 Okay, hello. Hello, can I get your attention? We are going to get started. We probably will have people wandering in, but we are going to go ahead and get started with our program so that we can proceed in a timely manner. I have a couple of reminders here. I have been reminded by our interpreter to let you know that the ACA includes Medicare, Medi-Cal and Medicaid. And then also the questions for this panel were collected ahead of time via the sign-up, and so we are not going to be collecting any questions from the audience today. If you have any questions that you feel you need answered, we will be moving after this part of the program into the NPR room and breaking into small groups, and some of our panelists will be available there. Our bathrooms are in the back of the theater. I believe on this side we have child care over in the NPR room. My name is Gloria Partita and I'm the co-chair of the Davis Phoenix Coalition, and I'd like to welcome everyone to our third gathering in a series of community conversations. These gatherings grew out of a sense of needing to preserve some of our most valuable and basic community principles. Our being here today is an affirmation of who we are and what we believe in. I'm heartened by the turnout at these and other gatherings in our community. We're happy to see that people have stepped up and we hope that this momentum will continue. I'd like to recognize our elected officials here today. Two of them are on our stage, Stan Saylor and John Garamendi, and Lucas Ferret, who's in the front row here in the way, and I believe that Helen Thompson is out there somewhere. Yes, there you are. And Don, there was one more. Jesse Lauren, Winner City Council. Jesse Lauren, Winner City Council, are you? There you are. Okay, thank you. You're showing up and spending your Sunday afternoon here sends a clear message of your support and what matters to your constituents. I'd especially like to thank Lucas and Don, who are part of the Gathering Initiative team, and I think that when you're elected officials or also community activists, it's a real bonus. I'd like to thank the many volunteers who have worked countless hours to make this event happen. Are our volunteers here anywhere? Well, they're mostly outdoing work, but whether you've chased down speakers, menus, computer glitches, or chocolate chip cookies, we would not be able to do this without you. In addition to the volunteers, we also need funding to keep these gatherings going, and so we have conveniently placed donation jars for your donations. Lastly, I'd like to say that today's topic, the Affordable Care Act, is one I deeply know the importance of. I have a son that was born with severe disabilities. While much of the conversations around why health care is important revolve around the benefits to the workforce or the economics of having a healthy citizenry, I know firsthand that having access to things like durable medical equipment coverage means the difference between a seven-year-old boy being able to bathroom himself or depending on others to help him. The value of having medical coverage, like the value of social justice, cannot be counted and graphed, but is tangible just the same. And I'd like to turn it over to Don Saylor. So thanks to Gloria Partita and the members of the Davis Phoenix Coalition for being the core of the Gathering Initiative. I think probably most of you know the story that four years ago, March 9, a young man in Davis, one of our own, was beaten savagely during a commission of a hate crime. Out of that tragedy, out of that terrible, terrible circumstance, was born the Phoenix Coalition. Over the last four years, they have built and organized and become the go-to organization for efforts like this. And that's what we do when we're knocked down. We stand back up and we make a difference together. So thanks to the Davis Phoenix Coalition. You know, recently, there was a man standing at a microphone and he said, who knew healthcare could be so complicated? Well, pretty much everybody in this room kind of knew that healthcare is pretty darn complicated. And we're here with a group of very talented, dedicated people who know a lot of the details about exactly how healthcare works in the United States and how that plays itself out in our local setting. And the panel will be introduced in a few minutes. We've tried to gather questions. You'll hear answers to some of the questions that were posed. And we're going to get to the bottom of exactly what is at stake here. And when we talk about what's at stake in public life, there's no one better to kick off an afternoon like this than our own congressman, John Garamendi. Now, John has dedicated his lifetime to public service. When he graduated from UC Berkeley after a stellar career as a football player and a scholar athlete, he could have chosen to become an NFL player. I've heard that, anyway. But he chose instead to join the Peace Corps. And with his wife, Patty, they made a difference in other parts of the world. And they brought that impulse back to California. John grew up in California on a ranch. And he served in the California State Senate. He was the first insurance commissioner in the state of California. As an insurance commissioner here, before he went off to be Assistant Secretary of the Department of Interior and before he was elected to represent us in Congress, as our state insurance commissioner, John introduced legislation that would have provided for healthcare delivery and coverage for virtually every Californian. He published a report that outlined 40 concrete recommendations on how healthcare delivery could be expanded to serve all of the people who need it. John just introduced legislation in Congress that would have a fair cost of living adjustment for social security benefits that are tied to the cost for retirees. He's been committed and his actions have shown his commitment to social security and Medicare and to Medicaid. John Garamendi, our congressman, will tell us what's happening in Washington, D.C., my friend, and how are we going to make a difference together? Thank you, Donald. Don, thank you so very much. And for all of you that are involved in the community forum, it's really important that all of the issues. And I think this is the fourth or fifth one that you've had covering a variety of issues, starting with that hate crime here in the city. Beyond that, there are many, many things that all of us care deeply about. But healthcare is a very personal thing, isn't it? When we were working way back in the early 90s on developing a universal single-payer program for the state of California, a couple of very wise folks that had spent a lot of time working on healthcare said, you need to understand that unlike any other public policy, healthcare is personal. It's about our own lives. And for those of us who are a little more generous, it's about our children and wife and then the rest of the community. But the personal nature of healthcare draws at this moment an extraordinary level of attention, concern, fear, and, oh, my, what are they doing in Washington? The Affordable Care Act now in place for almost five years. It is part of our healthcare system in so many, many ways. Here in California, we've seen almost four million people being joining onto the roles of MediCal, which is the California version of the Medicaid program. So there's four million people that now have ready access to a complete variety of healthcare and mental health programs. And there's another million or so that are on the exchanges. You're going to hear more about that a little later. We've become part and embedded into the very nature of personal and community as well as statewide healthcare here in the state of California. The hospitals have changed their procedures. Such things as hospital-acquired infections have plummeted as a result of the Affordable Care Act's little clause that said if it's a hospital-acquired infection, if there's a readmission rate, the hospital is going to pay mightily for that. A little bit of discipline brought into the system, saved the lives, perhaps 100,000 lives across the nation. We've also seen ramping up of mental health programs. There are 23 new clinics or clinics that are now operating in my district. Five, six different clinic organizations and providing initial care to individuals. It is working. And beyond that, we've seen the cost curve not decline, but we've seen it bend. The inflation rate is approximately one half of what it was before the Affordable Care Act. The result of some very, very important things taking place, for example, seniors being able to get a free annual checkup, makes an enormous difference if you can control things like diabetes, high blood pressure, other kinds of illnesses that are part of life, but can be controlled. And when they are controlled, better health, longevity, and