March 04, 2015
Area(s) of Interest: Access to Care Advocacy Health Care Reform
Sacramento – Preceding today’s joint legislative informational hearing to address pitfalls within California’s Medicaid system (Medi-Cal), Senate Health Committee Chair Ed Hernandez and Assembly Health Committee Chair Rob Bonta joined health care providers, patients and advocates on the steps of the Capitol. Newly introduced, legislation to restore a 10 percent cut to Medi-Cal reimbursement goes a step further than in past efforts by proposing that Medi-Cal payments to providers be on par with what Medicare pays for the same services.
“Expanding access to health care coverage, as we have done under the ACA, is a significant accomplishment but in order to truly be revolutionary that coverage must be accompanied by meaningful access to a provider,” said Senator Hernandez. “Unfortunately, millions of Californians in the Medi-Cal program lack that access because we pay providers an embarrassingly low rate. A Medi-Cal card needs to be more than an empty promise.”
In 2011, Medi-Cal payment rates to doctors, hospitals, dentists and other providers were cut by 10 percent as a way to balance the state’s budget. California now has one of the lowest payment rates in the country. At the same time, the Medi-Cal program now covers more than 12 million patients, one in three Californians, as a result of expanded eligibility under the Affordable Care Act (ACA).
“While I was growing up, I watched my dad as he set up health care clinics for farmworkers and other vulnerable communities throughout the state. I witnessed first-hand the importance of protecting and providing services to the most vulnerable members of our community,” said Assemblymember Rob Bonta. “I believed then and I believe now that health care should be a right and not a privilege. AB 366 and SB 243 are critical steps toward ensuring that the health care coverage millions have signed up for is meaningful and actually provides real access to quality health care.
“As physicians, we want to provide care to patients and especially to the poorest and most vulnerable among us,” said Luther Cobb, M.D., CMA president. “With primary care reimbursement rates as low as they are, many physicians are forced to stop taking new Medi-Cal patients as they simply can’t keep their doors open. In areas like rural, northern California where I practice, that can mean patients have longer wait times or have to drive further to get care.”
SB 243 and AB 366 would not only repeal prior year rate cuts to Medi-Cal, but would increase payments rates for inpatient hospital services and most outpatient services.
“Medi-Cal reform is the most important health care issue facing California in 2015. Hospital officials appreciate a thoughtful discussion with legislative leaders and the Governor to ensure Californians who today have coverage also have access to medical care,” said Sharon A. Spurgeon, Coalinga Regional Medical Center, said. “Governor Jerry Brown has demonstrated extraordinary leadership to help address California’s budget challenges, and hospital leaders look forward to working constructively with him to address this significant challenge.”
The legislative proposals would also require the Department of Health Care Services to pay Medi-Cal managed care plans at the upper end of their rate range so as to ensure a more robust Medi-Cal provider network.
“Unfortunately, I’ve learned that health insurance doesn’t always equal access to care,” said Jessie Perridon, a Sacramento patient. “Many physicians simply can’t afford to continue taking new patients in Medi-Cal because of the low rates, which means patients like me either have to go further, wait longer or rely on emergency care for what would otherwise be basic medical treatment.”
A 2011 survey funded by the California HealthCare Foundation (CHCF) of over 1,500 Medi-Cal beneficiaries identified difficulties in finding health care providers who accept their coverage, as 34 percent of Medi-Cal beneficiaries said it was difficult to find health care providers who accept their insurance, compared to 13 percent for people with other coverage. The survey found a higher percentage of adults with Medi-Cal say they have more difficulty getting appointments with specialists and primary care providers than adults with other health coverage (42 percent v. 24 percent for specialists and 26 percent v. 15 percent for primary care providers).
“I look forward to the day when our emergency room is just that – a place where people come when they have an emergency, not a place where they come for basic healthcare. That day will come when Medi-Cal is fully funded, and this bill is an important step in that direction,” said Michelle Ross registration clerk at Dignity Methodist Hospital in Sacramento.