Contingency Planning Amid ACA Uncertainty

Los Angeles County’s Health Care Reform Working Group testifying before the Board of Supervisors on Aug. 15. All photos by Bryan Chan/Board of Supervisors

Statement by Board of Supervisors Chairman Mark Ridley-Thomas on Contingency Planning amid efforts to Repeal the Affordable Care Act

I would like to thank all members of this healthcare reform task force for their hard work on this important topic.

While Congress is not actively discussing “repeal” legislation, that could change at any moment. For that reason, this remains an issue we are taking very seriously in LA County.

Let me begin by stating, unequivocally, that I am committed to doing everything within my power to maintain the hard-fought gains we’ve made under the ACA in LA County, regardless of what Congress ends up doing.

Let’s review the facts. Though far from perfect, the Affordable Care Act (ACA) – Obamacare – has greatly expanded healthcare coverage in Los Angeles County. According to the presentation we just heard:

The uninsured rate in our County dropped from approximately 21% of residents in 2013 prior to ACA implementation to about 11% in 2015.

Altogether, approximately 1.2 million individuals gained Medi-Cal coverage via the ACA in LA County and an additional 380,000 individuals received subsidized coverage through Covered California, the State-based insurance exchange.

Those who were covered include many of the poorest and most vulnerable residents of Los Angeles, including a large proportion of children, as well as the working poor.

As of May 2017, more than 70,000 undocumented children 0-19 years of age have gained health coverage thanks to passage of SB 75.

Additionally, nationwide, the ACA has increased minimum health benefits, and access to preventative care, women’s health services, and other essential health benefits like emergency care, hospitalization, prescription drugs, and out-of-network services.

It has also prohibited health plans from denying coverage for pre-existing conditions.

In doing so, the ACA has raised the bar on health care for not just the newly insured, but for everyone.

I would like to commend our County Health Agency, as well as the numerous community groups, advocates, private clinics and hospitals, and others who helped get the word out to ensure those who were eligible got covered.

These advances are precisely what is at stake with efforts to repeal Obamacare. Put simply, if repeal legislation were to be passed, the state of California would risk losing billions of healthcare dollars annually. This would put at risk the major advances in health care coverage and access that have occurred over the past few years.

I am heartened to learn that many others within the state, including my colleagues here on the Board of Supervisors, feel as I do that the ACA has been a very good thing for LA County, and that we should do everything within our power to maintain the gains we’ve made.

If the ACA ends up being repealed – which I very much hope it won’t be – I am glad to hear our leaders within LA County have been working hard to develop contingency plans.

While there are many nuances still being worked out, it is clear to me that our healthcare reform working group has put forth some important ideas that could help mitigate the potential effects of “repeal”, and improve healthcare for the residents of LA County regardless of the outcome.

For this reason, I would like to use this as an opportunity to read-in a motion recognizing the hard work our County leaders have done to develop contingency plans should “repeal” occur.

This motion would also establish a process for ensuring that the recommendations this group comes up with in collaboration with statewide stakeholders come to the Board for consideration in a timely way.

I want to conclude by stating, unequivocally, that I believe healthcare is a basic human right that ought to transcend politics. Too many people suffer and die without that right.

Thank you.

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Counties Unite to Preserve Health Care

Los Angeles County Supervisor Mark Ridley-Thomas welcomes incoming NACo President, Roy Charles Brooks.

Los Angeles County and the State of California stand to be hit the hardest with the potential repeal of the Affordable Care Act. The picture is just as devastating for counties nationwide, which was a major topic of discussion at this year’s National Association of Counties Conference and Exposition.

County Supervisors Mark Ridley-Thomas and Kathryn Barger traveled to Columbus, Ohio for NACo’s annual non-partisan meeting with over 2,000 county delegates from nearly every state in the nation. The annual conference is the only meeting that draws a cross section of elected officials and county staff from across the country. Attendees from rural and urban counties, with large and small staff and budgets – all come together for four days of education, networking and sessions aimed to help improve residents’ lives and the efficiency of county government.

This year, amidst federal uncertainty about the future of the Affordable Care Act, health care was a focus of concern at NACo’s Annual Meeting.

“Health care is not to be treated as a partisan issue,” said Los Angeles County Board of Supervisors Chairman Mark Ridley-Thomas. “We operate in a non-partisan environment and therefore aim to serve our constituents irrespective of their political orientation.”