a lowering of the healthcare cost. A whole series of reforms have taken place, including payment mechanisms that require healthcare outcomes, not just pay for services, but rather pay for services that are actually providing better healthcare. Very common in California, we've had those kinds of systems sometimes called capitated systems for more than, oh well, 30 years, good 25 years for sure. So all of these things are now embedded into the healthcare delivery system throughout the United States. So along comes Mr. Ryan and Mr. Trump, and they're going to repeal and replace, and not to worry, it's going to be wonderful. It's going to be awesome, and everybody's going to have coverage. Now, there's another statement from the president that you can believe, right? Well, it doesn't quite turn out that way. Early this week, no, early last week, being Sunday in a new week, early last week, the Republicans in the House of Representatives introduced, really in the dark of the night, their legislation. And when we woke up the next morning, like Wednesday morning, when the hearings began Wednesday afternoon, it hadn't even been out in the sunlight for 12 hours, they began a series of hearings, and those hearings began to explain to the American public what Congress intends to do to them. This is bad news. This is very, very bad news across the country. You can put this in very simple terms. Fewer people are going to have coverage, like maybe five to seven or more, maybe 15 million, depending on how it finally works out. But clearly, millions of Americans will not have healthcare coverage. For those who do, they will get less coverage, less benefits, and they're going to wind up paying more. That's the bottom line of the healthcare side of it. Now, if you happen to make, well, if you're in the top one tenth of one percent of the American wealth, top one tenth of a percent, you're going to get something like a $200,000 reduction in your taxes. And if you happen to be one of those 400 wealthiest families in America, you will have a $7 million reduction in your taxes. And if you happen to be in the top 20 percent, maybe you get a $20,000 reduction in taxes. The rest of the public, about 75 percent of the $700 billion tax reduction that's in this legislation will go to the top 20 percent of Americans. And the remaining 80 percent of Americans will find themselves actually paying more. Anybody in this room that's somewhere between the age of 50 and 65? And the rest of us are younger or older. That particular age group has always been the age group that is most at risk and the age group that has the greatest benefit in the affordable care, because they have access to healthcare regardless of preexisting conditions. Now, under the new proposal that's out, presumably they still have access, unless, of course, for some reason they lost the job, lost their insurance, in which case they get to pay the insurance company an extra 30 percent of what they usually would pay. And what are they usually going to pay under this? They, under the current law, under the affordable care act, they will pay no more than three times what a 20 to 30-year-old pays, presumably because at 50 to 65 you're more likely to have issues. Under Trumpcare, it's five times. They could pay up to five times more. Now, what does that mean? It means that for that particular age group, 50 to 65, when at point they can get into Medicare, they will pay approximately $4,000 a year more for their insurance. There's a very serious problem here. Remember, it was going to be wonderful. Remember, everybody is going to have coverage, not the case at all. So all across America, there is a deep abiding concern about what is happening to individuals, to families, to communities. And that deep abiding concern has raised a specter that I've not seen in a long time of outrage, of involvement, and determination that they're not going to let it happen. Now, here in California, my Republican friends, and they are friends, sort of, they're hearing from their constituents. I think Anthony is going to give you perhaps some examples during his presentation of what's going on around the state with health access and other groups literally banging on the doors of the Republicans and saying, what are you doing to us? Good. That's got to continue. And I know nearby, Mr. McClintock is learning a lesson in community involvement. So as I begin to wrap this up, right, Lucas? Oh, five minutes. Okay, I'm going to do this. If you have a question, shout it out, raise your hand and shout it out. I'll take a question and then we can go from there. Yes, right there. Oh, okay, the tax breaks. Nobody's talked about the tax breaks and obviously they haven't explained them well. When the Affordable Care Act went in place, it was paid for by a series of taxes that were very progressive. For the top 400 families, that top one-tenth of 1%, there is a 0.9% investment tax on their capital gains. That's where they make most of their money. And there's also a payroll tax way at the top end of the payrolls. And so those very, very progressive taxes are going to be eliminated, creating a 700 minimum, $700 billion shortfall of revenues. Now, we're either going to have a huge deficit or somebody is going to lose benefits. It's going to be the latter. It'd probably be both of them. That's the tax issue. Yes, I assume you all heard that. This lady knows what she's talking about. I think and we'll probably hear a little later here. I think California is going to keep covered California, which is a substitute for the individual market. The small group market kind of plays into that. The reforms of the small group market should remain in place. They have taken place over the last several years. It's always the individual market where a person gets hammered. They're out there on their own. They have a small business. They have one or two employees. That's what we're going to say. I think California is almost certain to keep covered California. The question, however, is the subsidy that's been provided, the tax subsidy, which is based upon income, is going to be eliminated and a tax subsidy based upon age will take place. So if you happen to be a little older or you happen to be low income, it can really hammer you. And that's what we're talking about the 50 to 60. But I think we'll see the small group market part of that reform, at least California. The fear here is being able to sell insurance across state lines, which will be a race to the most, the least financing, the least secure, secure financial insurance company. In other words, scams, which I dealt with every single year, insurance companies coming into California selling really lousy insurance with no financial backing. So when there's a big claim, they simply don't pay. So we'll see what happens with all of that. Lifetime coverage is those kind of things. Final question, then I'm out of time. Sir. Okay, with regard to Republicans, we've gone through that. What their bill is on the, what we need to improve the current situation. First of all, the Democrats aren't going to be able to improve anything until we take back Congress or the presidency. Bottom line starting point, okay? Secondly, should we, and we ought to, we would start with Medicare drug provisions being able to negotiate drug prices for Medicare. We like that one too. We ought to expand the coverages of, there's probably 10% of the population that is not yet covered. And we ought to continue to move towards a universal system. And that's, we can do that. Many, many ways we can get to a universal system. The state of California, we've tried many, many times in the state of California. My first attempt, Don spoke to this quickly. Back in 1991, we, well, when I became insurance commissioner, we developed, put together a task force, developed a single-payer universal healthcare system for the state of California. We gave it to Governor Wilson, legislature passed it, Wilson vetoed it, and it died at that point. But it could be reborn given the new legislature, and I know there's several, and I believe you're going to talk about this. There are different ways that can be done. But I think you'll see states beginning to move in the direction of expanding coverage. And always keep this in mind, and this is always forgotten when health insurance is, when healthcare is discussed. There are two fundamental different parts to the healthcare system. They're really different. They're tied together, but they're different. One is how you raise the money and pay the bills. We call that insurance. We call that Medicare. We call that Medicaid or Medi-Cal. Those are ways in which you collect the money, in this case by taxes, and then you pay the bills in different ways through a capitated system or fee-for-service system. That's the financing side of it. The other side is the delivery side