Medicaid is Essential to Our Health Care System

Medicaid is Essential to Our Health Care System

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While it was a relief when the Senate failed to repeal the Affordable Care Act (ACA), the reprieve is only momentary. Unfortunately, the battle to protect health care as a right is far from over.
As President and CEO of CaliforniaHealth+ Advocates, I represent more than 1,200 community health centers throughout California which serve the state’s most vulnerable populations. I have been closely tracking the day-to-day debates at the federal level because health center patients would have been the most impacted by the ACA repeal attempts.

Community health centers were founded over 50 years ago by community health and civil rights activists who fought to improve the lives of all Americans. In the early days, health centers were houses in the community where volunteer doctors would deliver care. Today in California, community health centers serve 6.2 million people – 1 out of 7 Californians. They are community hubs and major employers, creating 60,000 jobs in our state, and are instrumental players in the health care delivery system.

Three million health center patients in California are covered by Medicaid. Before the ACA, many health centers operated at a loss because the bulk of their patients were uninsured. In that environment, comprehensive and timely coverage was extremely challenging. Nonetheless, health centers continued to provide care because of their commitment to serve everyone, regardless of ability to pay.

After the ACA was passed, health centers finally began operating in the black because so many of their patients were part of the Medicaid expansion. The expansion has been one of the most important aspects of the ACA, providing comprehensive coverage to people who have no other health care options. There are currently more than 68 million Americans enrolled in Medicaid. It’s a program that works.

Right now, health centers are facing the possible expiration of a mandatory Health Centers Fund. Without a reauthorization of this funding before October, health centers could face major funding cuts. The federal health center grant enables continued delivery of necessary primary care services to the uninsured; a significant cut to this funding would not only stop growth but actually lead to a massive loss of existing capacity for the entire system.

This important evolution and growth would not have happened without a strong Medicaid program, made stronger through the ACA’s Medicaid expansion.

Looming over this is the Republicans’ ongoing efforts to restructure Medicaid by shifting it to a block grant or a “per capita cap,” which limits the amount that the federal government contributes to states for each Medicaid beneficiary. The proposed changes to funding levels would not be able to keep up with inflation. If Medicaid moved to a per capita cap or a block grant, there is a strong possibility that coverage programs would be cut, care would be rationed, and the health of our communities would suffer.

Imposing a per capita cap is a financial solution -- not a healthcare solution – as evident in the Congressional Budget Office’s shocking scores on the GOP’s ACA repeal proposals. The House-passed American Health Care Act would have cost 23 million people health care coverage by 2026 and 22 million people would have lost coverage under the Senate’s Better Care Reconciliation Act. And the Senate’s idea to “repeal now, replace later” would have cost 32 million people their health coverage by 2026 – 17 million of those people losing coverage within the first year. Right here in California, five million people would be left without coverage.

According to a survey sponsored by the California Health Care Foundation, 88 percent of Californians said Medi-Cal, California’s Medicaid program, is important to the state. Nationally, a Washington Post poll found 50 percent of people say they prefer Obamacare, compared to 24 percent who prefer the GOP proposals introduced in Congress.

Instead of repeal attempts, Congress should be working together to fix our current health care system. Right now, 71 percent of the public favors a bipartisan effort to improve the ACA. And 88 percent of Californians view Medi-Cal as important to the state.


Carmela Castellano-Garcia is the president and chief executive officer of CaliforniaHealth+ Advocates