GOP politicians' plans to repeal the ACA will "throw the healthcare system into chaos," one advocacy group claims.
More than 50% of residents in some California counties are enrolled in Medi-Cal and more than one-third of all state residents are part of the program, according to a recent study.
The California Budget and Policy Center analysis showed Medi-Cal enrollment rates in most California counties have increased dramatically under Medicaid expansion, topping 50% in four counties and 40% in 16 others.
The study did not provide statistics on the percentage of Medi-Cal enrollees in each county before the Affordable Care Act (ACA) was enacted.
Tulare County had the highest percentage of Medi-Cal enrollees in the state at 55% followed by Merced County (51.5%), Imperial County (50.6%), Fresno County (49.9%), Madera County (45.3%), and Kern County (45.1%).
"Medi-Cal enrollees live in all 58 California counties and comprise more than 25% of the population in 49 counties," the study authors wrote.
However, millions of Californians now risk losing Medi-Cal coverage if president-elect Trump and Congress enact proposals to repeal the ACA and cut federal funding for Medicaid.
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Los Angeles County had the most Medi-Cal enrollees, at 4.1 million or 40.2% of county residents. Orange County had the next highest total, at 911,194, but only 28.6% of residents are Medi-Cal members. Marin County had the lowest percentage of Medi-Cal enrollees, at 17.2%.
$4.6B in subsidies
A separate study from the Kaiser Family Foundation that looked at federal spending on subsidies in each state estimates that 1.23 million California residents received subsidies in 2016.
That study projects that total federal spending on subsidies in California this year will reach $4.6 billion and that enrollees receive an average subsidy of $309 per month toward their monthly premium.
Enrollees in some counties receive much higher average monthly subsidies, the Kaiser study found. In Kern County, the average Covered California enrollee received $417 per month while enrollees in Tulare County received an average subsidy of $592 per month.
While 90% of Covered California enrollees receive subsidies, the study found that 93% of Kern County and 96% of Tulare County enrollees receive subsidies.
California Budget & Policy Center Director of Research Scott Graves suggested that Republicans in the House and Senate could act swiftly in 2017 to reduce spending for both Medicaid expansion and the Medi-Cal program in general.
"There's a couple of ways they could go," said Graves. Congress could use budget reconciliation to repeal Medicaid expansion, which provides $15 billion in funding to the state annually, he said. Republicans could also change the Medicaid program itself.
"They could move to radically restructure Medicaid by creating a block grant system for funding or by creating a per-capita cap for funding," said Graves. "In both cases, the actions would shift more responsibility for funding Medicaid to the states and leave them with hard decisions."
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If the worst does come to pass, "state policymakers will face difficult choices about how to mitigate the damage and preserve a healthcare lifeline for millions of Californians," he added.
Concerns about a potential rollback of Medicaid expansion were raised earlier this month when California Congressman Kevin McCarthy (R-Bakersfield), House majority leader, suggested that federal lawmakers could seek to repeal the ACA before coming up with a plan to replace it.
Anthony Wright, executive director of advocacy group Health Access California, said in a statement that the strategy is "wildly irresponsible" and would "throw the healthcare system into chaos."