of medical care, and it's delivered in many, many different ways across America. A dock in a box, a single practice, group practice, big systems such as Kaiser and others. And you've got to keep these two in mind when you deal with healthcare reform. They're tied together, obviously, but they're very, very different. And when people talk about healthcare, they often get confused as to which one they're talking about. But we can deal with both of those. There's been a significant advancement in California on the delivery side. So across the nation, more and more delivery systems such as California has led the nation over the last 40 years with organized, comprehensive delivery systems. Kaiser was the first, and now there are dozens of them across the state. Excellent because there's a continuity of care through those systems. And we should continue that across the nation. On the financing side, there's nothing better than a single-payer universal system because it is very, very efficient in collecting the money and paying the bills. With that, I'm going to turn it over to the panel. Thank you so very, very much. It's good to be with you. So you can you can see why John's here with us today. Not only is he our congressman, but he's our champion. And let's let's do everything we can to help him be effective in Congress. So what we've done today is we we know that this this issue is actually a little bit complicated. This is a very well-informed audience. Your questions already have indicated that. And the questions that several of you submitted online are equally robust and show some deep knowledge and understanding and frankly, some some serious concerns about what's happening. We pulled together a panel where our intention is to have a conversation. These these folks are deep, deep thinkers in this topic. After the panel has as shared their insights, then we will have an opportunity for each of us to go to the other room and have some deep discussions there. Each of the four members of the panel will stay with us through that time. And if you have additional questions that you'd like to follow up with them individually, then that'll be an opportunity to do so. And we'll have a discussion at the end of the panel about exactly where to go and how that'll all work out. But but just to start off, Anthony Wright is the executive director of the Health Access California and Anthony, can you just tell us a little bit about what what does this Affordable Care Act any way what were the it's not been around all that long, but what actually happened and what are the what the results of those changes? How's it working in California? How do people really experience it? Hi there. Can folks hear me? Okay, great. So again, my name is Anthony Wright. I'm the executive director of Health Access California, which is the statewide healthcare consumer advocacy coalition, working for the goal of quality, affordable healthcare for all Californians for 30 years. And I've been head of that organization for half about 15 years. And I'm also a proud David site. The affordable close to like this, the affordable, the affordable care the passage of the Affordable Care Act really was a milestone for California. And I think it's important to remember before the Affordable Care Act, California had one of the worst uninsured rates in the country. We were seventh from the top in terms of the had the highest rates nearly 20% of all Californians were uninsured. And as a result, live sicker, died younger, and were one emergency away from financial ruin. And as then insurance commissioner now Congressman Garamendi said, there have been many efforts to try to reform the healthcare system. I see former assemblywoman Helen Thompson who had made her valiant efforts as well. But it's very hard. Healthcare is hard, as people are finding out now. And so with various efforts, and my organization was part of it, whether it was a single payer system, whether employer requirements, or whether it was expanding public programs, it really helps to have a federal framework and financing to provide that help. And what the Affordable Care Act does is basically it took the three ways that people to get coverage. You know, most people, about half of the people in California get coverage through employer-based benefits, either themselves or a family member. This provided some new consumer protections, some new definitions of what coverage should be. Limits on out-of-pocket, no lifetime limits, no standards for cost sharing, 10 essential benefits, things like that. For public programs, it largely kept those in place, but expanded and improved them. So Medicare, it closed the donut hole, and it extended the life of the program. And in Medicaid, Medi-Cal here in California, it expanded the program to cover millions more Californians, as the congressman said, four million Californians now have coverage through Medi-Cal than before. Prior to the Affordable Care Act, we didn't cover, we covered people who were under the poverty level, who were children or parents or seniors or people with disabilities, but if you were an adult without a kid at home, even if you were dirt poor, you were out of luck. You had no access to get Medi-Cal coverage. And so what this did was expand that out and said everybody under 138 percent of the poverty level, so from $12,000 for an individual to now about $16,000 for an individual, now had access to be able to Medi-Cal coverage. The final piece was the individual market, where people, if you don't get employer-based coverage or you don't get a public program, you now can buy coverage as an individual, but now what this provided you was a market where you wouldn't be denied for pre-existing conditions or charged differently because of your health status or because you were a woman or for any other reason, and that you would get financial help to be able to afford it on a sliding scale. And this now over 1.5 million Californians buy coverage through Covered California and 90 percent of them get financial help averaging $440 a month to be able to afford coverage. So those are the three big components of how people get coverage and what the Affordable Care Act did it. And so we, because California as opposed to some other states which frankly sabotaged the proposal by not expanding Medicaid, by not setting up an exchange, by not doing marketing, by other things, we actually had the most successful implementation in the nation. We had the highest, the biggest drop from 18, 19 percent. The CDC just came out two weeks ago, where our uninsured rate is now down to 7 percent and dropping. It was at 6, 7 million, now it's under 3 million. And we were taking additional steps. Last year, for example, we expanded, the state expanded MediCal further using the platform of the ACA to expand further to all children, regardless of immigration status. So right now in California, every child and every classroom and every playground has access to affordable health care. So that's the progress we've done just on the coverage side. Those coverage efforts then have enabled delivery system reforms to reduce a cost, to improve quality, to improve public health. I think my colleagues will talk a little bit more about that, but that gives you a framework of what has been achieved in just a short amount of time in the last three, four years. And we'll come back in a few minutes and learn about what the repeal of ACA might do to that circumstance that you're describing. So Robin Affreim has been with Communicare Health Centers for more than 30 years, a public health specialist with all the educational background that you might expect. But can you tell us a little bit about what the federally qualified health clinics provide and how did the Affordable Care Act affect your ability to serve the patients, the people who come across your door? Sure. Well, I agree with everything Anthony said. And I just want to, before I start, I just want to say it's good to be in California if, if you're low income and if you need access to health care. I just have to say that. We have, we have a wonderful infrastructure and a lot of good support. So Communicare Health Centers, which started as the Davis Free Clinic, has been around. This is actually our 45th anniversary this year. And as a federally qualified health center, we receive additional funding from the federal government for the uninsured because we still do see uninsured. And we get a preferential rate when we bill for Medi, MediCal, Medicaid. And so so and a little bit for Medicare as well. So the other thing about us is that it's part of our mission, but it's also part of being an FQHC, which is our abbreviation, is that we don't turn anybody away, even if they can't pay. So we do have a sliding scale, but if people cannot pay, we will see them anyway, and we will work something out. So that's really very, it's