By PAUL C. BARTON, firstname.lastname@example.org
Gannett Washington Bureau
WASHINGTON - California has put a lot of work into preparing for President Barack Obama's health care reform law to take full effect in 2014.
And because it has the highest population of any state, it would see billions in new federal dollars flowing its way if that happens, especially to its Medicaid program, health care analysts say.
But some analysts, as well as conservatives in the state's congressional delegation, contend California and the nation would be better off in the long run if it doesn't take full effect.
And they may get their wish.
Any week now, the Supreme Court will rule on the constitutionality of the Patient Protection and Affordable Care Act of 2010, a law designed to expand health insurance to more Americans and contain costs throughout the health care system.
The court's 2011-2012 terms ends this month.
Because of the tone of Supreme Court justices' questions during oral arguments in March, innumerable pundits and court watchers are expecting the law to be struck down either in part or in full.
"There is a lot riding on the decision of the court, both (fiscally) and in terms of human impact," Marian Mulkey of the California HealthCare Foundation said in an interview. The foundation is a health care research organization.
"There are 8.2 million uninsured Californians in a given year -- and as a result, Californians live sicker, die younger, and are one emergency away from financial ruin," the advocacy group California Health Access wrote in a recent report. More than one in five Californians lack coverage sometime during the year.
The Medicaid provisions of the law alone, it said, would bring health care to at least 2 million of those.
"Repealing health care reform would have a devastating impact on California families," Senator Barbara Boxer, D-Rancho Mirage, said in a statement.
"More than 6 million Californians could lose their access to free preventive services such as mammograms and immunizations. At least 355,000 young adults could be kicked off their parents' health care plans. More than 320,000 California seniors would face higher prescription drugs costs. And it would end coverage for about 10,000 Californians with pre-existing conditions.:
Added Sen. Dianne Feinstein, D-San Francisco: "Repealing the law would end these benefits and be a major setback for California and the nation."
But conservatives contend the law is one the nation and the state can ill afford at a time when the national debt is close to $16 trillion.
The cost of the Affordable Care Act, according to the Congressional Budget Office, is $1.76 trillion for the years 2012-2022.
"Is this really the best way to take of the most vulnerable?" asked John Graham of the Pacific Research Institute, a free-market think tank.
"This is just too much federal money. That offends a lot of people."
Republican members of the congressional delegation agree.
"The President's 1,000-page ... boondoggle is already driving up health care costs for Americans and threatening to sink many small businesses," Rep. Mary Bono Mack, R-Palm Springs, said in a statement.
"If the Supreme Court doesn't strike down the law, as I hope it will, then Congress needs to repeal Obamacare and focus on ensuring that no one can be denied coverage because of a pre-existing medical condition, children can remain on their parents' insurance plan until they're 26-years-old, and seniors will continue to get the help they need paying for expensive prescription drugs."
She added: "The rest of Obamacare is a confusing, complicated and costly mess which will eventually lead to Washington bureaucrats making health care decisions instead of patients and their doctors."
Similarly, Rep. Devin Nunes, R-Tulare, said the law has already "run amok" in the San Joaquin Valley, causing access and cost problems for both Medicaid and Medicaire recipients.
"The sad part is Obamacare is such a failure the American people are not ready to go back to a health care debate."
But regardless of how the Supreme Court rules, he said, that's what needs to happen.
"The economics are such we are going to have to have another debate," Nunes said.
State officials, however, want the law to take effect -- in full.
In written comments at the Supreme Court, California Attorney General Kamala Harris argues that before it strikes down the whole law -- rather than just the mandate requiring individuals to buy health insurance -- the court should consider the time and effort many states have already put into implementation.
"As the state with the largest uninsured population, California has been aggressive in putting the ACA (Affordable Care Act) into operation," said her legal brief, filed in cooperation with a dozen other states, including Oregon and Washington.
California alone, she said, has passed 11 laws since 2010 to implement various provisions, including the establishment of a California Health Benefits Exchange, a kind of central market through which insurers will compete to offer health insurance options to customers beginning in 2014.
Feinstein said she is convinced the exchanges will work if given the chance. The individual mandate and exchanges together "are critical to reducing the number of uninsured."
Harris, the attorney general, argues for keeping the mandate as well.
"Under the Commerce Clause (of the Constitution), Congress has the authority to enact the minimum coverage provision, as it substantially affects interstate commerce and is essential to the proper application of the (health care law)," she wrote in a separate brief, again in cooperation with other states eager for full implementation.
Many of those who can't afford to purchase insurance, she writes, will be covered through expanded access to Medicaid, the federal-state health insurance program for the indigent.
And it's the Medicaid provisions that promise to trigger billions of federal dollars flowing back to California, where the program is known as Medi-Cal.
California already has 11 million Medicaid recipients, nearly 30 percent of the population, a major strain on the state budget.
It's the highest percentage in the nation, according to the Kaiser Family Foundation, a health care research organization.
Sacramento County had 316,277 Medicaid recipients as of July 2010, according the California Department of Health Care Services.
The Affordable Care Act increases Medicaid coverage to individuals and families up to 133 percent of the federal poverty level. But the federal government pays for most of it, even all of it for the first three years, 2014-2016.
Beginning in 2017, the federal share would decrease slightly but remain as high as 90 percent in 2020 and beyond.
By bringing health care to millions of Californians who don't have access now, some advocates say, it would prevent various cancers and other diseases requiring early detection to treat effectively.
If the law is overturned, Mulkey, of the California HealthCare Foundation said: "It (would be) a missed opportunity."
Similarly, Rep. Sam Farr, D-Carmel, said, "It would have a very negative effect in this district."
He cites 7,400 young adults in his district already being allowed to stay on their parents' health plans until age 26; at least 5,000 seniors benefiting from more help with Medicare prescription drug costs; and 53,000 getting preventative services for the first time."
Farr said if the justices show respect for what most of the lower federal courts have ruled "they will uphold the law."
But Graham, of the Pacific Research Institute, said the United States needs a system that encourages more efficiency and price competition. And the best way to do it, he said, is by getting away from group health plans and making individuals more responsible for their health care costs.
For those who truly couldn't afford it, he said, "I think a sliding scale of subsidies would take care of it."
Gannett Washington Bureau