Obamacare insurance mandate repeal threatens Sonoma County, state health care expansion

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Congressional lawmakers voted Wednesday to repeal the federal mandate requiring most Americans to buy health insurance or pay a penalty, a decision that could increase the ranks of uninsured Californians by nearly 2 million people and hike premiums for those who remain covered.

Passed as part of the Republican-led $1.5 trillion tax overhaul, the mandate’s elimination will roll back a key component of the Affordable Care Act in 2019 when signed into law by President Trump early next year.

According to the Congressional Budget Office, the new law will mean an estimated 13 million fewer people nationwide will have health insurance in a decade, average individual premiums will rise about 10 percent and federal deficits will drop by about $338 billion.

Those changes will come primarily from a greater number of healthy people who decide not to buy insurance, a trend that would be exacerbated as premiums rise, causing even more people to forgo coverage, the budget office predicted in a recent analysis.

In California, as many as 1.7 million fewer people will have insurance in 2027 unless the state is able to soften the blow through its own aggressive outreach or other efforts, according to the UC Berkeley Labor Center. Sonoma County health officials expect similar trends to play out on the local level.

“This is a very serious issue that probably hasn’t been discussed enough,” said North Coast Rep. Jared Huffman, D-San Rafael, who voted against the tax plan. “You’re back to the days of millions and millions of people without coverage. That means they show up at emergency rooms, and the cost of that care gets passed on to others, so certainly those in the individual markets are going to see premium increases, but there will be indirect pressure even on employer plans.”

Huffman called the inclusion of the insurance mandate in the Republicans’ historic tax bill a “bit of a sneak attack.”

“This will have major health care cost impacts on millions of Americans,” he said. “I don’t think they really wanted people to connect the dots.”

Republicans in Congress have long viewed the insurance mandate as overreach from the federal government, but advocates of President Barack Obama’s signature health care law said it was necessary to make the legislation work properly. In the years after Obamacare’s passage, Sonoma County saw its insured population grow by about 58,000 people, including 23,000 who enrolled through the Covered California state health exchange. The county’s uninsured rate dropped to less than 7 percent from 14 percent previously, according to Barbie Robinson, the county’s health director.

Without a mandate, those trends could reverse.

“We anticipate that repealing the individual mandate will have adverse impacts on health care access for years to come in Sonoma County,” Robinson said. “What we’re going to see is a huge number of folks without insurance who are going to show up at the emergency departments and our health care centers without the funding and resources to have the staff to provide the services.”

But health care experts stressed the repeal of the insurance mandate does not wipe out the rest of Obamacare, including the state exchanges and the Medi-Cal expansion it authorized.

“People will still have access to the same coverage they have on the exchange in California and access to Medi-Cal, and they can and should keep enrolling,” said Suzie Shupe, CEO of the Redwood Community Health Coalition, which represents 17 local health centers in Sonoma, Napa, Marin and Yolo counties. “Just because you’re not mandated to have health care doesn’t mean it’s not a great thing to have. We are concerned that people will hear about that and think that they’re losing their opportunity for coverage, but in fact they have the same opportunities that they had before.”

In the absence of a federal mandate, California lawmakers may decide to go their own way. That could prove tough politically, since it would require two-thirds approval from the state Legislature, but it’s one option on the table, according to state Sen. Mike McGuire, D-Healdsburg.

McGuire said he was inclined to support such an effort, pending further analysis. The Senate’s health committee already began researching the issue in anticipation of Wednesday’s congressional vote, he said.

“I can’t say it enough: The individual mandate is one of the most important pillars to keep the Affordable Care Act solvent,” McGuire said. “One of many solutions California will be considering is advancing its own individual mandate ... I would be in favor of advancing the conversation, and I think that we’re going to need to do some additional research in the weeks and months to come.”

McGuire, who chairs the Senate Governance and Finance Committee, plans to hold a hearing Jan. 10 to examine how state residents will be affected by the federal tax bill, which he has called a “horror story.”

You can reach Staff Writer J.D. Morris at 707-521-5337 or jd.morris@pressdemocrat.com. On Twitter @thejdmorris.

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