very important because that is a real differential between us and the private sector. So for the ACA has been very good to our patients and to our community and to CommuniCare. And we what we were able to do is reduce our uninsured from 40 to 25 percent. We have a 15 percent drop in uninsured, which is a lot. We really expanded. We actually had about 150 percent increase in the number of encounters in our organization. And so what has happened is our patients have access to primary care. It's very important. That's a really important factor because if you don't have access to primary care in a timely way, guess what? You're going to go to the emergency room or you're going to get really sick and have to be hospitalized, much more expensive for the patient and it's not good care. So one of the things that was really good about the ACA is that the president recognized that health centers across the United States were going to be some of the main places where we'd be able to expand coverage. Excuse me, expand access to care. So there in addition to the expansion, which was really important to us, was the expansion of Medicaid for, like Anthony said, for a lot of single people that had never had coverage before. So just think about that. They never had had coverage before. They had come in, maybe, but now they could come in. We could help them control their chronic diseases. We could give them preventive health care, work on wellness. It's been really actually wonderful to see. But also the administration, the Obama administration, saw that we needed to build our infrastructure. So we built a new health center, brand new 20,000 square foot health center in Woodland, the Hanson Family Health Center, with a grant from the federal government for 50% of the cost. We would not have been able to do that without that help. And it allowed us to build our infrastructure, hire more staff, more providers. IT is very important. So it allowed us to do all of that. And I have some wonderful stories about patients and how it affected their lives as well. It was good for the county in that the CMSP program, county medical services program, pretty much didn't have to cover anybody anymore because all of those people that were uninsured, the single adults, now are covered. So CMSP went from, I don't know, a few thousand to 50. Zero. Yeah, there's really hardly anybody on CMSP. So for the county, it's been good for the community in that a lot of people who were too ill to work, when they got care, when they got control of what their health problems were, were able to work. So that's really great benefit and the economic impact is really important to think about on the positive side and actually on the negative side of what could happen when those benefits go away. So I think. Great. Thank you, Robin. And Dr. Ron Chapman. Thank you, Robin. So amazing, amazing work. And this is ACA has made a tremendous difference. So Dr. Ron Chapman is currently the health officer for Yolo County. He has previously served as the state of California director of the Department of Public Health and Ron, I'd like to ask you if you can talk to us a little bit about what the role of county government is and what the AC in providing health care for indigent populations and others and what did the ACA do and how did it make a change there and what are some of the other aspects of ACA that you'd like to share? Sure. Thank you. So I first want to start out with a very brief story. One of the hats I wear is I'm a family doctor and I've spent over 20 years my entire career taking care of folks on Medi-Cal, the poor and uninsured in the area. And before ACA, I saw a gentleman who was 30 years old who was working part-time in construction and he had no insurance. And six months before I saw him, he noticed a spot on his tongue and he delayed his care. He thought it would go away and then finally he decided to call a specialist office who wanted $500 in cash to see him and by the time he saw me six months after this lump started, he had a tumor the size of a golf ball on his tongue. And so I referred him to some specialists in the Bay Area and he had his tongue removed and half his jaw removed and he died a year later. And that was because he had no insurance. The Affordable Care Act is not a milestone. It is a miracle. It is saving lives. And this young construction worker would not have died if he was insured under the Affordable Care Act like many, many people are today. Beyond providing insurance and coverage and access to a health care system, the Affordable Care Act also has some real hidden gems. And one of them is called the Prevention and Public Health Fund. Anybody heard that? A handful of folks. John, you heard of it. Public Health colleague. The Prevention and Public Health Fund was started under the Affordable Care Act. It's about a billion dollars a year which is a drop in the bucket compared to the numbers that you've heard earlier and what health care costs. It provides about 12% of the entire budget of the Center for Disease Control, the CDC. A third of that budget goes into immunizations. We're talking about vaccines for children to prevent childhood infectious diseases. And that's a third of the budget. The budget also goes into preventing Alzheimer's, preventing diabetes, heart disease prevention. There's tobacco prevention and control program. It funds a lot of core critical programs in public health. And I was incredibly disturbed last week to see an article from DC quoting a congressman saying that was a slush fund. That is disgusting to me. It is despicable, deplorable. That is core public health funding and it is slated to be eliminated. Those vaccines are actually part of a program that covers the poorest families and poorest children in California. These are vaccines that come to the health department and are distributed to local physician offices. And those are going to be eliminated. Does that make any sense? No. So as far as the county's responsibility in all of this, there's something actually called section 17,000 that's part of California State Law that mandates every county in California care for its poorest, most needy individuals and families. People that have no care, have no access, section 17,000 says in the end, the county is responsible. And we in Yolo County were taking that responsibility very seriously, putting a lot of money to take care of these folks through a program that Robin mentioned earlier, CMSP for example, and in other ways. And when the Affordable Care Act came along, a lot of those folks became insured. So suddenly the county did not have that financial responsibility and the state in its great wisdom says, oh, okay, we'll come in and we'll take all that money from you. And so that's what happened in somewhat of a negotiation. The counties in California gave money back to the state of California because our section 17,000 fiscal responsibility had really been reduced. If the Affordable Care Act is repealed and we have many more people who are uninsured in Yolo County, we will have to assume that financial responsibility and there certainly is no guarantee we'll get that money back from the state. So a lot of implications, a lot of very, very bad implications for the health and the safety of the people in Yolo County. So again, who knew healthcare was so complicated? Millie Bronsting, thank you, thank you very much Ron, please. So Millie, thanks for joining us. Millie's a professor of nursing and has been an active registered nurse in the mental health world for many years. Currently she works as one of the co-chairs, like the chair of the Yolo chapter of healthcare for all. And Millie, can you just describe for us a little bit what single payer is all about, because I think Beverly, we all have some sense, but what is it that you all are advocating for? Well, I think that Congressman Jeremendi did a nice job of explaining that what single payer is is a funding system for the healthcare where all of the funds come into one pot. So that the premiums that we pay currently now would be called a tax. You know, we go into it whatever the employers are putting in now would be a percentage of their profits and also the number of employees they have. You know, those kinds of things would all come in as well as all of the government monies that are out there now that are funding healthcare. Right now, you know, we're hearing that's 25%, you know, of California money. I mean, for the healthcare money comes from the government through the Medi-Cal and Medicaid and the S-Chip and some of those programs. So what single-paired programs are is a way to have everybody covered. So we say everybody in, nobody out. We don't have to look and see where you're employed. Your healthcare is no longer tied to employment. It's no longer tied to any kind of revenue means testing and you don't have to go in every year to