Congressman Jimmy Panetta, D-Carmel Valley, led a Health Care Leadership Roundtable on Jan. 14, at Moss Landing Marine Laboratory, with Central Coast health care professionals and patient advocates onhand to discuss their concerns regarding the possible repeal of the Affordable Care Act (ACA), also known as Obamacare.

The Republican majority in Congress has stated it will move forward with legislation to repeal the ACA.  Panetta stated in a press release that he hopes to use the information gleaned from the roundtable to work with his colleagues to repair – not repeal – the ACA and build upon the initial success of the health care law.

On Jan. 12, Panetta testified in support of his amendment to the budget resolution (S.Con.Res.3) to allow people to keep their health care plan if the ACA is repealed. The stated purpose of the amendment would be to protect health care for 30 million people nationally, including 5 million Californians, half a million California children and 65,000 Central Coast residents. 

“I’ve received many phone calls and emails from my constituents voicing their concerns about the Republican majority’s plan to repeal the Affordable Care Act, and I’m honored to carry their messages to my colleagues in Congress,” Panetta stated in a Jan.14 press release. “Since the passage of the ACA, millions throughout our nation have gained health insurance coverage and people are living healthier lives. I know the plan isn’t perfect, but the ACA should be improved, not abolished. That is why I offered and testified about this amendment before the House Rules Committee last night (Jan. 13). Although the Republican majority blocked my amendment from moving to the House Floor for a vote, I will continue working to repair the ACA, not repeal it.”

Participants in the roundtable included: Pete Delgado, CEO of Salinas Valley Memorial Hospital; Susan Childers, CEO of Mee Memorial; Gary Gray, CEO of Natividad Medical Center; Elsa Jimenez, Director of Monterey County Health; Dan Limesand, Community Hospital of the Monterey Peninsula's director of business development and contracting; James Rydingsword, director of the San Benito County Health and Human Services Agency; Arica Padilla-Chavez, CEO of the Pajaro Valley and Student Assistance, Inc.; Dr. Larry DeGhetalai; Dori Inda, director of Salud Para La Gente; Alan McKay, CEO of the Central California Alliance for Health; Leslie Connor, executive director of the Santa Cruz Health Centers; and Max Cueves, CEO of Clinica De Salud del Valle de Salinas.

Panetta told the roundtable members that some Democrats believe that it is important to reach out and work with Republicans.

“Others say ‘no,’ let them fall on their faces,” he added. “That won’t work. I want to get things done. It would be irresponsible if we don’t at least reach across the aisle to do that. That’s why I got sent to Washington, D.C. That’s the one thing I’ve heard the most throughout the campaign trail, ‘what the hell is going on back there?’ and ‘why don’t you guys work together?’ I’d be remiss if I did not take that opportunity to reach across the aisle with solutions.”

Panetta said that if Republicans want to ignore Democrats and fail, then it’s on them.

“A lot of the freshmen Republicans in the House who I have come to know feel the same way,” he said. “They heard the same thing throughout their campaigns that people were pissed off and are dissatisfied with what is not going on in DC. Democrats and Republicans heard that and, fortunately, you’re seeing the younger Republicans understand that.”

Panetta told the group that he has already been able to develop good relationships with Republicans and that while the first few months will be tough for them, Democrats will take into account everything Republicans say. He said that while he wants to work with Republicans, Democrats will fight against a repeal of the ACA.

“I need evidence from you,” he told those around the table, “to show them why we’re going to do this.”

Rydingsword told Panetta that there is considerable evidence available just for the asking. He said that in order to leverage it, those sitting around the table had contacts around the country who are knowledgeable and could provide information representatives could use to build a case against repeal. Panetta said he particularly appreciated Rydingsword’s comments because there are many in Congress who need to be educated about the knowledge base among health care professionals.

When Leslie Connor emphasized the importance of going door-to-door to talk to and educate the public about the benefits of the ACA, Panetta responded that he has leaned that his and other Congress members’ constituents don’t understand the benefits of ACA.

“We need to do the basics. Talk to people,” Conner said. “Knocking on doors and telling them what’s going on. Having learned in the 50s and 60s, I would be willing to get it started.”

Max Cueves asked what Republicans want to do about healthcare. Panetta told him that all Republicans know is that they want to repeal Obamacare, but they do not have a specific plan of how to replace it. Cueves wondered at the rationality that some of president-elect Donald Trump’s people have said about wanting to keep parts of the plan, while others just want to repeal it.

“Now they’re learning how much it’s going to cost and how much it’s going to add to the debt,” Panetta said. “They’re going through a learning process.”

