Hub & Spoke

Thousands rally in Sacramento against Medi-Cal cuts

“We Care for California” Rally at the State Capitol in Sacramento (Image by: Vivian Nguyen)

By Vivian Nguyen

On June 4, 2013, over 8,000 healthcare workers and community supporters gathered on the steps of the State Capitol for the largest healthcare rally in California history.

The event was hosted by We Care for California, a coalition of physicians, dentists and health care workers who are working to protest Governor Brown’s reduction of Medi-Cal provider rates by 10% or roughly $1 billion per year. Among those present were doctors, nurses and hospital administrators from all corners of the state, many of whom boarded buses early that morning in order to make their voices heard.

The purpose of the rally was to demonstrate support for two bills –Senate Bill (SB) 640 and Assembly Bill (AB) 900—that were designed to reverse the 10 percent Medi-Cal provider cuts. Although SB 640 became stranded on the Senate Appropriations suspense file and AB 900 was amended to only reverse provider cuts for skilled nursing facilities, supporters continue to push for rescinding Medi-Cal cuts through negotiations in “trailer bills” that will accompany the budget bill for floor votes this Friday.

Still, hundreds of advocacy and professional organizations were present at the rally last week, including the California Primary Care Association, Services Employees International Union-United Healthcare Workers West, and Kaiser Permanente. One organization that brought in more than one hundred volunteers from all over the state was Planned Parenthood.

Workers at the Planned Parenthood booth (Image by: Vivian Nguyen)

According to Susannah McDevitt, Public Affairs Director for Planned Parenthood Shasta Pacific, these cuts would be extremely detrimental to Planned Parenthood branches all over the state.

“Medi-Cal cuts really affect reproductive healthcare access for our clients.  The cuts make it impossible for Planned Parenthood to cover our cost of providing health services, and consequently harder to see the patients who need them,” McDevitt said. “Our doors are opened for everyone and these cuts would hurt those who don’t have anywhere else to go.”

Susannah McDevitt, Public Affairs Director at Planned Parenthood Shasta Pacific Action Fund (Image by: Vivian Nguyen)

The consequences of these cuts would not only adversely affect existing Medi-Cal patients but also the approximate 1.5 million new beneficiaries who would be added under the Affordable Care Act (ACA) in 2014. According to McDevitt, because California already has one of the lowest Medicaid reimbursement rates in the nation, it is crucial that the $1 billion in funding be restored. 

“Given the timing of the Affordable Care Act, it will make it difficult to expand our services if Medi-Cal is being cut,” McDevitt said. “We’re hoping that our legislators take leadership on this issue because it will be a crisis if the cuts go forward.”

More photos from the event:

Hundreds demonstrated their support for the rally through photos and notes (Image by: Vivian Nguyen)

LifeLong Medical Care Health Promoters, Nora Vigil (left) and Margarita Mendoza (right), along with Community Clinic Consortium Director of Community Affairs & Finance, Sarah Ross (center) show their support (Image by: Vivian Nguyen)

Thousands gather to hear legislator Dr. Richard Pan speak (Image by: Vivian Nguyen)

Vivian Nguyen is a Community Affairs Intern at Community Clinic Consortium of Contra Costa & Solano Counties. She can be reached at [email protected].

In Plain Language, Today's Supreme Court Decision

 How does the Court's decision to uphold Healthcare Reform affect community clinics?

Awesome news today! As you've probably heard, the US Supreme Court supported and upheld President Obama’s Healthcare Reform law. What does this mean for community clinics and our patients? In plain language, here are the important points:

Lots more people are eligible for Medi-Cal coverage

• The Supreme Court said that if states want to grow their Medi-Cal programs to cover more people, they can

• California has already decided to expand its Medi-Cal program, for example by covering low-income childless adults

• WHY DOES THIS MATTER? Growing Medi-Cal matters because now millions more people in this state will be looking for health care providers like community clinics! Clinics will be able to serve many more low-income people

Lots more people will be able to afford private health insurance

• The Supreme Court said that it agrees with President Obama: the healthcare reform law will require adults in this country to have health insurance

• California has set up a program to help people shop for health insurance, and will provide discounts so they can afford it

• WHY DOES THIS MATTER? Requiring adults to have health insurance, and making it affordable, matters because it means millions more Californians will soon be shopping for a new place to go for medical care.  We want these newly-insured people to be community clinic patients!