get re-upped on whether or not you qualify for whatever program is that you happen to get your insurance through. If you want to change jobs and then you have to be well, well, they cover me as well as I'm covered now, you know, what is their healthcare plan or if I make this move now, then I'm going to have six months before this other plan's going to kick in so I'm out there in limbo. I don't think I need to explain all of the various problems that we have for it, but that's essentially in a nutshell that it's a finance system for providing the healthcare. And it is not a delivery system. Okay, thanks. And we'll come back. Thank you, Millie, for your work and we'll come back in a few minutes and hear if there's how feasible such a system might be and what the status of proposals in California and elsewhere might be. So we have this, obviously we have this elephant in the room and it's Speaker Ryan's proposal to repeal the Affordable Care Act and let it be clear, it's not reform it, it's to repeal it. So what exactly does that proposal contain and what would happen if that were to go into effect? So first of all, here it is. It's, the White House Secretary is making a big deal that it wasn't a lot of pages. I don't know what the merit of that argument is, but this is not even a week old and it's already passed through two committees in the House of Representatives. They have yet to get even the standard independent analysis of how bills, how much they cost, what are the coverage impacts from the Independent Congressional Budget Office known as the CBO score. They have yet to even do that and they've already passed it through two committees. Something tells me it's because they don't wanna know the result of that analysis. What I wanna suggest here is that we tried to describe a little bit about what the ACA did and so you think logically, okay so the repeal bill is just basically undoing that and what I wanna convey to you is that it's actually much worse than that. So whatever you've heard, it's actually worse and so let me just break it down in these two key ways that the ACA expanded coverage. One is through the Medicaid expansion but it does much more to Medicaid than just undoing the repeal and then the other is getting rid of the, or reducing the subsidies and tax credits that people get to afford coverage and it does much more than just doing that. On the, so let's start with the individual market. If you don't have the benefit of having an employer-based coverage or a public program like Medicaid and Medicare, then you are left to buy coverage as an individual. Prior to the ACA, you were left all alone at the mercy of the insurers and the help here was to provide and what Covered California did was provide a structure here in California to give you some sense of what the options were, some standardized benefits and again, this financial help to be able to afford coverage on a sliding scale. If you were at, say, 138% of poverty level, then you did not have to pay more than 2% of your income in order to get coverage and then the rest would be made up in tax credits. If you were at 400% of the poverty level, which is about 48,000 for an individual, 94,000 for a family of four, then that is at 9.5% of income, so a sliding scale between two and basically 10%. What this proposal does is basically significantly reduce that financial help for people to afford coverage and no longer have it related to the cost of the premium or to your income. They basically make it a flat tax credit depending on certain ages and so what that means is that if you are low income healthcare will no longer be affordable because it's no longer tied to your income. You'll get a flat. Again, I said that the average person gets $440 a month assistance to be able to afford coverage. If you're low income, you might get just a 2000, annual 2000, which would be a significant reduction of thousands of dollars and that would just mean that you probably couldn't afford it. If you're making $20, $30, $40,000 a year, it just becomes unaffordable. On the flip side, the other thing they do, what Congressman Garamendi said is that they would no longer take away the limit on how much you can charge based on age by the insurers. There's now a limit of three to one from the youngest to the oldest that would expand at the five to one so that means that people who are older would get hammered. As a matter of fact, the former actuary from Kaiser said it would basically double rates for that 50 to 65 year old population. So whether you're young and low income or older, you'd see an increase and of the couple of million people who buy coverage as individuals, you would see hundreds of thousands of people lose coverage. However, the thing I want to be clear is then that impacts the rest of us because if hundreds of thousands of people leave the market, if the insurance pool, if you no longer have that many paying people into the market, whatever they were paying into and whatever subsidies were coming into it, that leaves the rest of us in a smaller and sicker pool. And you don't have to be an actuary, although maybe some of you are, to realize that that just means that rates would skyrocket as a result. If there's less people paying in and the people who are on there are gonna be on average sicker because those are the ones who are gonna hang on the most, that means that rates will skyrocket and the Congressional Budget Office suggested that that could, in earlier proposals, suggested that that could actually double premiums over and above medical inflation within a decade. Now, how about for Medicaid and Medicare? What happens there? So on Medicaid, this would phase out the Medicaid expansion by 2020. So that's something that the four million people who just got Medicaid coverage should be concerned about. That is just to be clear, California right now gets a $17 billion to fund that Medicaid expansion. Just to give you a sense of the scale of that, that is more than what California spends on our higher education in total. UC, CSUs, community colleges, et cetera. So it's a lot of money. And so that would basically, we would potentially lose that money. Plus, it puts a per cap at a cap on the whole program which covers 14 million Californians. So that, the traditional way Medicaid works is that for every dollar we put in, we get a matching dollar from the federal government, it would radically restructure the program where that guarantee goes away. And we would just get a set amount of dollars per person. Even if medical inflation goes up, even if we have an aging population, even if we have a public health emergency. And it's basically a massive shift of cost and risk from the federal government to the state. That is actually a much more profound change than anything the Affordable Care Act had. And that is actually sort of, if there's any one piece of this that is getting under covered, it's that. That is far, far more dangerous. That goes beyond the expanded number. That goes beyond the expansion. California has, there's four million people who got expanded Medicaid, but the overall program is for 14 million Californians, a third of our state. Actually here in the Central Valley, especially as you go down into the Central Valley, it's actually closer to half of our population. And yet it would basically cap the federal contribution for care. And that would basically force cuts into our healthcare system, throughout our healthcare system, whether it be our clinics, our hospitals, and the healthcare system we all rely on. So Ron, in this expanded, in ACA implementation in Yolo County, I think we increased from 26,000 to 59,000, the number of people who are receiving Medicaid, or MediCal in California. So there are about 55, 56,000 on MediCal in Yolo County. There are about 6,000 that are in covered California. So add those numbers up. There's 200,000 total in our population. So a huge percentage. But when you look at some of the subgroups, it gets even higher. For example, pregnant women in Yolo County, 50% of pregnant women in Yolo County are on MediCal. So half the children being born in Yolo County are born into MediCal. So what would this change that Anthony just described, how would that play out with the people in Yolo County that we're working with? Well, the numbers would start going back down. And so we would see, again, fewer people covered under MediCal, fewer people in covered California. Maybe somebody else could answer this. I think pregnant women would still be protected because that is a very vulnerable population. We wanna have healthy babies born in Yolo County. And that's always been a very special group to make sure that they're insured. So hopefully that will stay. Okay, Robin, how about with the population that comes to your centers? Well, I think one of the things that's important to understand about what the