According to the National Association of Counties, it is the duty of local government to fulfill public health and safety services for some of the most vulnerable residents including children, older adults, and people with disabilities. NACo asserted that the health care debate should be about improving health outcomes and not simply a budget exercise. NACo further asserted that Congress is orchestrating a massive cost shift beyond the capacity of states and local communities to bear. Every proposal to date would adversely impact the federal, state, and local partnership for Medicaid. Medicaid is a key tool in the battle against the opioid epidemic and is the largest single funder of mental health services and substance abuse treatment. Counties in 26 states help fund Medicaid and many help to administer the program. For these reasons, NACo is currently engaged in the health reform debate on Capitol Hill. Whether or not the Senate passes a bill, NACo continues to focus on the real life impact on counties and their residents and the potential federal cost shifting to local government.

Supervisors Ridley-Thomas and Barger interviewed live on the importance of lifting up the issue of homelessness in the media and Affordable Care Act reform.

“This is a non-partisan issue that impacts all counties,” said Supervisor Kathryn Barger. “This is a crisis and people’s lives are being played as a political pawn.”

Counties continue to invest $80 billion annually in community health — $1 in every $5 of county budgets. Counties support nearly 1,000 hospitals and 900 long term care facilities through these resources. They provide behavioral health services through 750 behavioral health authorities and community providers. About 75% of the United States population is served by county-based behavioral health systems. The debate being advanced about repealing the Affordable Care Act puts these services at risk. NACo further noted that Counties support comprehensive tax reform that lowers the rates for taxpayers and spurs economic growth. But NACo added this was not about tax reform, but about health outcomes for the most vulnerable among us.

“The County of Los Angeles would be the most adversely impacted county in the nation,” said Chairman Ridley-Thomas.

Los Angeles County Chief Executive Officer Sachi Hamai estimates that Los Angeles County stands to lose $1 billion in funding should the Affordable Care Act be repealed.

Supervisors Ridley-Thomas and Barger tour Van Buren Center homeless shelter in Columbus, Ohio.

Also on the minds of county delegates are ways to combat homelessness and enhance local economic development. Biotech, one of the biggest boom industries of this century has found its way to Columbus, Ohio — now one of the leading cities in the nation for the growing industry. Chairman Ridley-Thomas toured Rev 1 Ventures, a 64,000 square foot business incubator that co-locates 25 tech and pharmaceutical startups, with a quarter of them being bioscience and biotech companies with the hope of inspiring similar ventures in Los Angeles County much like LA BioMed on the Harbor UCLA Campus.

Chairman Ridley-Thomas tours Rev 1 Ventures in Columbus, Ohio.

Fighting Against Repeal of the Affordable Care Act

Board of Supervisors Chairman Mark Ridley-Thomas and several members of the board denounced a Trump Administration-backed Senate Republican bill to repeal the Affordable Care Act, warning it could strip more than one million Los Angeles County residents of their health insurance with devastating results.

Mounting opposition – including within the U.S. Capitol – has already prompted Senate Republican leader Mitch McConnell to delay a vote on the proposed legislation.

“We will not retreat. We will not relent. We will fight for the people of this County because healthcare is a right, not a privilege,” Board Chairman Ridley-Thomas said.

image6“This nation can do more for the uninsured. It is unconscionable to do less,” he added. “This bill would hurt the residents of our County by assaulting our safety net. Therefore, we have to do what is right as people of conscience and as people of purpose.”

Supervisor Sheila Kuehl, who led a press conference to oppose the Senate Republican bill, said, “The slogan for the proposed plan may as well be ‘Make America Sick Again.’”

“LA County will be especially hard hit, because during the Medicaid expansion, we pushed hard to enroll men and women who had previously been uninsured,” Supervisor Kuehl added. “We cut the rate of uninsured in the County by nearly 50 percent. If this terrible plan passes, Medicaid, as we know it, will be virtually gutted and LA County will be ground zero for the plan’s deadly consequences.”

Supervisors Hilda Solis and Janice Hahn also spoke out against the Senate Republican bill, as did LA County’s Health Agency director, Dr. Mitch Katz; Public Health director, Dr. Barbara Ferrer, and Mental Health Director, Dr. Jonathan Sherin.

image2Dr. Katz warned, “About 1.2 million people in LA County gained Medi-Cal coverage via the ACA, and the ACA brought the County’s Department of Health Services about $560 million of new revenue, which allowed us to expand the outpatient delivery system and modernize our infrastructure. The Senate Republican bill risks all these gains.”

The health officials also estimated 323,000 people in LA County could lose the subsidy that has enabled them to pay for their health insurance. Over the next several years, an estimated 4 million people, or nearly 40 percent of LA County residents – including 1.1 million children under age 19 – would be at risk of losing their health insurance and/or will have much greater difficulty accessing vital health care services.

A Congressional Budget Office analysis found the Senate Republican bill would result in 22 million more people nationwide that would be uninsured 10 years from now.