• If clinics are going to attract these new patients, we need to show them why we’re their best choice: we provide excellent, cutting-edge medical care, and we know their cultures and their languages better than anyone else 

Millions of dollars are available to community clinics in California

• The Supreme Court said that the healthcare reform law can move ahead with providing millions of dollars to California community clinics

• WHY DOES THIS MATTER? This new money will help clinics across the state grow!

State cuts would cripple community health centers

  Just as President Obama’s Healthcare Reform bills are poised to deliver on the promise of providing health care for millions of Californians, Gov. Jerry Brown’s budget would cut funding to neighborhood-based, community-governed health centers. These centers are the only cost-effective alternative to costly, overcrowded emergency rooms.

Federally qualified health centers have a long history of providing quality care to MediCal, Medicare and uninsured patients. Most private providers cannot serve these patients because California has the lowest MediCal rates in the country.

Across California, clinics provide care in the poorest communities that have staggering unemployment rates. Many of these patients have lost health insurance or cannot afford coverage.

Under federal law, health center MediCal payments take into consideration their unique delivery system that goes beyond traditional primary care. Through these centers, patients receive prevention services, health screenings, comprehensive primary care, chronic disease management, behavioral health services, care management and on-site translation services.

The governor’s budget would require community health centers to continue providing care to the uninsured and underinsured, but with 10 percent less funding. This is simply impossible given their mission to serve all who come through our doors. The proposed budget cut would shred the city and state’s safety net. To date, California health centers have lost more than $100 million in the past three years due to harmful budget cuts.

They cannot survive further cuts.

This proposal would force some health centers to close and most to reduce services and access to care. This proposal is simply the wrong prescription for the health of California.

Community Health Centers provide care in a cost-effective structure. They are proud of the fact that they were ranked by the Federal Office of Management and Budget as one of the 10 most effective federal programs currently in existence. And they take pride in their role as a great steward of the taxpayer’s money and as an economic engine in their communities.

The governor’s budget proposal is NOT reform; it is simply a budget cut. Countless studies have concluded that health centers provide high-quality and cost-effective health care to the most vulnerable populations in the state, while reducing overall costs to the health care system. This is what they do well, and they must not let the governor’s plan interfere in their mission.

We urge you to call the governor and tell him that our health care system is fragile enough without this additional devastating cut.

Tell him to let our health centers do the important work they do in keeping our families and communities healthy.

Explaining our healthcare system to alien invaders

Sometimes the healthcare situation in this state (and this country in general) really makes us want to cry. When things are this bad - as they are now - the only way we know to avoid breaking down into hysterics is to write short fictional pieces in which we imagine being visited by an alien species, unfamiliar to our (in)human(e) ways. 

Here's how a close encounter of the third kind would sound this week:

Alien Invader: Greetings, Earthlings! We have traveled across the Universe to search out new ways of delivering healthcare to our species.  Please teach us how you do this in "California."

Human:  We're happy to explain our healthcare system to you, friendly Alien Invader! But how much time do you have? Our system of medical services makes rocketing across the Universe seem simple by comparison. 

AI: Ah, I see.  Well, our brains are 7 times larger than yours, so go ahead and give it a try.

Human: Okay then, first thing we should say is that every person in California has a right to comprehensive, preventive medical care no matter their income or age.

AI: That's Excellent! Teach us how you do this!

Human: Right, okay, so…. see, you have to understand, the system's not perfect.

AI: No system is.  Except for the solar system.

Human: Yah, for example, every year on January 10, we have a ritual that we call the Governor's Proposed State Budget.  In this ritual, the government proposes stripping tens of thousands of people of their healthcare benefits.  

AI: I see. That does seem like a bit of an imperfection.

Human:  Right now, the state government is proposing the elimination of Adult Day Healthcare services, services that keep low-income elderly people out of nursing homes and hospitals and enrich their lives immeasurably.  

AI: Hmm. Are these cuts being made because there is simply no other choice?

Human: Well, we could modestly raise the cost of registering a car and extend existing taxes for another couple years. 

AI: That doesn't sound so bad.

Human: It does to almost half the Legislature in Sacramento, which refuses to bring the proposal to the public for a vote.

AI: Ah, those legislators must be Romulans.  We know them.

Human: Another ritual we have here on Earth is called, "Devastating common-sense healthcare programs for political gain."

AI: That sounds….fun.

Human: For example, right now our federal House of Representatives has voted to cut 1/3 of all federal funding to community clinics.  It also voted to roll back a set of improvements to the healthcare system that our President, Barack Obama, passed last year.  

