Commentary

By Dianne Feinstein

Originally appeared in the East Bay Times

House Republicans last week unveiled their plan to “repeal and replace” the Affordable Care Act. It would result in 24 million fewer Americans having health insurance by 2026.

At its most basic, the Republican plan slashes the subsidies that allow low- and middle-income families to buy health insurance while cutting taxes for the wealthiest 5 percent of Americans, those who make more than $200,000 annually.

On average, individuals would pay $2,400 more per year for their health insurance. Older Americans between 55 and 64 would be hardest hit, paying an average of $7,000 more per year.

In contrast, millionaires would save around $50,000 each year in reduced taxes.

It’s unconscionable to make working families pay thousands more for health coverage so the wealthiest can see another tax cut.

Under the Affordable Care Act, a person’s subsidy is determined by their income and health plan’s cost. The subsidy increases to ensure individuals do not pay more than a certain percentage of their income.

This provision is particularly important for California because the cost of health care in the Bay Area and rural counties is especially high.

In contrast, under the Republican plan a person who makes less than $75,000 would receive a tax credit determined by their age.

If you are between the ages of 60 and 64, you would receive a $4,000 tax credit. If you are under the age of 30, you would receive a $2,000 credit.

These tax credits would not be nearly enough for older Americans, who are charged more, to afford insurance.

For example, a 60-year-old in Contra Costa County who makes $30,000 per year currently receives a subsidy of $11,050. The Republican plan would provide a flat $4,000 tax credit, meaning this person would pay $7,000 more just in monthly premiums.

Congress should instead be looking for ways to strengthen the Affordable Care Act. One option would be to increase subsidies to more middle-class and upper-middle class families to help address current affordability issues in the individual market.

The problem in California is that many who use the individual market — known as Covered California — make too much money to receive subsidies, but not enough to afford insurance.

A 60-year-old making $47,521 per year — one dollar more than the limit — has to pay between $600 and $900 per month for a standard plan in California. That’s not affordable. Helping these individuals who are harmed by this sudden cliff in subsidies is a smart solution to make current law stronger.

The Republican plan would also gut Medi-Cal, the state’s Medicaid program that covers one in three Californians.

Under the Affordable Care Act, Medi-Cal was expanded to cover working-class adults. Four million low-income adults were added to the program.

The federal government currently covers a fixed portion of the cost of health care services for Medi-Cal beneficiaries — 90 percent in the case of the 4 million people added under the Affordable Care Act.

Under the Republican plan, the federal government would end its support for the expansion and place a strict limit on the amount it pays for each Medi-Cal beneficiary.

It would be impossible for the state to continue covering those 4 million Californians.

For the 8 million Californians remaining in the program, the state would be on the hook for all costs above a certain threshold. These changes would cost tens of billions per year, a crippling blow.

Three in five Californians who live in nursing homes are covered through Medi-Cal, and two-thirds of Medi-Cal dollars are spent on care for the elderly and individuals with disabilities.

The state would be forced to short-change other priorities.

Rural counties like Fresno have the highest rates of Medi-Cal enrollment and would be especially hard hit.

Public hospitals in these communities would once again see overcrowded emergency rooms and high rates of uncompensated care.

Democrats in Congress support improving the Affordable Care Act but we can’t support this plan.

Dianne Feinstein is the senior U.S. senator from California.