As the debate over the fate of ObamaCare rages on Capitol Hill, few groups have more at stake than the nation’s Hispanics.
Hispanics benefited more than any other group from the Affordable Care Act (ACA), partly because they occupy many of the informal and transient jobs that didn't previously offer health coverage but were required to do so under President Obama's signature healthcare law.
As the Republican-led Congress and the Trump administration discuss a replacement for the ACA, many Hispanic leaders are worried their communities could be forced out of coverage and back into emergency rooms for primary care.
“As goes the Affordable Care Act, so goes the healthcare for Hispanics, disproportionately,” said Rep. Tony Cárdenas (D-Calif.), the head of the Congressional Hispanic Caucus’s campaign arm.
The financial security provided by health insurance is not the only issue worrying Latino leaders as President Trump and the Republicans press ahead with their plan to dismantle ObamaCare.
The ACA has also pumped billions of dollars into the health sector of local communities.
“Do they have any idea how many folks are in the workforce who are trying to figure out if they can stay in these jobs?” asked Rep. Michelle Lujan Grisham (D-N.M.), head of the Congressional Hispanic Caucus.
“It brought literally billions of dollars to the economy, the Affordable Care Act and the growth in the healthcare sector. It is the only industry growing in our state. There’s nothing else.”
The Commonwealth Fund, a nonpartisan research foundation, estimates New Mexico would lose 19,000 jobs over a year and $10.1 billion in gross state product over five years if the ACA were repealed.
Rep. Raul Ruiz (D-Calif.), a physician and CHC member, said a particular threat from the GOP’s repeal plan is the provision eliminating ObamaCare’s Medicaid expansion. If the Republicans pass their bill — and millions of people are left without coverage, as some outside groups are predicting — that would mean more hospitals would be forced to absorb the costs of uncompensated care. Some are warning they would close down altogether.
“They’re going to have to make some tough decisions to lay off individuals,” Ruiz said. “If all of that hospital sees is a dramatic rise in uninsured patients, then they’re going to take the biggest brunt of it, which means that then they will have to shut their doors and go out of business. There are some hospitals, even in my district, that are very concerned about not being able to sustain the care for uncompensated uninsured patients that go to their emergency departments because they’re the only hospital in town.”
A New York Times investigation last year found that, although Hispanics remain the least covered demographic group in the country, enrollment rates under ObamaCare grew by 7.2 percent.
And liberal Hispanic leaders are reluctant to change a system that they say has worked for their community.
"This irresponsible bill will cause millions of Americans to lose their healthcare coverage, including millions of Latinos. Let's remember that Latino uninsured rates dropped dramatically thanks to the Affordable Care Act and now Republicans want to take that progress away," said Cristobal Alex, president of the Latino Victory Fund.
Closures of medical facilities would send ripple effects through local communities, particularly rural areas, which would face higher hurdles in attracting companies to their regions.
“This is very detrimental to employment and job opportunity and economic growth. Because if you don't have access to care, who's going to go open a factory in your area?” House Minority Leader Nancy Pelosi (D-Calif.) said Thursday.
In a state like New Mexico, those fears are especially pronounced.
"What about our labs? Is anyone going to come and take these jobs, the scientists, if our healthcare system is [plagued by] instability?” Lujan Grisham asked.
But Republicans say opponents of the proposed ACA replacement, the American Health Care Act (AHCA), are attacking it unfairly.
"There's still too many unforeseen potholes out there where people are selling things that are not true, up to and including, here's a good one: We shouldn't give money to people. People aren't going to get the money, it will be a refundable tax credit, it does not come to them," said Rep. Pete Sessions (R-Texas), chairman of the House Committee on Rules.
Sessions said small businesses — a key factor in the Latino economy — would derive "enormous" benefits from the tax credit system proposed under the AHCA.
And with Latinos starting more businesses than any other demographic group, business-oriented policies could prove attractive to them.
According to a study by the Stanford Latino Entrepreneurship Initiative, "the five-year average growth rate in the number of Latino firms has remained at double or triple that of the national average for the past fifteen years."
"The number of Latino-owned businesses grew over 15 percent over the last decade, leaps and bounds over every other American demographic," Vice President Pence told The Latino Coalition, a gathering of Hispanic business owners this week.
Pence said the AHCA would help spur their business growth.
"ObamaCare has placed a crushing burden on job creators," Pence said.
And some Republicans who aren't fully sold on the AHCA say it is at least an alternative the Hispanic community can live with.
"I worry if we don't pass this one, the next one will be much worse, more conservative," Rep. Ileana Ros-Lehtinen (R-Fla.) said.