By the time Democrat Xavier Becerra left Washington, D.C., more Americans than ever had health insurance, owing partly to his work over the years to pass, defend, and expand the Affordable Care Act. It's an achievement the former congressman and U.S. secretary of Health and Human Services often touts as he campaigns for California governor against Republican Steve Hilton, a former Fox News commentator. But should Becerra cruise to victory in November, as polling suggests, he will face what may be the steepest decline in health insurance coverage in a generation, one that will land especially hard in his home state.
By 2030, the number of uninsured Californians under 65 is expected to nearly double from 2.4 million to 4.6 million as recently enacted state and federal cuts to Medicaid and ACA marketplaces begin to roll back historic gains in health coverage, according to a May analysis by the University of California, Berkeley Labor Center. The anticipated rise in the uninsured population could have broad implications for hospital systems, insurers, and the economy. In February, Miranda Dietz, the labor center's healthcare program director, told legislators the changes could end up costing California about 200,000 jobs, mostly in the healthcare industry.
Hospital executives have begun reporting more unpaid medical bills, and experts warn health plans will raise premiums further as they're left with enrollees who are, on average, sicker and more expensive to cover. "It's triage," said Jessica Altman, executive director of Covered California, the nation's largest state-run health insurance marketplace. "That's what the next governor is walking into." California achieved one of the most dramatic drops in its uninsured population in the nation, largely credited to the state's robust adoption of the ACA.
If tapped to lead the wealthy, progressive state, Becerra would wrestle with how uninsured Californians get care and who pays as the Trump administration shrinks a federal safety net he once oversaw. Becerra has some experience pushing back against Washington, D.C. As California attorney general, he successfully defended many provisions of the Affordable Care Act, including access to birth control.
Becerra said he would issue an executive order to keep those affected by federal cuts insured. But he has not detailed how the state would backfill as much as $30 billion in federal funding California stands to lose annually. At a policy forum hosted by Politico this month, Becerra promised Californians would not lose health coverage despite federal cutbacks, saying he would push the industry to eliminate waste from "attorneys, accountants, pencil pushers" that cost consumers billions.
"I'm going to ask them to help me extract some of that waste and put it into healthcare, which helps us cover the cost of keeping Californians insured," he said. His opponent, Hilton, is trying to appeal to voters opposed to President Donald Trump, despite receiving the president's endorsement, and has stumped on cutting off coverage for Californians without legal status, which is paid for with state funds. Hilton has vowed to use those savings to issue state income tax breaks, calling it an immediate antidote to high costs.
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