If the Supreme Court repeals the Affordable Care Act, California will feel substantial impact

Originally published in CalMatters – March 19, 2020

By Elizabeth Benson Forer, Special to CalMatters

When Venice Family Clinic opened its doors 50 years ago, two volunteer physicians provided free medical care after hours in a dental clinic. They served about a dozen patients that first day.

Today, our 370 health care professionals and nearly 1,400 volunteers provide comprehensive care to nearly 28,000 men, women and children annually at 12 centers in Venice, Culver City, Mar Vista and Inglewood.

Venice Family Clinic’s transformation from a small storefront operation into a thriving comprehensive health care provider for people in need is the story of a community’s dedication and the revolution in care made possible by the Affordable Care Act.

March 23 will be the 10-year anniversary of its adoption. Over the past decade,  the Affordable Care Act has become so ingrained in every aspect of the nation’s health care that a U.S. Supreme Court ruling declaring it unconstitutional – without Congress enacting a credible replacement – could cause a collapse in California’s and the country’s health care systems.

The Supreme Court’s recent decision to hear arguments in a case that could scrap the Affordable Care Act raises the specter of its demise because, at this point, it’s not clear what would replace it.

In California, repeal of the Affordable Care Act without a replacement would mean that one in three of the state’s residents covered by Medi-Cal could lose their health insurance or face substantial coverage limits. That could mean delays in care and foregoing preventive measures, causing more deaths, serious illnesses and higher costs.

Safety net hospitals and health care providers that serve poor people would be financially devastated. At Venice Family Clinic, for instance, the percentage of our patients with insurance has more than tripled, largely because of the Affordable Care Act’s Medi-Cal expansion.

Medi-Cal expansion enabled us to increase our investment in health care programs and services by more than 80%. This has meant more comprehensive care, including adding dental and mental health services, and on-site pharmacies. It’s also meant we serve 34% more patients than in 2014.

In addition, the Affordable Care Act substantially increased funding in the Community Health Center Fund, which made possible the expansion and enhancement of community health centers, like Venice Family Clinic. These clinics provide care to 1 in 12 people in the U.S. by serving the nation’s most vulnerable.

The Affordable Care Act expanded insurance coverage to some 20 million more Americans from 2010-17 and radically reformed how hospitals, providers, pharmacies and health insurance companies operate.

Young adults are now covered up to age 26 on their parents’ medical plans. Insurance companies can’t refuse to cover or charge more for pre-existing conditions. All plans must provide essential benefits, which include mental health coverage.

With more than a fourth of patients with serious mental illness relying on Medicaid, Medi-Cal expansion under the ACA has played a critical role in providing mental health services and substance use treatment to Californians, including people experiencing homelessness.

Under the Affordable Care Act, the federal government also encouraged health care providers to improve the quality of care by basing some federal payments on patient outcomes and preventive strategies, like improving access to healthy food.

We expanded preventive care to include educational programs, including exercise classes, diabetes management courses and a Teaching Kitchen where patients learn how to prepare simple, healthy meals using affordable ingredients.

Is there room for improvement of the Affordable Care Act? Yes. We must ensure that everyone has access to affordable and comprehensive health care. The coronavirus outbreak is a reminder of the importance of keeping all of us healthy, regardless of income, immigration status or insurance coverage.

Abandoning the Affordable Care Act without a replacement is a prescription for chaos in California’s and the nation’s health care systems, and that is a condition we simply cannot afford or justify in a country where all should have a right to the care they need.


Elizabeth Benson Forer is the CEO of Venice Family Clinic, a community health center celebrating 50 years of providing comprehensive care to people in need, regardless of their ability to pay or immigration status, vfcinfo@mednet.ucla.edu.