HANFORD – The GOP plan introduced this month to replace the Affordable Care Act could have some damaging effects on Kings County, according to Keith Winkler, director of the Kings County Department of Public Health.
Winkler said that as of November 2016, 45,131 Kings County residents were enrolled in Medi-Cal, the health insurance program for low-income California residents.
Winkler said that in 2012, before the ACA was implemented, there were 24,775 Kings County residents on Medi-Cal.
That means 20,356 people in Kings were added to Medi-Cal under the ACA.
The ACA, the expansion of health insurance coverage passed under the Obama Administration, is also referred to as Obamacare.
That figure far outpaces the 2,340 Kings County residents who got insurance through Covered California, the state-run insurance exchange set up under the ACA.
Winkler said that the American Health Care Act, unveiled by the GOP on March 6 in Congress, threatens the Medi-Cal expansion.
"My biggest concern is that it would result in a substantial reduction in the number of low-income people [on Medi-Cal]," Winkler said. "It just reverses all of that."
Winkler's estimate of 20,356 additional people in Kings covered under Medi-Cal differs from the number provided on the state's Department of Health Care Services website.
The website reports that, as of September 2016, 13,397 people in Kings County between the ages of 19 and 64 were added to Medi-Cal as a result of implementation of the ACA.
Winkler said the difference – 6,959 – probably consists largely of children 18 years old or younger.
According to the Children's Defense Fund, a total of 156,000 people under the age of 18 in the 21st Congressional District are covered by Medi-Cal.
The organization didn't have a breakdown available for Kings County.
The 21st Congressional District, represented by David Valadao, R-Hanford, includes all of Kings and parts of Fresno, Tulare and Kern counties.
Because so many people in the district would be affected by the GOP plan, Valadao has been under pressure to say what he thinks of the proposed legislation.
"As I continue to review the recent proposal from House Republicans, ensuring that my constituents have access to affordable, quality health care will remain my top priority," Valadao said in a written statement this week.
On Jan. 13, Valadao voted "yes" on a budget resolution giving the green light for the House to start the process of repealing the ACA.
Valadao said in the statement that "our health care system was broken before Obamacare, but Obamacare made it worse."
In expressing concern about what will happen to Medi-Cal under the new GOP plan, Winkler cited the recent Congressional Budget Office report that estimated that an additional 24 million people nationwide would be without health insurance by 2026 under the GOP plan.
The report doesn't include a breakdown for Kings County.
The report estimated the plan would cut federal spending by $337 billion.
Winkler said the plan would "limit the amount of money that [California] receives" for Medi-Cal.
Winkler said the federal government has been picking up 100 percent of the cost of adding additional people to Medi-Cal under the ACA.
"As the population eligible for Medi-Cal increases, is that going to be covered?" he said. "Will there be limits on coverage and benefits? Will there be a limit on the number of enrollees?"
Winkler said the loss of Medi-Cal coverage would put Kings County in a bind.
He said that under state law, counties are required to provide basic care for low-income residents who can't otherwise get coverage.
"Rural counties like ours are going to have to pick up the slack and cover people," he said.
Winkler said the program, called the County Medical Services Program, was largely discontinued because of the ACA.
"It hasn't been a big expense, particularly since the Medi-Cal expansion occurred," he said. "But that could totally change."
Winkler said a rollback of Medi-Cal would likely increase the number of people going to the emergency room at Adventist Medical Center in Hanford.
ERs are required to treat people who come in.
"They're going to impact hospital emergency rooms," he said. "Where [else] are they going to go? The hospital has to absorb that. There is a concern."
In a written statement, Adventist Spokeswoman Christine Pickering said the hospital figured out a way to absorb the cost of many uninsured patients before the ACA and would continue to do so if the ACA goes away.
"We anticipated caring for uninsured community members and worked that into our business model," the statement reads. "We would find a way to continue to care for them."
The statement didn't elaborate as to how.
The statement said that Adventist has "seen an increase in the number of patients we're caring for [since the ACA was implemented], but that growth can't all be attributed to the Affordable Care Act."
The statement said that the increased number of local residents insured under the ACA "generally leads to an increase in their use of health care services. Their increased visits led to an increase in reimbursement for us, which we re-invest back into services such as our new Family Birth Center in Hanford."
"The Affordable Care Act is one of many factors that affect the way community members access health care," the statement said. "Our focus is on meeting community members where they're at and caring for them, regardless of the legislative or financial situation."