ACA covers now and how it finances. So for the MediCal population that's under 100% of poverty, the federal government pays some 50% match. To incentivize states to expand, the government I think may have started at 100% match, which meant the states didn't have to pay anything. It's down to 95% now. And I think it was supposed to get down to 90%. And I don't think it was gonna go lower than that. So right now it's 95% match. That will go away. That absolutely will go away. And what we're really concerned about is all of those people. Just think about, for us, it's about 4,000 people that got on the expansion, the patients that we're seeing. And just think about all of them that had never been on insurance before. We got them on, we worked really hard to get them on to MediCal or Cover California. They're used to coming in now. They have a primary care provider that they see all the time. And now all of a sudden, they may not have coverage again. And so the per capita cap is gonna be based on the number of MediCal patients in 2016. So in 2020, when this supposedly will take place, there probably will be more people, but it will be based on the 2016 number of people. And what I believe, so one of the things also that was really great for our patients. So as adults, they never had access to dental care. But when you're on MediCal, you also are on dentiCal. So we had a lot of people that also were able to see the dentist. So what I'm really concerned about is not just the loss of some of the people on MediCal. I really don't know how many people will still be able to stay in the expansion. I'm guessing not very many. But I'm concerned that the state won't be able to afford to have all the people on coverage. And so some of the benefits may go away. So I'm very concerned about dentiCal for adults going away. There may be some other benefits that we actually lose. So we really don't know, but we do hope that, and I do believe that pregnant women and children will still be covered. I believe even regardless of their income. Does anybody know what this 2020, why was that date chosen? Oh, I don't know. It's after the election. It's after, he said it's after the election. After the midterm election. You know, who knows? I think the other thing too that our primary care association did an analysis, a quick analysis of the Ryan's plan and it actually defunds Planned Parenthood. I mean there's a whole section that does that. There's an assault on women's health by this administration and it's so obvious. So I think, I mean, I believe that a lot of people should be protesting that as well because Planned Parenthood is a very important part of our healthcare system. What's this business of if you stop your insurance coverage for a month, then you have to have a higher premium when you come back. Can somebody describe what that's all about? So one of the things that, one of the other reasons why I think premiums are skyrocketing the individual market is because they actually replace the quote unquote individual mandate with a proposal that is number one, more punitive and be less effective. So right now, the way the Affordable Care Act works is that for those people who are buying coverage there, if you don't buy coverage, there is a tax penalty that you pay when you file your taxes in April. And the idea there is to encourage all Americans, whether, especially if you're healthy and maybe not needed to be able to go into the market and buy and get covered. The alternative to that, that they have put in this proposal is that they would reduce the tax penalty to zero, but then they would say, if you have been uninsured for more than 63 days, then when you do sign up for coverage, you will get a 30% surcharge on your premium for a year. And so basically, as opposed to having a, let's everybody chip in and pay into a public source that then can go to fund coverage, we'll say is we'll just let the, instead of having that kind of system, we're just gonna get the insurers charge you 30% more. So this is somebody graduates from college, looks for a job, is out of the insurance market for a couple months. Right, and if they're not able to afford it, they have that 63 day gap. And then the problem with that is that that's not actually, once you have that 63 days, why would you enter in until you're sick? And so it actually is, it's not prodding healthy people to sign up, it's actually encouraging people to wait until they get sick to sign up, which then means that what's that gonna do to the rates of everybody who's in the market? It's gonna increase them even further. So it's actually, again, more punitive in terms of the dollar amount, but it's actually far, if not less effective, actually counterproductive to the goal. So for so long, many people have been working hard on mental health parity, on trying to be sure that behavioral health had equal treatment and was a part of the comprehensive health package and in practice that took place. Does that have a, is that affected in this business? What's this repeal do with mental health services? From what I understand is that that's no longer going to be covered. Now there are many people quite distressed about that, so who knows what the final advocacy for that will be, but that was taken out also. Any other comments on that? Well I was just gonna say that Ron and I were talking about this. Medical includes behavioral health services and includes mental health services. So if you're on, if you're on MediCal, you should still have those benefits. Of course there's just gonna be less people on insurance, they're gonna be on insurance, they won't have any benefits at all, but you should, you should still have that benefit. I just wanna say that this is the tragedy of this is that we were actually getting to a point where we were finally, because this population, adults without kids at home, which includes your homeless population, which includes a lot of people who need substance abuse, mental health treatment, we were getting to a point where we could finally treat their issues medically rather than criminally. And you know the, an ACLU lawyer told me, I worked all my life on the war of drugs. The ACA was the replacement for the war on drugs. It was the way to actually treat these positively in a productive way. And there was, we were just starting to see that change in how policing and corrections was being done, getting people into systems of care, having systems of care available if people were in jail, people having systems of care for folks who were in different fragile situations and to have that then start to undone. The issue about this is that what they did was they didn't totally, directly unfund mental health, they just removed the benefit floor for MediCal in this bill. And so, and then they're also then gonna cut the MediCal program by tens of billions of dollars. They are giving the states the flexibility to figure out where to cut. And that's, but, and so that's the sort of evil genius behind this, is that it's not a direct cut to any one population. It's just saying, you're gonna have tens of billions of dollars less California. You decide what you're gonna do. Are you gonna reduce benefits? Are you gonna reduce rates to providers? And so they have to scale back services. Are you gonna cut eligibility for certain populations? That's left to our state legislators and leaders to try to figure out. But at the end of the day, if you lose tens of billions of dollars, something's gotta give. And it's gonna be the things that are sort of, that are not nailed down to the ground. So I hear a lot about groups that will be impacted, problems that would occur. What's the motivation to the, is there something that you see that is a public policy objective underlying all this? We all have our sense of this, right? But what do you see as is there any reason that this would make sense to any human being? Well, I just wanna say one thing. Words matter. And because it was called Obamacare, there's a lot of people that just, one, did it change. There was nothing that they could really point to that was really a problem. Because people were really happy with the Affordable Care Act. It was working. And what we know now is that there were a number of states that didn't do the Medicaid expansion and now have done it. And a lot of those states are run by Republican governors. And what they saw were the benefits of having an insured population on the economy of the state. And so they may not say that they like Obamacare, but they will say that they like the Affordable Care Act. So I know I'm speaking to the public, but I really feel like you're a bright public. Let me just clarify that. There is an incredible level of ignorance, just like what Robin's describing. I remember when there were town hall meetings, when they tried to generate some enthusiasm for the Affordable Care