“Healthcare is such a complex issue and on the surface looks real simple to them,” Cueves said. “People think that since healthcare is local and you talk to Joe Six Pack on the corner and ask ‘what do you find good about ACA?’ and they say, ‘nothing,” without understanding what they had before all of this was there. I don’t think people understand the cost-shifting in health centers that provide health care to farm workers who have no access to health care, no insurance, and continue to be under-insured as a population and part of an industry.”

Cuevas, of Clinica de Salud, said the centers he manages are reimbursed at cost through Medical, but in exchange, they are required to provide care to those without insurance.

“The reality for California, and probably anywhere in the country, is where you have agriculture you have the undocumented working there,” Cueves said. “That’s not going to change. What has changed is people don’t go back and forth to Mexico, or another country, as they did in the past. If you take away the Medical Expansion program, we won’t be able to take care of as many of the uninsured as we did before.”

Cuevas also wondered how agriculture would survive without those uninsured, undocumented workers.

“In Monterey County, we’re looking at the farm worker population getting older,” he said. “Organized labor thought if they could get good working conditions for people they wouldn’t continue to be farm workers. That hasn’t happened and it’s going to pose some public health issues. If you take away MediCal programs and you can’t do the cost-shifting, what’s going to happen to that population?”

Without knowing where Washington will end up going on this issue, Cuevas said it’s important to get back to basics and figure out how to better use the resources that remain. He also said the doctor shortage is at a crisis stage.

“We’ve expanded our clinic system, but we don’t have enough doctors to continue to see patients,” Cuevas said. “We’ve had to resort to going to Mexico, working with the National Autonomous University to identify physicians who are board certified and meet the qualifications to practice medicine in California, so we set up legislation to make that happen. We’re working with the Medical Board of California to make that happen to provide a three-year, non-renewable license to physicians who will practice in community health centers in agricultural areas in California.”

Cuevas added that clinics in Hollister, as well as Monterey, Ventura and Tulare counties are planning to bring in Mexican physicians to care for agriculture workers. Part of the problem, he added, is the fact that planning for training new doctors is 20 to 30 years behind what is needed.

After the meeting, Rydingsword said he hopes Panetta will make the case for the value of the Medicaid Expansion program and the services it provides to lower income Californians. He agreed with Panetta that Republicans don’t really understand the complexities involved in repealing Obamacare, which would adversely affect up to 35 percent of San Benito County residents who presently use it.

“That’s up from about 17 percent prior to the Affordable Care Act,” he said. “In other counties, like Merced County, it’s over 50 percent who are on Medical. About half of those didn’t have any health insurance coverage before.”

Rydingsword said the most common way for people to receive ACA coverage is through MediCal. If they are not eligible for it, they have to go through the ACA exchange, Covered California, in order to buy coverage from insurance providers.

“Right now, we have a managed care organization through Anthem-Blue Cross, which takes care of a certain portion of the people,” he said. “We also have fee-for-service, which is a fairly significant number that are billed directly by the hospitals and clinics to MediCal at the state level. One of the issues is, does that cover all the costs for Hazel Hawkins? If you listened to the roundtable discussion today, we know that ACA has given us the opportunity to better coordinate and keep people better connected to their physicians in order to reduce emergency hospital visits, which in the long run can lead to some cost savings for the hospital.”

 Panetta said that what he learned from the roundtable discussion was how important ACA is for the most vulnerable in America.

“If you take that away, you’re not only going to damage them, you’re going to damage people who work in the health care industry and many people across the country when it comes to jobs,” he said. “When you look at the damage it can do to our federal government if you repeal it, it will add $9 trillion to our debt in 10 years.”

When asked about Republicans’ intention to not just repeal, but to replace Obamacare, Panetta said Democrats are still waiting to see with what the GOP intends to replace it.

“We haven’t seen any sort of legislation from the majority party, but there is hope that they come up with something that is mindful of the losses that could happen,” he said.

Panetta admitted that the failed amendment he had put forth to retain the health care gains under Obamacare had little chance of passing. He said the amendment was not to ACA, but more of a preemptive move to the budget reconciliation, S. Con. Res. 3, put forward by Republicans on Jan. 13.

“Whenever you put forth something like that, it’s serious and you hope that it does pass, but more importantly, you hope you highlight the benefits of ACA, and that there are people out there, and our legislature knows there are people out there,” he said. “If you take this away, there’s going to be damage to our constituents.”

Panetta said of the chances that Democrats can stop the move to repeal and replace Obamacare, “Republicans are in the majority. A majority House; a majority Senate; and a Republican president-elect coming into that position. So, the answer is ‘no.’ But you just hope we will be able to work together to put forward something that repairs, not just repeals the Affordable Care Act.”