The state Assembly and Senate yesterday passed companion bills to expand Medi-Cal eligibility to more than one million Californians making up to 138% of federal poverty level. The bills also simplify the Medi-Cal enrollment process.
"This bill takes an important step to make sure California remains a leader in health care reform," said Assembly Speaker John Pérez (D-Los Angeles), author of ABX1-1. "And this also helps bring billions of dollars in federal funds into California."
The Senate passed its version of the legislation, SBX1-1, authored by Sen. Ed Hernandez (D-West Covina). The expansion will be fully funded with federal money for the first three years, declining to 90% in 2020.
The main objection raised on both the Assembly and Senate floors was that federal health care reform money might be unreliable, in part because the state would need to chip in 10% of expanded coverage starting in 2020, and in part because that funding could be withdrawn at some point by Congress.
"It's clear that Obamacare is going to be implemented," said Sen. Joel Anderson (R-Alpine). "And I'm going to everything in my power to implement it. However, it runs out at the end of three years. We're all eager to implement the ACA, but it runs out in three years. What's our backup plan for these people?"
Assembly member Don Wagner (R-Irvine) focused on the potential withdrawal of federal health care dollars. "We are talking about implementing an optional expansion. Optional. We don't' have to do this," Wagner said. "Somewhere down the road, we risk having the federal government pull the rug out from under us and leave our state government on the hook for billions of dollars."
That's a hard argument to swallow, said Assembly member Holly Mitchell (D-Los Angeles. "Ultimately this will save us a lot of money," Mitchell said. "If Congress changes their mind, well guess what, we can, too. The Legislative Analyst's Office said this makes good fiscal sense. Do we leave billions of dollars on the table, out of fear of what could potentially happen five or six years down the line?"
"We make budget corrections all the time," said Assembly member Nancy Skinner (D-Berkeley). "We do our best at predicting what the revenues will be, but we often … make corrections. So certainly when we adopt this economically sound bill, if the federal funding changes [in the future], we can change."
Skinner also said the state is already paying for the cost of health care for Californians without insurance. "We are now paying for the lack of health care," Skinner said. "When people who don't have insurance reach a crisis point, they go to the emergency rooms. And we pay. When people have contagious disease and don't get it taken care of, and then there's an outbreak, we pay."
Pérez took it a step further, saying that the arguments against a program that's 100% federally funded and could save the state money are disingenuous.
"When I hear these kind of arguments, it makes me wonder whether this is really a debate," Perez said, "or just rhetorical points because they're against [federal health care reform].
"When people put up false choices between health care and education, I have a hard time thinking it's an honest question," Perez said. "I've never given a partisan speech on this floor. But now, I ask for you to think about where our priorities are, so we can move beyond simple rhetorical fights. This shouldn't be the false choice some of my colleagues have put before you."
ABX1-1 passed the Assembly on a 53-22 vote. SBX1-1 passed the Senate, 24-7. Both were partisan splits.