June 03, 2020
Area(s) of Interest: Public Health Access to Care Advocacy
By P. Brian Savino, M.D., MPH., FACEP
The COVID-19 pandemic has wreaked havoc on society. As of late May, there have been over 100,000 cases in California and nearly 4,000 deaths. Millions more have been affected by unemployment, mental health challenges and loss of health insurance. It is an unprecedented time when our state leadership should be rallying to create a robust and secure health care system.
So why instead is the State of California sacrificing key pieces of its health care safety net in the middle of a global pandemic?
Medi-Cal provides essential health care to over one-third of Californians – including nearly half of the state’s children, half of all people with disabilities and over 1 million seniors. Medi-Cal also pays for more than 50% of births in the state and 58% of patient days in long-term care facilities. On top of everyone Medi-Cal provides for, the state is estimating a 2 million patient caseload increase in 2020 due to COVID-19.
Even so, Governor Gavin Newsom’s updated 2020-21 budget proposal would decrease patient access to health care for some of the state’s most vulnerable populations.
In 2016 California voters approved Proposition 56, which utilizes tobacco sales tax revenues to drastically expand funding for health programs and research into cures for cancer and other illnesses caused by tobacco products.
That funding created programs like CalHealthCares, which provides physician and dentist educational loan repayment in exchange for serving Medi-Cal patients, particularly those in underserved communities.
Delivering on the state’s long held promise to provide quality health care to its most vulnerable population requires California to ensure there are enough physicians in areas with high numbers of Medi-Cal beneficiaries. Already facing a statewide physician shortage, low Medi-Cal reimbursement rates make it difficult to sustain medical practices and pose a significant barrier to increasing access to care. Compounding the problem, physicians enter practice with hundreds of thousands of dollars in educational debt – the average debt burden of a CalHealthCares applicant is over $360,000.
The CalHealthCares program is clearly needed: over 1,000 physicians and dentists applied during the inaugural cycle, which ultimately issued awards to 239 physicians now serving Medi-Cal patients in 38 counties across 40 specialty areas of medicine. Thirty-eight dental awardees are serving 19 counties across general and pediatric dentistry. With the success of the inaugural cycle, the program rapidly became popular among physician residents and dental school graduates. Applicants from across the country were itching to set up shop in California to provide health care to vulnerable populations who depend on Medi-Cal.
Ending CalHealthCares would decrease access to care for hundreds of thousands of patients from low-income, rural and underserved communities, as well as punish dentists and physicians – myself included – who want to ensure all patients, regardless of income or zip code, have access to health care when they need it. I hope Governor Newsom and the state legislature consider how many lives will be damaged, ruined and in the worst cases, lost, because of their short sightedness. How much taxpayer money will be wasted when Medi-Cal patients are forced to visit the emergency room because they are unable to see a primary care physician? How many patients with preventable conditions will be forced to wait to seek care until they deteriorate, now requiring hospital admission or critical care, further straining our health care system?
At the beginning of the COVID-19 pandemic Governor Newsom tweeted “thank you” to those of us working on the front lines. He praised health care workers for their “courage, service and sacrifice” and lauded that we “are an inspiration.” While the kind words are appreciated, gutting our real-world ability to serve patients, especially those who need it most, is a strange way of showing support.
Now is a time when we need to take leaps forward for our health care system; instead, cutting CalHealthCares is taking an enormous step backwards.
We cannot sacrifice public health, and we cannot afford to turn our back on the promise of timely, affordable and quality health care for all Californians.
P. Brian Savino, M.D., MPH., FACEP, is an Assistant Professor of Emergency Medicine and Director of Prehospital Care for an Emergency Department in California. He is an applicant for the CalHealthCares program. The opinions expressed are his own and he does not speak on behalf of his employer.
EDITOR'S NOTE: The California Medical Association is urging physicians to contact their Assemblymembers TODAY as they consider how to balance the budget. It is critically important that the legislature understands the need to protect access to care for Medi-Cal enrollees and REJECT the Governor’s repurposing of Prop. 56 tobacco tax revenue.