Republican efforts on Capitol Hill to dismantle Obamacare could complicate Democratic efforts in Sacramento to take health care in the other direction.

Revealed Thursday, June 22, after closed-door talks involving U.S. Senate Republicans, the Better Care Reconciliation Act of 2017 allows states to waive certain Obamacare insurance requirements and provides less-generous insurance subsidies than Obamacare, also known as the Affordable Care Act or ACA.

The ACA’s expansion of the Medicaid health insurance program for the poor and disabled would be rolled back. Federal Medicaid spending would be capped, and states would likely be forced to scale back Medicaid benefits or reduce eligibility to save money.

Roughly one in three California residents – about 14 million people – are on Medi-Cal, the state’s $102.6 billion Medicaid program. California went “all in” on the Medicaid expansion, said Shannon McConville, a research associate at the Public Policy Institute of California.

“The state’s going to face a lot of big choices,” she said. “It’s hard to be able to fill a hole that could be that large, barring some major changes to the state revenue system.”

Democratic leaders in the Golden State were quick to condemn the bill.

“Trumpcare 2.0 has the same stench – and effect – as the bill House Republicans and the White House slapped together last month: Millions will lose health care coverage, while millionaires profit,” said Gov. Jerry Brown. “The American people deserve better.”

Senate President pro Tem Kevin de Leόn, D-Los Angeles, also had a visceral reaction.

“It’s sickening in every sense of the word, and it will be disastrous for California,” de Leόn said.

Besides wrecking Medi-Cal, the bill would hurt Covered California, the state’s private insurance exchange created through Obamacare, said U.S. Sen. Dianne Feinstein, D-Calif.

“On the individual market – Covered California – individuals and families would pay more money for less health care. Insurance companies could cover less health care costs and the cliff for tax-credit subsidies would be even steeper than under current law,” Feinstein said. “This is a problem I’m trying to fix and the Republican bill makes it even worse.”

A union representing domestic workers slammed what it said was a $400 million cut to In-Home Supportive Services, a Medicaid-funded program that pays workers to care for indigent adults who otherwise couldn’t live at home.

That could lead the state to ask counties to shoulder more of the load for IHSS, a request that was originally part of the new state budget. The governor later provided $400 million for the program after counties warned they’d have to make deep budget cuts to cover IHSS.

With four Republican senators already opposed, it’s not clear whether the new bill has enough votes to pass the Senate. If it does, it would have to be reconciled with the Obamacare repeal bill that passed the House in May.

It’s also another headache for the push to enact a single-payer, government-run healthcare system for everyone in California, where Democrats control state government.

In a party-line vote, the state Senate passed a bill June 1 to create a single-payer system without a clear way to pay its estimated $400 billion price tag – more than twice the state’s annual budget. The bill, SB 562, is now before the Assembly.

“More and more, Californians believe healthcare is a basic human right. The momentum to provide universal care is building, and the moment is right to create a single-payer plan,” one of SB 562’s sponsors, Sen. Toni Atkins, D-San Diego, said in a news release.

The California Nurses Association, which supports SB 562, commissioned a study by economists at the University of Massachusetts Amherst, which found the bill would save Californians $37.5 billion a year because they would no longer pay premiums, deductibles or co-pays.

A state Senate committee analysis found that the state would have to raise $200 billion a year to support the bill, which could be done through a 15 percent payroll tax.

Republicans say the bill is unaffordable, requires massive tax hikes and creates a bureaucratic system delivering poor care.

Rep. Ken Calvert, R-Corona, defended the Senate GOP’s approach to Medicaid.

“Like the House bill, the Senate bill aims to refocus Medicaid on the most vulnerable Americans, while not pulling the rug out from anyone who has benefitted from the Medicaid expansion,” he said. “In the long run, massive expansions of expensive government programs like Medicaid are simply not fiscally sustainable.

“That’s the same fundamental flaw with the single-payer health plan Democrats in Sacramento are trying to ram through – it’s not fiscally sustainable,” Calvert added.

“This would take a wrecking ball to California’s economy and place a major burden on hard-working California families. Sacramento Democrats want to eliminate choice by forcing all Californians onto a DMV-like government-run health care system, including seniors on Medicare and people who now get their health coverage through their employers.”

Any single-payer system in California would likely rely on federal money for Obamacare, Medi-Cal and the Medicare program for seniors. If that money’s cut through the Obamacare repeal, it means the state would have to find even more money to fund a single-payer system.

“It makes the cost of single-payer more and it makes the cost of the current system more,” said Robert Kaestner, professor of public policy and economics at UC Riverside.

Don Nielsen, government relations director for the state nurses association, said the GOP bill “heightens awareness and focuses more than ever on the need for health care change and improvement in California.”

“One of the things we get hit with when we talk to Democratic lawmakers – they say, ‘Let’s see what happens at the national level,’” Nielsen said. Those lawmakers have their answer, he added.

Rather than raise taxes to shore up the existing health care system, “If we’re going to talk about revenue increases, let’s talk about a comprehensive fix that goes all the way (and) fixes an extremely inequitable system” through single-payer, Nielsen said.

BY THE NUMBERS

The Senate Republican bill to repeal and replace the Affordable Care Act has big implications for California.

14 million – the number of Californians covered by Medi-Cal, the state’s version of the Medicaid health insurance program for the poor. The Senate bill includes major Medicaid cuts.

$102.6 billion – the current cost of Medi-Cal.

$400 billion – the estimated cost of providing government-run universal health coverage in California. Fewer federal dollars from the Senate bill would complicate efforts to cover that price tag.