Notes from the Field: California Legislative Hearings Put a Spotlight on the Impact of the ACA

April 3, 2017

Insure the Uninsured Project (ITUP) recently had the honor of participating in several health reform public hearings held around California. At the invitation of state elected officials, ITUP’s executive director, Deborah Kelch, testified as an independent expert on California’s success in implementing the Affordable Care Act (ACA) and the emerging threats from federal “repeal and replace” efforts. (Click here to view the slides Deborah used for her presentations.)

Following the March 6, 2017 introduction of H.R. 1628, the American Health Care Act (AHCA), ITUP’s testimony included an overview of the House Republican-sponsored bill. Since this blog was originally posted, the House passed the AHCA and sent it to the Senate for consideration. (See ITUP’s analysis of the AHCA here.)

In this ITUP blog, Deborah shares highlights and moving stories from the events she attended.


Participating in recent legislative forums on emerging threats to federal health reform not only gave me a chance to publicly highlight California’s progress under the ACA, but also the opportunity to hear the first-hand stories of individuals, providers and community members around the state.

In my decades working on state policy and legislation, I heard many stories about Californians unable to obtain coverage because of health status or inability to afford the premiums. With that as backdrop, I was profoundly moved to hear the difference the ACA made in people’s access to care and coverage. Witnesses shared story after story about how coverage under the ACA changed, and saved, lives. What I heard clarified for me the importance of protecting California’s gains and continuing to improve access, care and health in the state.

Here are a few highlights of the testimony provided by consumers.

    • A home care worker in her early 50s, and mother of seven adult children, suffers from two serious lung diseases, Pulmonary Hypertension and Chronic Obstructive Pulmonary Disease (COPD), even though she has never smoked. Doctors believe the illnesses are caused by the poor air quality in the Central Valley. Uninsured, she was without the resources to afford the treatments she needed.In January 2016, now covered by Medi-Cal, she was rushed to the emergency room with life-threatening pneumonia, received the treatment she needed to survive and maintenance medications made it possible for her to return to work. Worried that the ACA could be repealed, she discovered her regular medications would cost four thousand dollars a month, higher than her monthly income, not including the oxygen she needs twenty-four hours a day. She told members of the Senate Health Committee that “sickness has no gender, no color, no internationality.”
    • A Bakersfield resident suffering from severe mental illness was uninsured, homeless and without access to the medications that could treat his condition. Now covered under the ACA Medi-Cal expansion for adults, the symptoms of his mental illness are controlled, allowing him to begin job training and to have the hope of a productive future. He told legislators that if he were to lose coverage, and access to his medications, within two weeks he would most likely find himself confined in a mental health facility.
    • Prior to ACA implementation, a consumer on a salary of $1,640 a month, with Type 2 diabetes, paid $1,327 a month for ten medications. Now enrolled in coverage through Covered California, he pays $118 a month. He asked, “If I get the ACA taken away from me will I get an arm cut off, feet, go into a diabetic coma, lose my sight? I am working right now. Do they want me to go on disability? Or would they rather that I have health insurance so I can work?”
    • In the years leading up to passage of the ACA, a Fresno family of four, all of whom suffer from late-stage Lyme disease, had high deductibles and skyrocketing health care bills. With the economic downturn in 2008, the wife lost her job and her husband became too sick to work. The family’s health challenges launched them on a journey from an upper middle class life in Silicon Valley to homelessness and financial devastation in the Central Valley where they moved to be near relatives. The family clung to high-cost, high-deductible, COBRA coverage because it was the only option, knowing if they dropped the coverage all family members would be uninsurable because of their illness. Now covered under the ACA, the family no longer must decide between “no coverage forever or expensive nominal insurance without meaningful benefits.”
    • A San Diego resident in his 30s went without health insurance for over 10 years, paying out-of-pocket for over the counter remedies to address an episodic array of symptoms. Once insured under a Covered California health plan, his initial health screening revealed he was borderline diabetic. He believes that if he had not received timely intervention he would have died within two years.
    • When a San Diego 22-year old was diagnosed with non-Hodgkin’s lymphoma two weeks before her college graduation, she could rely on her parents’ policy under the ACA provision allowing young adults to keep parent coverage until age 26. Her mother tearfully told legislators about the challenges the family faced as their daughter navigated her illness, expressing deep gratitude that they did not have to worry about medical costs or coverage during the ordeal.

Providers throughout the state also shared the positive impacts of the ACA and the potential damage from ACA rollbacks.

    • Since 2012, Clinica Sierra Vista, a Federally Qualified Health Center (FQHC), serving uninsured and low-income patients in Fresno, Kern, and Imperial counties, experienced a reduction in the number of uninsured from 60,000 (39 percent) to 25,000 (16 percent). Clinica’s Medi-Cal population grew from 72,000 (46 percent) to 115,000 (68 percent) patients. The expansion of Medi-Cal and Covered California coverage improved the financial viability of Clinica Sierra Vista, allowing them to add staff and clinic capacity. Clinica recognizes that its current service level could not be sustained if the ACA or the Medi-Cal program are unraveled.
    • Neighborhood Healthcare, a FQHC in the San Diego area, increased its Medi-Cal enrollment by 20,000 patients. Neighborhood Healthcare’s rate of uninsured dropped from 18 percent in 2012 to 7 percent in 2016. With increases in coverage and pent-up demand from previously uninsured individuals, Neighborhood expanded clinic capacity, including extended evening and weekend hours in their Escondido clinic. Neighborhood is concerned that capping Medi-Cal federal funding would require them to cut back and reduce access for working families who benefit from being able to get health care during off hours.
    • From 2010 to 2015, California’s public health care systems expanded primary care capacity by more than 20 percent. Because of improved access to primary care, the systems also reduced the hospitalization rate of diabetes patients for short term complications by more than 20 percent. In this timeframe, public health care systems have reduced hospital acquired infections and increased patient safety. The ACA brought more stability to public health care systems and supported the shift to primary and preventive care, along with a greater focus on improved health outcomes. Repeal of the ACA would erode this progress and could result in reduced federal funding for public health care systems by as much as $2 billion and lost coverage for 560,000 patients in the systems.
    • Children’s hospitals treat California children with all types of medical conditions, including special needs children and rare conditions such as spina bifida, sickle-cell anemia or cystic fibrosis. Children with hard-to-treat rare conditions rely on the same pediatric specialists regardless of the source of coverage or payment. The stability of the regionalized network of pediatric specialists depends on both public and private payers. Stated differently, a cap on Medi-Cal federal funding does not just pose a risk for children on Medi-Cal but to all children in the state with complex medical needs.

These stories and messages tell us the real story of California’s successful implementation of the ACA and warn us about the potential impact of its repeal. ITUP will continue to highlight California’s success and analyze proposals that could reverse the state’s accomplishments. (Click here to watch the hearing videos.)