For 5 million Californians like Hugo Campos, Donald Trump’s stunning election last week was accompanied by the unsettling sound of a ticking clock.
Campos, a self-employed Oakland business consultant, once went without health insurance because he has heart disease. He was able to buy a subsidized Kaiser policy in late 2013 only because of the Affordable Care Act, which prevents insurers from denying him coverage because of a pre-existing condition.
But Trump’s vow to repeal and replace the health care law has left the 50-year-old Campos in shock. “We just got started,’’ he said. “Are we going to stop and go back to the way things were before?’’
Campos is one of 1.4 million Californians who get their insurance from Covered California, the state’s insurance exchange established under the 6-year-old Affordable Care Act, commonly called Obamacare. And the prospect of losing his health plan is sending shivers up and down his spine.
“This is like my worst fears coming true,’’ Campos said of Trump’s election and how it could jeopardize his health insurance. “I don’t know what to expect, and it’s hard to plan ahead when there is so much uncertainty. It’s all very frustrating.’’
On Friday, in interviews with the Wall Street Journal and CBS’ “60 Minutes,” the president-elect said he was open to keeping two parts of Obamacare: a provision that prohibits discrimination based on pre-existing conditions and one that allows Americans up to age 26 to remain on their parents’ health plans.
But Campos doesn’t trust Trump, calling him “unpredictable.”
Healthcare experts, many of whom support the Affordable Care Act, say they can’t be certain what the Republican-controlled Congress will replace Obamacare with. Trump has revealed few details, other than to say the replacement will be “something terrific” and that he has no intention of letting people “die sitting in the middle of a street” because they lack health care.
Democrats, however, say that cutting off 20 million newly insured Americans from health coverage would be devastating.
But there is one thing almost everyone — even Obamacare’s critics — agree on: Whatever changes Congress enacts will take time to implement, possibly as long as two years.
“It will almost surely take most of 2017 for Republicans to create the replacement plan,’’ said Robert Laszewski, a Virginia-based health policy expert who has warned that not enough Americans are signing up for Obamacare to be sustainable in the long-term because many of the policies it offers are unattractive.
Jill Horwitz, a law professor and health policy expert at UCLA, said if Trump sticks with his campaign promise to completely repeal and replace the law, it will be very hard to do because Democrats can filibuster efforts to repeal the entire law with just 41 votes in the Senate.
Democrats are expected to have at least 46 senators, plus two independent senators who caucus with them.
The nonpartisan Congressional Budget Office last year forecast that repealing Obamacare would increase budget deficits by $353 billion over the next decade, largely because of the elimination of health care taxes — and that the number of Americans with health insurance would drop by 24 million.
Horwitz said there are parts of the law — those that involve federal spending — that can be overturned with a simple majority of the Senate, using a process called “reconciliation.” They include the individual mandate that requires almost all Americans to have health insurance; the steep subsidies that make health insurance affordable for people who buy it through health care exchanges; and the expansion of Medicaid — in other words, most of the key parts of the law.
Horwitz and other experts noted that even if Trump wants to keep the part of the law forbidding insurers from denying coverage to people like Campos who have pre-existing conditions, there’s a catch.
“It isn’t a feature that can stand alone,’’ Horwitz said. “It requires that broad swaths of the population have coverage — you can’t run an insurance program with only sick people in it.”
Health care experts are urging Californians to sign up for Obamacare coverage in 2017 during the current open enrollment period, which ends on Jan. 31.
“Right now, the election has cast a big cloud of uncertainty over the open enrollment period that just got under way,” said Larry Levitt, a vice president at the Menlo Park-based Kaiser Family Foundation. “But for now, the law is still in effect, including the individual mandate and the financial help for people to get covered.’’
About 3.8 million Californians also are enrolled under a provision of the law that allowed single adults without children to sign up for Medicaid (called Medi-Cal in California), which provides coverage to the state’s poor.
Devorah Levy, a 50-year-old massage therapist from San Pablo, is among the beneficiaries. But she didn’t realize Trump’s plan could derail her Medi-Cal plan — something she has come to rely on.
“I went many years without insurance because I could not afford it,’’ Levy said. “But my income is so up-and-down that if they nix the plan, that will hurt.’’
On his website, Trump’s plan suggests that he might want to turn the entire Medicaid plan into a block grant, which will give states more control over how they use Medicaid money. But Levitt and others say there’s no guarantee the grant would cover the costs of the millions of Americans who obtained health coverage through the expanded Medicaid program.
Officials at Covered California, the state insurance exchange that has been held out as a national model, vigorously defend the law.
Peter Lee, CEO of Covered California, noted that California’s exchange is so healthy that it’s still expanding. In Northern California, for example, Kaiser is expanding to Santa Cruz County, while Oscar Health Insurance — a company spawned by Obamacare — will now be available in San Francisco County. (In an irony noted by many, Oscar was co-founded by Joshua Kushner, the brother of Trump’s son-in-law, Jared Kushner.)
“What is happening in Washington will take time,’’ Lee said. “But what is happening today in California is that people are renewing their coverage.’’
Laszewski questions Lee’s optimism.
“We are going to be starting over from scratch,” the health policy analyst said of the GOP plan. “I don’t see a scenario right now where the exchanges survive. That could change when the negotiations begin, but right now the Republicans do not want any government-run markets.”
Not everyone enrolled in Obamacare is nervous about the coming storm.
Campbell resident Robert Chery, who works for an optician, believes the politicians and bureaucrats in Washington will be arguing about health care for a while.
“It took them a long time to get to this place — it was something that was never done before,’’ said Chery, who pays $700 monthly for a subsidized HealthNet policy for himself, his wife and two children. “I just don’t think they will be able to completely overhaul it.’’
