San Francisco health workers are bracing for changes in health care coverage. (Cindy Chew/2008 S.F. Examiner)

SF braces for possible changes to Obamacare

Repealing Obamacare could impact a third of San Francisco residents who depend on health coverage through the Affordable Care Act and Medicaid.

As many as 250,000 people in San Francisco depend on health care through the ACA and Medicaid, according to the Mayor’s Office. The ACA has allowed for 90,000 new patients in San Francisco to become insured in the last few years alone.

Medicaid was expanded under Obamacare in 2014 and primarily serves low-income individuals for no or low costs. The most recent census estimate shows there were just over 860,000 people in San Francisco as of July 2015.

With such a large swath of residents relying on the ACA, the Mayor’s Office convened a meeting in San Francisco last week for local, state and federal officials to coordinate their efforts around the ACA as President-elect Donald Trump prepares to take office in January.

Trump and Congressional Republicans have signaled their willingness to strip down Obamacare beginning early next year, including the requirement that every person have health insurance, while preserving a part of the ACA that prohibits discrimination based on pre-existing conditions.

Catherine Dodd, director of the San Francisco Health Service System, which manages health care plans for city employees, said that’s a problem.

While eliminating the insurance mandate would reduce an administrative burden for the agency — “We spent a month worth of time configuring and sending out the proof to the IRS that all of our people have insurance” — Dodd said healthy people need insurance to balance the system.

“It’s a three-legged stool,” Dodd said. “You need the healthy people to balance the cost of people with pre-existing conditions.”

For that reason, Dodd said she does not expect major changes to the ACA in early 2017, at least not until Republicans find another way to finance the system.

Dodd said the major changes for her agency that the ACA rolled out are likely to remain in place even if Obamacare is repealed. That includes lowering the number of hours that a full-time employee has to work to receive benefits.

Still, various local agencies and representatives for House Minority Leader Rep. Nancy Pelosi, D-Calif. and Assemblymember David Chiu, D-San Francisco met in The City last week to prepare. Both Pelosi and Chiu are staunch supporters of the ACA.

“Leader Pelosi will continue fighting against Republican attempts to repeal the Affordable Care Act that benefits many thousands of San Franciscans and millions of Americans,” Jorge Aguilar, Pelosi’s spokesperson, said in an email.

The costs associated with the repeal of Obamacare are still unknown for San Francisco. The Mayor’s Office has directed certain agencies to identify the financial impacts.

One area where The City would be stuck footing the bill is Healthy San Francisco, a local program that provides health care to low-income individuals.

Healthy SF spent almost $150 million on uninsured residents at its peak in 2010, as previously reported by the San Francisco Examiner. In 2014-15 the program’s costs dropped as a result of the Medicaid expansion and it spent just over $70 million.

The program could regrow to serve low-income individuals if Obamacare is repealed, putting the costs back on The City.

Nonetheless, the local numbers are dwarfed by federal data on the ACA released Tuesday.

In California, about 3.8 million people gained insurance coverage between 2010 and 2015, according to the U.S. Department of Health and Human Services. In August there were 11.8 million adults and children in California enrolled in Medicaid or the Children’s Health Insurance Program, which are both for working-class families.

“If Donald Trump carries through with abolishing the ACA, that would be catastrophic for our country and for California,” Chiu told the San Francisco Examiner. “It’s enormous, it’s keeping every Democratic policy member up at night thinking about these possibilities.”

Repealing Obamacare could cost the state up to $20 billion largely from federal funding it received to expand Medicaid, Chiu said.

“We’re going to have to have to a very significant conversation around how we move current portions of the budget to deal with making sure that Californians have access to health care as well as consider other revenue options,” Chiu said.

“If the worst case scenario comes to be, everything is going to be on the table.”

Editor’s Note: This story has been updated from its original version.

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