Support for In-Home Caregivers

The Board of Supervisors took a stand against Governor Jerry Brown’s proposal to slash $626 million from the state budget for in-home caregivers starting this July, essentially passing the cost onto counties.

Acting on a motion by its Chairman Mark Ridley-Thomas, co-authored by Supervisor Kathryn Barger, the Board voted to send a letter signed by all five of its members endorsing AB 675.

Authored by Assemblyman Sebastian Ridley-Thomas, AB 675 calls for appropriating $650 million from California’s general fund to continue the In-Home Supportive Services (IHSS) program as a benefit available through Medi-Cal managed care health plans under the Coordinated Care Initiative.

“The Governor’s proposed budget cuts would have a potentially devastating impact on our County,” Board Chair Ridley-Thomas said. “It could jeopardize funding for other critical services such as healthcare and child welfare for our most vulnerable residents.”

Supervisor Barger added, “The elimination of IHSS funding would result in significant funding curtailments for critical County programs and many individuals in need of care may wind up in hospitals, which would cost the state even more.”

IHSS helps pay for services to low-income elderly, blind or disabled individuals, including children, enabling them to remain in their own homes. It is an alternative to more expensive out-of-home care, such as nursing homes or board and care facilities.

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County CEO Sachi Hamai testifying about the impact of the Governor’s proposed state budget cuts to IHSS programs. Photo by Diandra Jay/Board of Supervisors

Under the Governor’s proposed budget cuts, Los Angeles County stands to lose $220 million in IHSS funding in fiscal year 2017-2018, based on estimates by the County’s Chief Executive Officer Sachi Hamai.

The price tag is projected to soar to $500 million by fiscal year 2020-2021, as the number of IHSS patients grows and state-imposed actions such as the minimum wage increase to $15/hour, paid sick leave and overtime benefits take effect.

Several in-home caregivers attended the Board meeting to applaud the Supervisors’ unanimous support of AB 675, and to plead with the Governor to leave state funding for IHSS intact.

“It’s something that’s so very important to people with disabilities, senior citizens and children that need care,” said Louie James, who looks after his paraplegic wife, Charlsa Tina James.

Patricia Santana, who takes care of her disabled husband, said, “Governor Jerry Brown, now is the time to put your hand on your heart, give dignity to our workers, to our families, and to our clients. You have the power in your hands.”

Representatives of several labor unions representing IHSS caregivers also attended the Board meeting or expressed support, including SEIU Locals 2015 and 721, the Coalition of County Unions, the Los Angeles County Professional Peace Officers Association and the Association for Los Angeles Deputy Sheriffs.

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IHSS workers attend the Los Angeles County Board of Supervisors meeting to urge that state funding for the IHSS program remain intact. Photo by Diandra Jay/Board of Supervisors

Rally to Save Obamacare

Thousands of demonstrators took to the streets of downtown Los Angeles to oppose the repeal of the Affordable Care Act hours before it was set to go to lawmakers in Washington for a vote.

“If it ain’t broke, don’t fix it!” said Los Angeles County Board of Supervisors Chairman Mark Ridley-Thomas.

The rally, convened by APLA Health, was convened to encourage Republican lawmakers to vote against plans to repeal and replace the Affordable Care Act. The March started on the steps of the Kenneth Hahn Hall of Administration in the morning and culminated at the Edward R. Roybal Federal Building on East Temple Street in the afternoon.

As the crowd arrived, the count indicated that 28 Republicans intended to vote against the measure, which would stop the overhaul. If all Democrats and 23 Republicans in the House vote against the bill, it would be defeated.

“I think it’s great, I’m hoping those 28 don’t change their mind between now and tonight,” said Dr. Paul Gregerson, the Chief Medical Officer for John Wesley Community Health.

“We believe in justice. We believe in fairness. We believe in healthcare for all!” the Supervisor said.

“If it wasn’t for the Affordable Care Act, I wouldn’t have been able to have my son,” said one clinic patient from Westside Family Health Center who brought her two year son on stage in her arms. “We can’t afford private healthcare, and the ACA has been such a blessing for our family. We are fighting for our right to take care of our next generation so they can be the best citizens they can be!” she said.

40% of the residents of Los Angeles County are enrolled in Medi-Cal. 360,000 residents of the County are enrolled in Covered California.

“Do we have enough faith and enough courage to say, ‘it’s temporary Los Angeles’,” said SEIU ULTCW President Laphonza Butler.

“We’re not going to let them loose their insurance are we? We’re going to keep fighting,” said Department of Health Services Dr. Director Mitchell Katz.

During the press conference after the march, GOP House leaders announced that they would postponed the vote.

“Don’t postpone. Cancel!” the Supervisor said.

The move was seen as a setback for President Donald Trump and House Speaker Paul Ryan in their first major legislative test.