Act. And I remember, I think it was ABC or NBC, there was a video of a town hall meeting in some small town in the Midwest. And there was an elected official talking about the Affordable Care Act and this elderly gentleman stood up and he said, you know, whatever you do, I'm on Medicare. And whatever you do, don't let the government touch my Medicare. I mean, that's just incredible. People don't understand how the government is working for them, supporting them. And the same thing goes for, I've heard the same, that get rid of Obamacare, but let me keep my Affordable Care Act. It's just a level of ignorance that's astounding to me. I'd like to make a comment too. We've been talking about the good that the Affordable Care Act has done. And so there've been many people helped. And you can see the impact it's had in Yolo County. And we're also, you know, the threat, I don't think anybody is concerned about, I mean, I don't mean that, that the threat is real. But what I haven't heard in the conversation yet is that everybody doesn't love the Affordable Care Act. And there are some real issues with that act. People who have insurance and get it through their employers have found that their insurance policies are increasing, the premiums are. They're having increased co-pays and increased deductibles. And we're even starting to see that some in our Medicare premiums. And also with some of the deductibles. And then there's a whole group of people who get into the Affordable Care Act on a bronze plan. Or maybe a silver plan. You know, not everybody can afford that gold plan. So if you're on a bronze plan, you only get 30, you have to cover 30% of that bill yourself. Well, if you have a doctor's bill that's $45, you know, you can cough that up and you might even pay for it on your own. But if you end up in the emergency department with appendicitis or a broken leg, or whatever, you are paying one heck of a lot of money. And then there's another issue that we also have not dealt with is the tremendous, tremendous increase in overhead right now that we are paying through this kind of a system. You have to, if you want to get into the Affordable Care Act and get your coverage through that, you have to then go through a navigator who is paid, you know, we've got a huge number of people now who are employed just to try to enroll people and every year they have to re-up for enrollment. So you have to then go in and re-qualify which is very confusing for some people. So you have people going to do an outreach for our homeless and some of our disadvantaged populations to try and help them through that and navigate that system. And so that even though we are distressed by what we're going to lose in the Affordable Care Act, I think we also have to be very aware that it is not the panacea. So it's always a work in progress. In 1935, President Roosevelt signed the Social Security Act. It took 30 years until 1965 before President Johnson was able to sign the Social Security Act amendments that established Medicare and Medicaid. And it was a long time coming where we've been talking about these sets of issues for decades. I really agree with that and nothing's perfect. And that's what we should be working on is fixing the things that aren't perfect instead of destroying all the good that is done. So with that, let's turn to what the advocacy efforts or what can we do about this? And I know Millie's going to tell us in a minute about what's happening in that front. But what's going on across the country? How can we engage in attempts to influence the outcomes here? But I do want to get to, I just want to say that I do think there's two answers to your question about why, which is one is the tax cuts. I mean, it's a tax cuts and it's... Winners and losers. There's winners and losers and this is... Maybe the president's correct. Maybe it's not so complicated after all. This is taking away coverage from low and income people to give a massive tax break to with the wealthiest as well as the healthcare industry, health insurers, drug companies, et cetera. There is, in addition to the tax breaks that the congressman mentioned, there's actually a specific tax break in there for health insurance executives who make more than $500,000 a year. It removes the deduction on, I mean, it's amazing how the extra mile they went to make sure that they provided that assistance to remove the deduction, to remove the cap on the deduction for compensation to health insurance executives. And then I think there's this ideological thing which I think goes to Millie's thing is that I think that they see this, Senator Ted Cruz said when he was on, had his filibuster a couple of years ago, never had the terms slippery slope to single payer been mentioned more in the floor of the Senate than during that filibuster because, and I think that ideologically they think that this goes in the wrong direction toward a more universal system where California was really taking it. I think the metaphor is different. I don't think it's a slippery slope. I think it's scaling the mountain. We were, it's not like the rest of the mountain isn't higher and steeper and harder, but we were getting closer and this brings us back to the base, if not further because of what it undoes, not just for the progress of the last five years but the last 50, not just with the ACA but with Medicaid. But in terms of what we can do, I think that we here in California have, I think a special role. Number one, we had the role to lead to show that it could work, that if you don't have the state trying to sabotage it, you can actually make progress in dealing with these vexing issues that have been done with a while. Number two, we need to be part of this national campaign that's been going on around the country and yes, the most likely place where this could get stalled is in the Senate with senators from Maine and Nevada and Arizona and Ohio and Alaska. But the campaign doesn't work if it's just in those states. It has to be a national movement, national narrative and the fact that you've had these great protests and actions around the country, including in our major media markets like Sacramento and San Francisco and LA of like the Women's March, the protests at the airports, the events around the Affordable Care Act, that's been great. And then number three is that California actually has a really important role. We have more Republican Congress members than all but two other states, Florida and Texas. I didn't know, I know you didn't think of California that way. But we have 14 members who have said that they want to repeal Obamacare but in the same breath they said that they want to repeal it and replace it with something better if not terrific. And so we need to hold them to that promise. And we have of those seven, of those 14 members, seven to half of them are in districts that Hillary Clinton won. So we have a lot to contribute here and some of them are an hour north, Mr. Lomalfa, an hour east, Mr. McClintock, an hour south, Mr. Denim, there to every side. And up and down the state, down to Central Valley where I said even, where again, down to Central Valley, Orange County, there's some members in Orange County who didn't even realize that they were in swing districts until they saw how well Clinton did against Trump in their own district. So I think we have a role to play in spotlighting that and there has been this effort. Here, even in this district, there are efforts to, we need people to tell their story. If you're actually impacted by, covered California, by MediCal, if you'd be impacted by these things, we need to tell your story. My colleague, M.G. Flores, is here and we want to collect your story. We need people to help phone into red districts and red states to connect their constituents with Congress members. We need folks to come out to these broader events to highlight the issue. We can talk more about that as we go on, but there is specific things we can do here in California. So the petitions, the online signatures, that's good. The narrative, the personal story, how it connects. Should we call the mothers of these congressmen in other states? Because they should be ashamed of themselves. Others, what other comments on what we can and should be doing? Well, I don't know if there's that much to add. I think I just, I do want to say that the personal stories are really what our elected officials want to hear. We actually were hearing from our senators, Senator Feinstein particularly, because she wasn't getting enough stories. She wasn't getting enough information from individuals, from health centers, from counties, about the good that the Affordable Care Act did. And so, I believe that's the most compelling thing. I went to, one of our health centers is in West Sacramento. So actually, Congresswoman Doris Matsui represents West Sacramento. And I went to one of