​Petra Rasmussen is a Ph.D. student in Health Policy and Management at the UCLA Fielding School of Public Health and the co-author of a new Center study on how the American Health Care Act would have affected Californians. In this brief interview, Rasmussen talks about how the fight over health reform is not over, why Americans are confused about the existing law, and whether California could go single-payer.

Q: Is the battle to "repeal and replace" the ACA over?

​The Republican failure to pass the American Health Care Act (AHCA) and repeal and replace parts of the Affordable Care Act (ACA) is a victory for health reform. The bill was defeated because it would have caused tremendous damage to Americans across the country.

However, just because the AHCA is gone for now does not mean that the fight is over. The Trump administration has already begun to make fundamental changes to the ACA outside of legislation, and the consequences of these actions are already being seen in the reduced enrollment numbers in the law's health insurance exchanges.

In his first week as Secretary of Health and Human Services, Tom Price introduced proposed rule changes that would weaken the patient protections in the ACA and make it harder for people to enroll in coverage. This set of proposed rules is likely just the first of many that the administration will put forward to undermine the law. Furthermore, the Trump administration and the Republican-controlled Congress can still return to repealing the ACA at a later date.

The policy ideas that were included in the AHCA are ones that Republicans have been touting for many years, and they won't go away with just one bill's defeat. Understanding these ideas and the very real impact they could have on Americans is a key challenge for researchers and policymakers moving forward.

Q: Why is the ACA so unpopular among conservative voters?

T​here's been a lot of misinformation about the law and what it provides. Some people are even under the incorrect belief that the ACA they like and use is different from the "Obamacare" that they hate!

This is in part because the ACA is a complicated law to understand. The Kaiser Family Foundation's Health Tracking Poll has consistently found that people support the separate policies included in the ACA, but are not as supportive of the law as a whole, and many have misconceptions about what is included in the legislation. The same poll has also shown that most Americans support the Medicaid program and very few want to see a reduction in its funding.

We all know that the ACA provisions protecting young people and people with pre-existing conditions are popular across the political spectrum. And the move by the Freedom Caucus to try to eliminate essential health benefits was politically risky. All of this goes to show that Republican lawmakers aren't paying attention to the majority of their constituents or looking out for their best interest when they push forward with attempts to destabilize or repeal the ACA.

Q: Do you think a single-payer system in California is possible? Would the federal government allow it, and how could it be funded?

​If there's any state that could be successful with its own single payer system, California is it. The diversity and size of the state, its high-quality health care system, and the largely progressive political leaning of residents make the possibility of a single-payer system very real.

California State Senator Ricardo Lara introduced a bill in mid-February to create such a system in the state. And California has explored this option before with the legislature passing single-payer legislation in 2006 and 2008. These bills were eventually vetoed by then-Governor Schwarzenegger. Lawmakers have learned a lot from these previous attempts and could have an even better shot at success at the state level under Governor Jerry Brown.

However, there are challenges. The federal government would need to approve any changes to Medicaid and Medicare that would incorporate them into the state's single-payer system. While the Trump administration has voiced support for greater state flexibility in Medicaid, it is unclear if the current administration would approve a waiver to allow federal funding for the program to go towards a system many ideologues regard as tantamount to socialism. And if future legislation looks to alter the funding structure for Medicaid like the AHCA did, it is possible that federal funding could be cut, increasing the cost to California.

Furthermore, it is unlikely that the current federal government would allow the state to include the Medicare population in any plan to switch to a single-payer system. This would leave the state with a two-tiered system ― one for residents 65 years of age and older, and another for the under-65 population.

However, Californians have shown a willingness to increase taxes in order to pay for important programs that improve the well-being of the state's most vulnerable. There are also alternative funding streams that could be tapped, including taxes on recreational marijuana. The state should definitely move forward with exploring the potential costs and benefits of a single-payer system.