I administer both Medi-Cal and insurance through Covered California, as well as food stamps.

When I started this job a decade ago, pre-ACA, coverage was extremely limited.

We have seen a massive expansion of eligibility since the ACA, with some changes beginning about a year prior to it taking effect.

Previously, as an adult, you had to have a dependent minor, be disabled, or aged. Undocumented immigrants were eligible only to emergency services. If you break your arm, you can see a doctor. But if you need a primary care physician for preventative care? Good luck.

This left countless adults without children or disabilities without coverage.

We got ACA, and suddenly there was an explosion in eligibility.

Single and married adults without dependent minors suddenly became eligible to full scope benefits en masse. Undocumented minors gained full scope coverage.

We also expanded eligibility linkage from indigent children meeting deprivation criteria such as an absent or unemployed parent, to tax dependent status.

This means, if your adult parent lives with you, and you claim them as a tax dependent, you can add them to your tax household for the purposes of your own coverage, even if they themselves are ineligible, or even aided on their own.

This is significant, because expands the household size, which increases the income limit.

I've seen that make the difference between free, full scope coverage for a family of 5, and a $350 a month premium for the two parents, while the children retain their free coverage.

It also expanded the restoration period from 30 days to 90 days, meaning a much longer period where you could simply regain compliance to restore, rather than having to apply from scratch.

People think ACA is just the insurance exchange, but it brought with it sweeping Medicaid changes as well, though that expansion doesnt hold for a states. Some states opted not to expand their Medicaid programs.

California expanded in a big way. I am not familiar with exactly how directly tied this expansion is to ACA from a legislative standpoint, so I concede my ignorance on that front.

But if repealing ACA only knocks out the exchanges, that alone would kill coverage for millions.

People already panic if they lose coverage and have to wait for open enrollment. It will be so much worse when we have to tell them they're assed out completely. Because then, it's not just a matter of waiting two months for open enrollment. It's a matter of, you better look for something else all together.

Worse still, we are nowhere near out of the woods on the COVID issue. Again, even if the only change is the removal of the exchanges, that could lead to a catastrophic domino effect from both a public health standpoint, but an economic standpoint as well.

That means increased ER visits and increased bills not being paid, creating financial burdens for people and hospitals.

It's not Bout whether it's "popular". It's vital. It could stand some tweaking, and I'm sure there are better frameworks to be had.

But to repeal this without an immediate, and similarly robust replacement is an absolutely terrible idea.