her town hall meetings and it was really about individual stories. And of course she's a great supporter and just like Congressman Garamendi of the ACA and not repealing. But it was really compelling for me to be there even though I have a lot of stories of our patients to hear about the people that mostly, I think we're on the exchange, we're on cover California, what it had meant to them and their families. I think it's very important to do that. I think it's important for people to spread the word. I'm a third generation Californian. I have family all over the state, north to south. I'm sure many of you do as well and you need to get the word out. Beyond our own district and our own elected officials get the word out all over the state of California. And I want to reassure you that our state and national associations that represent our work are in DC, walk in the halls. All the public health associations I belong to in the state and the country, they're in DC, pound in the halls. So there's a lot of energy around this in big associations but in the end it comes down to all of you. So Millie, can you talk about SB 562 and what's going on in the state capital? Sure, I'd be glad to do that. What I'm feeling very proud of is the fact that while all of this is going on nationally and our threat that we have to the Affordable Care Act our senators and our assembly people in California are really working hard because we don't know what's gonna happen in Washington. And we have been working in California now on single payer, often on for many years. And I was very pleased to hear Garamendi speak about his time as insurance commissioner. And so starting back in 92 and there was a bill and Wilson then vetoed it. But then, well, we'll talk about that more later but with the introduction February the 12th of SB 562 so you really need to take very careful attention of that and it's called the Healthy California Act. And let me give you the website. Well, and you'll get more of that later. But anyway, Senator Laura and Senator Atkins introduced the bill of intent that we want to get a single payer in California and not only finance it by establishing the universal financing but also look at healthcare cost control. And we'll talk about the feasibility later but what's, it's anticipated now though the full text of that will be available to us toward the end of March. And for those of you who've been involved watching what Senator Kuhl did with SB 840 and 810, we're anticipating the coverage is going to be very similar to what's in there so that if it's an essential healthcare benefit that people need, it will be part of that bill and it will be available to all residents in California. And so that it will get the text of it in 30 days and I mean in toward the end of the month and then we'll have 30 days for comment where they will be hearing this. And then it'll be heard in the Senate Health Committee probably in late April. And then there'll be a hearing in appropriations at a future date because simultaneously there is a study that is being done on the financial how this will be supported. And that's being done by Robert Pollan at the University of Massachusetts along with Jim Kahn at UCSF. And so that once that and the healthcare economists but we have a state that has worked on this issue for many years and we have some excellent healthcare policy people that are behind this. So that once the financial study is completed then it will go through appropriations and then start working its way through. So it'll probably be a two year bill. So that is something that is very important for us to be watching. Thank you. Friends, I'd like to ask the panel members, each of you to give us any closing comment. We've got a couple of minutes left and I want to thank you very much for being with us but do you have anything that you'd like to, one last comment that you want to share with this group? Milly, do you want to start? Okay, I guess since we talked about this bill because there's been a lot of question about the feasibility and of such a plan in California. And we have a long history now of a lot of activism and a lot of careful studies and work that's done on it. And we often will hear it's not politically feasible. And I think that as Californians that we need to take a look at what our values are and it's going to be feasible when we decide to find our voice and say this is what we need for California. And that, how do we want to make a difference? And so that right now our system is fragmented, it's broken, many people are being hurt. And is that how we want to be as a state? And then mobilize ourselves to work around and understand what this bill is, share it with our family and our friends and neighbors and then be out and be active for it. And there are some healthcare for all advocates in the audience and they will be around later to talk with people and we'll probably have some discussion of it in the breakout groups if people want. Thank you very much. Ron, about a minute or so. Sure. So just again, reminder to think about the prevention and public health fund, you've heard a lot of potentially detrimental aspects to the repeal. This is from the CDC website, their description of the prevention and public health fund it states losing this funding would cripple CDC's ability to detect, prevent and respond to vaccine preventable respiratory and related infectious disease threats including pandemic influenza. And when I read that from CDC's website, I get a little depressed. But when I see all of you attending this on a Sunday afternoon, I become optimistic. And so I really appreciate all of you being here. I look forward to the breakout session and talk with some more. Thanks. Well, what I'd like to say is my grandmother always used to say if you have your health you have everything. And I think about our patients that didn't have access and now do and their ability to be productive members of society. So for an administration that says it wants to put people back to work, this is actually doing the opposite when you take away access to healthcare. So just remember that everybody, everybody deserves access to quality healthcare. And we should all be working towards that, whatever means that is. So I mean, again, I just, first of all, just thank everybody here for being here has said, my organization has been working for this goal of quality affordable healthcare, universal healthcare and whether it be single payer or any other means for 30 years. And this is a generational moment that, and I wanna say both feasibility about that and feasibility about this fight. I think this is a winnable fight. I think that this is that, remember that their first plan was to have this passed in the first two weeks and to have the president sign it on inauguration day. And then that slipped. And then it was January 27th. And then it was February 20th. And then it was, so they keep slipping and they keep finding, I think that there is a possibility that they've spent so much time, just focused on repeal Obamacare that they don't know what they're for. There's so many contradictions within the party in power that they might not be able to get it out of the house. We have a, but we need to make sure that we can get folks who realize the life and death consequences, the real policy trade-offs and get them to oppose it. And I think we can do that if we tell our story, if we make sure that not only ourselves, but all of our friends and all of our neighbors throughout California and throughout the country are firmly clear with our Congress that this is nuts and that this goes in the opposite wrong direction. And if we can be active in all the different ways that we'll talk about in the small groups. And if we can do that, then that enables us to take the additional steps here in California. If we don't, if we lose that, that's 20, repeal the ACA by itself without the other stuff is a $23 billion cut to our healthcare system. Last year, we worked really hard to raise a tobacco tax, which raised $1 billion for our healthcare system. We would have to do the equivalent of 23 tobacco taxes to make up the money we would lose just in the repeal of the ACA. So this is a generational fight, but if we win it, then that allows California, that's the new platform, which then we can take additional steps for the goal that everybody should have healthcare regardless of their status. A winnable fight, a generational moment. If you've got your health, you've got everything. We're optimistic because we're together. What a panel, what a panel, and what a group for you all to allow yourself to be talked at for this period of time. We really appreciate it. And Judith McBrine, wherever you are, please come in and tell us what's next so that we can move our folks to productive engagement. Thank you, everybody, and please one round for our panel.