Is Medi-Cal sustainable?
Health Access
April 13, 2004
Budget Subcommittees on Health Consider Cuts
Earlier today, both the (California) Assembly and Senate Budget Subcommittees on Health considered a range of health care cuts, and heard testimony from numerous organizations representing consumers, providers, and communities throughout the state.
The Assembly Budget Subcommittee on Health, chaired by Assemblyman Mervyn Dymally, followed the lead of its Senate counterpart in rejecting the full range of proposed enrollment caps. The committee rejected proposals to deny coverage to children applying to get Healthy Families (SCHIP) coverage; children with disabilities applying to get into California Children’s Services (CCS); recent legal immigrants applying to get Medi-Cal; undocumented pregnant women and infants, as well as long-term care to undocumented seniors, applying to get Medi-Cal; immigrants with cancer applying to get into the Breast and Cervical Cancer Treatment Program in Medi-Cal; and hemophilia patients and others applying to get into the Genetically Handicapped Persons Program.
The Subcommittee decided to hold the provider rate cut proposal open, and did not take a formal action.
Both subcommittees heard testimony regarding concerns about the Medi-Cal redesign process and proposals, and new information came out about the proposals.
One proposal was entitled “a conceptual framework for a tiered approach to benefits and cost sharing,” and also included charts indicating who got what benefits and cost-sharing in each of the three tiers, but also the fiscal analysis that presumes such changes would generate savings of over $111 million.
Another proposal under discussion is to geographically expand the reach of Medi-Cal managed care, even though many of these counties have not proven to be able to sustain managed care plans in either the private or Medicare markets.
Health Access Updates (message for April 13, 2004):
http://www.health-access.org/blogger.html
Health Access website:
http://www.health-access.org/
Medi-Cal Redesign:
http://www.medi-calredesign.org/
Comment: It is a relief to know that California legislators cannot accept capping enrollment for those who cannot afford the costs of essential health care. Slamming the doors on low-income individuals with health care needs is an unacceptable, inhumane approach of containing costs.
But a review of the Medi-Cal Redesign website demonstrates that most of the news is bad. For decades, innumerable efforts have been made to reduce expenditures in the Medi-Cal program. There is virtually no slack left. The program is chronically underfunded. New innovations can only result in a decrease in services available, or a mass exit of willing providers who would not be able to sustain solvency with the proposed 15% further reduction in payments.
Separate health welfare programs for low-income individuals will always be underfunded. Other nations have resolved this dilemma by placing everyone in essentially the same insurance risk pool (though through different models). It is now past time for us to consider a similar approach, not just for California, but for the entire nation. With the $1.79 trillion that we are currently spending, we can certainly afford to do it.