What will Trumpcare do to the Medicaid success story in California?

One in 20 of the nation’s Medicaid recipients lives in Los Angeles County. Let’s take a second and hear from them.

Sign-carrying demonstrators representing doctors, hospitals and unionized health care workers rally against cuts in the amount the state pays for Medi-Cal reimbursements, in Sacramento, Calif. CREDIT: AP/Rich Pedroncelli
Sign-carrying demonstrators representing doctors, hospitals and unionized health care workers rally against cuts in the amount the state pays for Medi-Cal reimbursements, in Sacramento, Calif. CREDIT: AP/Rich Pedroncelli

Ruth Hernandez is happy with her primary-care physician. She gets her health insurance through California’s Medicaid program, Medi-Cal. Some Republicans, in favor of Medicaid federal funding cuts, liken Medicaid insurance to being uninsured, saying the health outcomes are no better. But for Hernandez, that’s simply untrue.

Her doctor found a cyst in her left breast. Almost immediately, steps were taken to get Hernandez a mammogram. She was able to get it at her local community health center in Palmdale, a city in Los Angeles County. And she was able to get it for free through her insurance. Hernandez isn’t alone; most adults with Medicaid coverage continue to rate Medicaid highly, according to a Commonwealth Fund poll.

When the Affordable Care Act (ACA) passed in 2010, much of the attention afterwards centered around the individual and group marketplaces across the country. But for L.A. county’s health care providers, the ACA’s Medicaid expansion was the most important.

The ACA’s success story in California is in large part due to the expansion, which increased federal funding for states that expanded Medicaid eligibility. In California, the uninsured rate fell from 17.2 percent in 2013 to 8.6 percent in 2015. And L.A. County’s uninsured rate fell by even larger numbers, from 20.9 percent in 2013 to 11.1 percent in 2015. One in 20 of the nation’s Medicaid recipients lives in L.A. County and relies on the program for their healthcare. If L.A. County were its own state, it would have more expansion enrollees than any state except California, according an analysis by the Labor Center at the University of California, Berkeley.


If the expansion is repealed, 1,160,501 low-income adults who are enrolled in the Medi-Cal expansion would lose their health insurance. That’s 11.4 percent of the county population, according to the UC Berkeley analysis.

Both the Senate and House health care plans repeal Medicaid expansion and make overall cuts by changing the current federal-state split cost to a per capita cap financing system. The changes limit federal funding assistance to states. The Senate health bill is subject to change, as Republicans look to revise the bill to get the 50 votes needed to pass. But the final bill will still fundamentally change the program.

“Medicaid was initially set up to help poor women, children and the disabled,” Sen. John Barrasso (R-WY) told reporters on Tuesday. “And it is taken in a direction way than that with bonus payments to sign people up for Obamacare who are able-bodied working aged individuals.”

That sentiment is echoed by many other Senate Republicans, and many don’t see health care as a federal role of government. You can see that in the Senate bill, Scott Graves, a researcher at the California Budget & Policy Center, told ThinkProgress. In the Republican health care plan, the federal government will be pulling the rug out from under states.

Currently, California splits the Medicaid tab with the federal government, 50–50, but because of its large number of Medicaid enrollees, it accounts for some of the highest levels of federal expansion funding, according to the Kaiser Family Foundation. To maintain the expansion without the help of the government, California would need to increase funds by 50 percent in 2021 and 400 percent by 2024, according to the Center for Budget and Policy Priorities.


It’s unclear if California can sustain the Medicaid expansion due to its budget limitations, said Graves. Bound by state law, the budget needs to be balanced. California could either raise revenues, make cuts to existing spending, or do something in between, Graves said. “It’s not that easy to raise taxes in California,” he said.

The most likely outcome is that there will be grave cuts to Medi-Cal.

“In general, it really turns back the clock in negative ways,” Francisco Oaxaca, senior director of communications and community relations at L.A. Care Health Plan, told ThinkProgress. “Taking us back to a time where some [health care providers] lived grant-to-grant to keep doors open and lights on.”

Medicaid federal funding creates more choices for health care professionals and patients, said Oaxaca. In 2009, Antelope Valley Community Clinic, an L.A. County clinic, was a mobile van that offered checkups and employed fewer than 10 people. Today, it operates out of two clinics and two vans, treats about 500 patients a day, and employs about 235 people.

“Our patients are deeply concerned [about the Republican bill],” Jim Cook, executive director of the clinic, told ThinkProgress. “A vast majority got primary care in emergency rooms.”

Under the expansion, patients not only saw their primary care improve. They also saw overall improvements and expansion in care. At least in the two Antelope Valley Community Clinics, patients saw expansion in primary, dental, and mental treatment largely due to increased federal Medicaid funds. For many of its patients, it was the first time they really prioritized dental and mental health care, said Cook. At the Antelope Valley clinic, more than 90 percent of patients have Medi-Cal.


Half the revenue of all L.A. County community clinics also comes from Medi-Cal, Louise McCarthy, the President of the Community Clinic Assn. of Los Angeles County, told ThinkProgress. Community health centers in L.A. County will be disproportionately hurt under the Republican health care bill, she said. “Turning this to entitlement program to a capped spending program changes the fundamental nature,” said McCarthy, “and we are opposed to that.”

For now, Hernandez is closely following the health debate in Washington, D.C. As a preacher at her local church, she sees it as her job to stay positive, for the sake of her community. But it’s easy to become discouraged with the rhetoric about individuals taking advantage of the Medicaid system. Hernandez is able-bodied, but due to immigration circumstances, she’s still at a financial disadvantage. “For a person to do their job, and do it right, they have to be in good health,” Hernandez said.