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Obamacare enrollment push continues despite clouds on horizon

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Even as President-elect Donald Trump and Republican leaders in Congress vow to dismantle Obamacare, promotions for 2017 enrollment are forging ahead.

Covered California plans to launch a statewide bus tour on Saturday, starting in San Diego County, to urge the uninsured to sign up and get current policyholders to renew their health plans for another year.

And on Tuesday, the health exchange had sent out an alert to hundreds of affiliated organizations, advising them to tell clients that their “coverage is not in jeopardy” amid threats in Washington, D.C., to repeal the Affordable Care Act. Those customers range from the roughly 1.3 million people enrolled in Covered California to the millions more on Medi-Cal, the insurance program for the poor that has expanded greatly in recent years with money from Obamacare.

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Altogether, about 22 million Americans get their health insurance through Obamacare.

With his White House transition process just beginning, Trump has not specified how and when he would try to unravel the health law. Amid the uncertainty, many people continue to show up for enrollment-guidance sessions at health centers, designated storefronts and other locations across the state.

Roberto Rios, eligibility supervisor for the San Ysidro Health Center, said his 23 certified enrollment counselors have not seen a rash of post-Election Day appointment cancellations — though some clients have started to ask whether the Affordable Care Act might be curbed or discontinued.

Rios said the center is following Covered California’s guidelines on how to address such questions. “We do let them know that Covered California is going to stay for 2016-2017,” he said.

Meanwhile, experts on health-care policy are outlining the ways Trump and the Republican majority in both the House and Senate could undermine President Barack Obama’s signature legislation.

Timothy Jost, an emeritus professor at Washington and Lee University School of Law who has been a preeminent commentator on the Affordable Care Act’s ins and outs, wrote a long blog post Wednesday that analyzed the most likely avenues of attack.

He said outright repeal of the law would take significant time and that removing some of the law’s central provisions, such as guaranteeing coverage for anyone with a pre-existing medical condition, could be politically difficult.

However, a special budget reconciliation bill could allow Congress to deny funding for the subsidies that defray Obamacare premiums for millions of people — including 87 percent of Covered California’s enrollees. Also, if the federal government decides to stop appealing a court decision that questions whether the subsidies were legally granted in the first place, it could imperil the fundamental financial structure for Obamacare.

In its alert this week, Covered California officials said subsidies are “protected under the law,” that coverage will remain intact for 2017 and the foreseeable future, and that next year’s insurance rates for the exchange will not be revised.

Jost said he agrees on the assertions about rates and coverage not changing, but he disagrees that subsidies are guaranteed for next year.

“It’s correct as long as the law doesn’t change,” Jost said.

James Scullary, a spokesman for Covered California, said Thursday afternoon that the exchange is sticking with the current set of facts.

“Based on what we know right now, the tax laws and contracts that govern the coverage and subsidies for Covered California enrollees will remain in place for 2017. Secondly, we believe any changes in the law will take time,” Scullary said.

Jost said he does not see any substantial risk in enrolling for next year because even if the health law changed and subsidies were eliminated part way through the year, exchange plans are paid for one month at a time and can be discontinued at will.

“People should go ahead and sign up during open enrollment. The worst-case scenario is that you have to drop your policy later in the year,” Jost said.

As Trump met Thursday with House Speaker Paul Ryan and Senate Majority Leader Mitch McConnell to discuss assorted issues, including the Affordable Care Act, various health analysts signaled that they expected some sort of grace period for people currently enrolled in Obamacare plans.

Back at the San Ysidro Health Center, an enrollment counselor went through the application for coverage process with nearby resident Francisco Ruiz and his 7-year-old son, Francisco Jr.

A tow truck driver, Ruiz said through a translator that he decided to look into enrollment because he wanted to make sure his son has what his school requires — including immunizations and annual physicals. After providing his Social Security card, a copy of his most recent tax return and proof that the government has declared him and his son as lawful permanent residents, Ruiz said he would move forward with an application for Medi-Cal coverage.

What about all the talk of reversing Obamacare? Ruiz said he’ll worry about that issue if and when it occurs.

“Whatever the changes, we’ll just have to adjust to that at the appropriate time,” he said.

Any revisions to the Affordable Care Act in 2017 are likely to directly impact community health centers like the one in San Ysidro. The organization, which operates out of 12 locations throughout southern San Diego County, saw its number of uninsured patients drop from 52 percent in 2013 to 30 percent last year.

Leticia Cazares, director of outreach and eligibility at the center, said she was serving in a congressional office in Washington in 2009 when the law was being written and believes in its value. She said health centers are not going to stop serving their clients even if an important source of ongoing funding appears to be imperiled.

“I feel discouraged on one hand but, on the other hand, I’m fired up,” she said.

Hospitals, which have seen thousands of newly insured patients come through their doors in recent years due to the Affordable Care Act, will also need to figure out strategies to cope with any changes to the law.

Chris Van Gorder, chief executive of the Scripps Health network in San Diego County, said he believes any rewriting of the law can be weathered, though doing so may be painful for organizations that have not left themselves enough flexibility to embrace changes in sources of government payments for health care.

Van Gorder said he does not see the health law evaporating overnight once Trump is sworn in, regardless of what statements have been made during campaign debates and stump speeches.

“I don’t believe they are going to repeal the (law) in its entirety. But I think they’ll want to tweak it fairly dramatically. This health care problem we have has been seen as belonging to the Democrats for many years. Now it belongs to the Republicans,” Van Gorder said.

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paul.sisson@sduniountribune.com

(619) 293-1850

Twitter: @paulsisson

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