Obamacare repeal is a giant risk for California’s dwindling Republicans

In this March 31, 2014, file photo, SEIU-UHW worker Kathy Santana, left, assists Ruben Torres, 27, during a health care enrollment event at the SEIU-UHW office in Commerce, Calif.
In this March 31, 2014, file photo, SEIU-UHW worker Kathy Santana, left, assists Ruben Torres, 27, during a health care enrollment event at the SEIU-UHW office in Commerce, Calif. AP

The last major Republican stronghold in California is one of the nation’s most dependent areas on Obamacare, creating an enormous political risk for the GOP congressmen who represent the area and are eager to repeal the health care law.

They represent the inland expanse from the Mojave desert through the Central Valley, an area emerging as an important flashpoint in the battle over Obamacare. The tension is so heightened that a conservative group tied to Republican House Speaker Paul Ryan is employing Spanish-language ads to build local support for replacing the health care law.

More than 100,000 people in each of the districts represented in Congress by Republicans Jeff Denham, David Valadao, Doug LaMalfa and Paul Cook receive direct assistance through Obamacare, according to estimates from the Kaiser Family Foundation and the advocacy group Health Access California.

That is at least one in seven of their constituents – dwarfing figures in congressional districts elsewhere in the nation.

President Trump signs his first executive order which requires federal agencies to ease the economic burden of the Affordable Care Act until it is repealed.

They’re districts that are lonely Republican holdouts in a state where one in three people in a recent poll supported secession from the Trump-led United States. Republicans in wealthy areas such as Orange County might not be so affected by Obamacare repeal. But the members of Congress from the Central Valley “are representing the less affluent wing of the Republican Party,” according to Stanford University political scientist Bruce Cain.

The pressure on the Republicans is intense. Hundreds of people protested against Obamacare repeal last week at the Bakersfield office of House Republican House Majority Leader Kevin McCarthy, who represents a district where an estimated 80,000 people receive benefits through Obamacare.

“Those members of Congress who are in more challenging seats –and by challenging I mean those with a lot of people who have benefited from Obamacare – need to be at the forefront of saying ‘let’s look at the details of what it is we’re actually going to enact,” said Mike Madrid, a Republican consultant in California.

With no Republican agreement in sight on an Obamacare replacement, the uncertainty is particularly stinging in California, which embraced Obamacare more than any other state, especially through the expansion of Medi-Cal, the state’s version of the federal Medicaid program for low income people.

Some 3.7 million adult Californians obtained insurance through Medi-Cal following the expansion resulting from the 2010 Affordable Care Act. also known as Obamacare, according to research from the University of California. That represents one-eighth of the adults in the largest state in the nation.

Stanford political scientist Cain said the Obamacare repeal could have “terrible political consequences” for California Republicans in Congress.

“The Republicans in Congress will own this vote, they can’t blame the Democrats,” Cain said. “They are going to be doing it themselves so they need to get in there and make sure their district doesn’t get screwed.”

Central Valley Republicans themselves are saying the same thing, at least in private.

“We’d better be sure that we’re prepared to live with the market we’ve created (with repeal),” Rep. Tom McClintock, R-Elk Grove, said in a recording from a closed-door meeting of Republican lawmakers leaked to media outlets. “That’s going to be called Trumpcare. Republicans will own that lock, stock and barrel, and we’ll be judged in the election less than two years away.”

It could be a pivotal moment for California’s struggling Republican Party. The state’s coastal region has become increasingly Democratic, with even Orange County, once home to Nixon’s western White House, voting Democratic in the presidential election for the first time since 1936.

Denham and Valadao, who represent increasingly Latino districts where the number of registered Democrats now outnumber Republicans, could be especially vulnerable if the Obamacare replacement is a bust.

The conservative American Action Network is using Spanish-language ads to bolster support for replacing Obamacare in Denham’s 44-percent Latino district, in the Central Valley surrounding Modesto, and Valadao’s nearby district, which is about three-quarters Latino.

Denham is urging his constituents to contact him about the health care issue.

“I’ve heard from a lot of families that are very concerned about their health insurance,” he said. “We must repair our health care system and return the choice and control back to patients needing care.”

Valadao said Obamacare has worsened the nation’s broken health care system.

“As Congress considers alternatives in the coming days and weeks, I will make sure the needs of my constituents are heard loud and clear in Washington,” Valadao said.

The Republicans at this point have no consensus on a replacement package.  

Gerald Kominski, director of the UCLA Center for Health Policy Research, said plans put forward so far by Rep. Tom Price, Trump’s nominee to lead the Department of Health and Human Services, and Ryan, would scale back subsidies for buying health insurance.

“Not everyone who gained insurance will necessarily lose it under the Ryan or Price replacement plans but substantial numbers would lose their health insurance,” Kominski said.

Republican proposals also call for making Medicaid into a block grant so federal funding is not tied to the number of people who enroll in the program, he said.

“All the risk gets shifted back on to the states and it’s up to the states to figure out how to deal with an ever-shrinking pot of money,” he said.

Sean Cockerham: 202-383-6016, @seancockerham