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CA Health Exchange Girds for Uncertain Future

News  |  By Doug Desjardins  
   December 05, 2016

The current open enrollment period won't be affected, regardless of what happens after the new administration takes arrives.

The policies of president-elect Donald Trump won't affect the current enrollment period for Covered California, but future changes are likely to impact the health exchange in California.

Despite the uncertainty, exchange officials are focused on the current open enrollment period that runs from November 1, 2016 to January 31, 2017, said Covered California Executive Director Peter V. Lee.

"We're here for the foreseeable future and we're the place to sign up," said Lee.

Covered California is projecting that 400,000 new members will enroll for coverage during the three-month open enrollment period.

Most analysts believe Trump is likely to follow through on earlier vows to "repeal and replace" the ACA, but it's still unclear how far those changes will go and what impact they will have on ACA funding.

"The debate is very much in flux and there's a lot of uncertainty about what's going to happen and about the timing," said Larry Levitt, vice president of the Kaiser Family Foundation.

"The conventional wisdom is that the new Congress will attempt to repeal the ACA starting in 2017 through some type of [budget] reconciliation strategy," Levitt said.

Future Uncertain for CA Healthcare Reform Under GOP

Levitt and other policy experts said they expect changes to the ACA to be incremental, unfolding over the course of two or three years. Republican majorities in both houses of Congress could expedite changes to the ACA.

"Many of the changes could be passed through budget reconciliation, which only requires 51 votes in the Senate, a majority of the House, and the president's signature," said Anthony Wright, executive director of Health Access California.

Reduced funding for federal subsidies could also play a major part in weakening the ACA in the state. Covered California estimates that 90% of the 1.4 million people who have enrolled for coverage through the exchange are receiving federal subsidies to help pay for premiums.

The state does not have the financial capacity to backfill the proposed federal cuts to health insurance subsidies or the cuts proposed for public plans, California Insurance Commissioner Dave Jones said recently.

Analyst Micah Weinberg, president of the Bay Area Council Economic Institute, estimates the state is receiving about $5 billion per year in federal funds for subsidies and more than $15 billion to fund Medicaid expansion.

The impact on California depends on "how much of that $20 billion federal spigot will be turned off," Weinberg said last month.

The state has added more than 3.5 million new members to Medi-Cal under Medicaid expansion, according to Sandra R. Hernandez, MD, president and CEO of the California HealthCare Foundation (CHCF).

Proposals to roll back or defund that program could have a major impact on the state, which now has more than 13 million Medi-Cal enrollees.

"If you undermine Medicaid in any way, it would really disrupt the [healthcare] market," said Hernandez. "You have literally half of the people in places like Fresno County covered by Medi-Cal, and changes to the program could have a major impact on the state."

A report from the California Budget and Policy Center estimates that Tulare County has the highest percentage of residents enrolled in Medi-Cal, at 55.5%, followed by Fresno County at 49.9%.

Levitt said Republicans have proposed a plan that would modify Medicaid using a block grant system that would potentially reduce funding for Medi-Cal. Other proposals call for rolling back or reducing spending for Medicaid expansion. 

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