a year in new revenue for the nonprofit organization.

“It’s a very big economic engine for the county,” Fuchs said, noting the Medi-Cal money pays for the cost of health services, creates jobs and buys supplies.

More insured

In Sonoma County, 35,240 adults — roughly equal to the population of Windsor and Sebastopol combined — obtained Medi-Cal after eligibility was expanded by Obamacare to cover adults, primarily those without children under 18 living at home, with incomes below 138 percent of the federal poverty level.

Overall, the county had 112,732 men, women and children enrolled in Medi-Cal last year.

The increase as a result of expanded eligibility, along with an additional 19,620 residents who purchased government-subsidized health insurance from Covered California, the state’s health benefit exchange, resulted in a 51 percent decline in the number of uninsured Sonoma County residents, from 64,000 in 2013 to 31,000 in 2015, the Berkeley-UCLA report said.

Mendocino County gained 12,275 new Medi-Cal recipients and Lake County gained 8,823.

Statewide, the uninsured rate declined from 17.2 percent in 2013 to 8.6 percent in 2015 — the sharpest drop across the United States. The correlating jump of those now covered by some form of health insurance was unprecedented, said Laurel Lucia, manager of the health care program at the UC Berkeley Center for Labor Research and Education.

The uninsured rate in Sonoma County dropped from 13.1 percent in 2013 to 6.3 percent in 2015, she said.

“That’s fantastic,” said Mary Szecsey, executive director of West County Health Centers, which operates clinics in Guerneville, Sebastopol and Occidental.

More than 1,800 clinic patients were enrolled under the Medi-Cal expansion, which took effect three years ago and prompted the West County nonprofit organization to sign up all its patients who had become eligible, Szecsey said.

More preventive care

For both people and their caregivers, the difference was dramatic.

Szecsey recalled an elderly man who suffered from heart disease and other conditions and hadn’t been able to afford ongoing care. With Medi-Cal, he and other patients can come in for preventive care, tests and prescriptions rather than waiting for a health emergency, she said.

The new Medi-Cal enrollments cut the percentage of West County’s uninsured patients from 40 percent to 6 percent, boosting the average reimbursement per patient visit about 20 percent, Szecsey said.

“It made a big difference to our financial stability,” she said. Uninsured patients pay what they can for services at nonprofit health centers, which “don’t turn anyone away,” Szecsey said.

California’s Medi-Cal gains are threatened by Republican congressional leaders’ renewed intent to repeal Obamacare, now that they have an ally in the White House. Republicans in Congress have differed over how soon to roll out a replacement measure, with many wary of the political repercussions that could come from stripping millions of Americans of health care coverage.

Trump said on Tuesday Obamacare must be replaced immediately, within a matter of weeks, not years. The president-elect has also said he favors parts of the law, including mandatory coverage for people with pre-existing medical conditions and allowing children to remain covered by their parents’ insurance until age 26.

“The Republicans are on a real collision course with themselves,” said North Coast Rep. Jared Huffman, D-San Rafael. In his district, stretching from Marin County to the Oregon border, about 63,000 people have gained coverage under the Medi-Cal expansion.

But in saving popular parts of the program and doing away with others — such as the widely unpopular health insurance mandate and penalties for those who don’t secure coverage — Republicans risk destabilizing the entire program, which depends on a large pool of healthy people to help cover the cost of those who are ill, Huffman said.

Another complication is that premiums for people who buy their own insurance or get it as an employment benefit have been held down by Obamacare’s expansion of the insurance pool, he said. Hospitals pass some of their losses from treating uninsured people onto the insured population, an impact known as the “hidden tax” on insurance premiums.

“The point is we’re all in this together,” Huffman said.

Economic impact

Tighe, who still relies on Medi-Cal for the care she receives at Russian River Health Center in Guerneville, said lawmakers preparing to repeal Obamacare should be prepared to replace it with something else.

“If they don’t do that, there’s going to be some serious backlash, because a lot of people are depending on it for their major health care,” Tighe said. “At the doctor’s office I go to ... there’s a lot of patients that go there, and it’s great care. It’s quality care. If we didn’t have (Obamacare), I know that other people wouldn’t have access to that type of care. Neither would I, for that matter.”

Partial repeal of the health care act, including the Medi-Cal expansion, would impose a statewide net loss of 209,000 jobs and $20.3 billion in lost production of goods and services from reduced demand, the UC Berkeley research center estimated.

The calculation is complicated, but stems from the loss of about $20.5 billion in annual federal funding for the Medi-Cal expansion and Covered California subsidies, the center said.

The loss to Sonoma County would be about 2,000 jobs and $192 million in lost economic activity.

Repealing the Affordable Care Act would mean a $17 billion cut in federal funding for California’s Medi-Cal program, which covers 14.3 million people and is “a pillar of our health system we all rely on,” said Anthony Wright, executive director of Health Access California, a statewide consumer advocacy coalition.

Gov. Jerry Brown’s $125 billion budget for 2017-18, released Tuesday, included no major cuts to Medi-Cal “but also not the investments that Californians might have expected after voting for three different ballot measures to support Medi-Cal,” Wright said in a news release.

He predicted a “vigorous conversation” within California this year in defense of Medi-Cal, and said “we should all be concerned with Congress’ rush to repeal coverage without any replacement in place.”

Local health care officials said they are taking a “wait and see” approach to the future of Medi-Cal.

The single adults previously excluded from Medi-Cal would be hardest hit, said Karen Fies, director of Sonoma County’s Human Services Department.

“Depending on how big a repeal it is, it could be pretty devastating,” she said.

Staff Writer J.D. Morris contributed to this report. You can reach Staff Writer Guy Kovner at 707-521-5457 or guy.kovner@pressdemocrat.com.