AI: We are still waiting to hear how you ensure comprehensive, preventative healthcare to all.

Human: Huh? What? Oh, no no no.  You misunderstood.  

AI: We did?

Human: Right, so what I meant was that everyone has the RIGHT to comprehensive, preventative healthcare. But not everyone actually GETS comprehensive, preventative healthcare.

AI: This does not compute.

Human: Silly Alien Invader - so technologically sophisticated, so politically naive.  

AI: We are going to take off now.  We hear there is a land called "Canada" where people have the right to healthcare and actually get it, too.

Human: Yes, we have another ritual that involves packing our elderly onto busses and driving them north across the border to buy affordable prescription drugs from that land.

AI: You have a remarkable system, here, Human.  We will note it under our "Do Not Adopt" file.  Thank you for your assistance.

Human: Wait, I didn't get to tell you about local healthcare funding!

AI: If you attempt to do so, we will blast you with lasers.

Human: Okay, bye now!

 ---

Well, writing that kept us from crying. But now we're just angry! If you're similarly upset with what's going on with healthcare in this state and country, be sure to sign up to take action on our website (click here). Together, we can make a change. And there's a lot to change.  

 

New Action Alert Live & Ready for....Action

This week, just a short note to point our faithful readers to Round 2 of our website's new policy advocacy action system, or PAAS. 

Just kidding, there's no way we're calling it PAAS.

But our advocacy action page is live and ready for you to use.  What is it, exactly?  It's an automated system that allows you to send an email to your elected officials regarding important issues on healthcare.  

We've already written the email for you, so all you have to do is plug in some basic info about your address (so the system can find which elected officials are yours) and press Send.  Of course, if you'd like to modify the email text in any way, you can do that, too, and we'll try not to take offense.

This week's issue is the upcoming budget hearings in the Legislature - where cuts to Medi-Cal and Adult Day Health Care are once again on the table.  It's vital that our Senators and Assemblymembers know they can't plan to balance the budget on the backs of our communities!  

Follow this link to the advocacy action center!

And for more background info on the cuts, check out the California Primary Care Network's bullet points here.  

Finally, if you have a better suggestion for what we should be calling this advocacy action system, please let us know.  

Waving Hi to a New Medi-Cal Plan

Guided by the time-tested adage that "week-and-a-half-old news is still news worth blogging about," we're interested in sparking a conversation here at Hub & Spoke about the recently-finalized 1115 Medicaid Waiver.  

As most of our readers will know, 1115 Medicaid Waivers are agreements between the state and federal governments that determine how California structures major parts of its Medi-Cal program.  It's a "waiver" because the agreement on Medi-Cal structure, while approved by the feds, deviates from the plain-vanilla federal template that the Medicaid program would otherwise default to.  

Here's how the LA Times framed the story:

The Obama administration on Tuesday approved a $10-billion plan to help California modernize and expand its Medicaid health insurance program for the poor, pushing the state to the forefront of the national effort to implement the new healthcare law.

The administration's much-anticipated decision to grant a so-called Medicaid waiver could ultimately help cover hundreds of thousands more Californians over the next five years. State and federal officials hope that will bolster efforts to improve the quality and efficiency of care provided to the state's poorest residents.

So, that said, the question for this community is this: how will the new 1115 Medicaid Waiver impact Contra Costa and Solano Counties?  

More specifically:

1. In Contra Costa County, given that a Health Coverage Initiative already exists - a facet of the previous 1115 Waiver - what will change for low-income adults under the new Waiver?
2. In Solano County, what are the opportunities presented by the new Waiver that the County might have the resources to take advantage of?  

We don't pose these questions rhetorically - we really do want to know.

So if you, dear reader, have insight into any of these mini-mysteries, please comment below and share the wisdom for our online community!

De-Symbolizing Healthcare Reform

With a couple of breathing days since the election that swept a near-record number of majority-party congressmembers out of their seats, we thought we'd add our own voice to the din of analysts trying to figure out WHAT THIS MEANS FOR HEALTHCARE REFORM.  

Because, as we all know, the (former) majority party voted the reform law into existence.  Now that many of them are gone, we and others are left nervously wondering what the future holds.  

Couple of points here.  First of all, it's notoriously hard to judge the public's opinion on an issue based on the party it votes into power.  It's not like a vote for a Republican is an automatic vote against extending health insurance to those with pre-existing conditions.

And even direct polling, in which members of the public are explicitly asked whether healthcare reform should be repealed, is hard to decipher.  In October, the Kaiser Family Foundation published a round-up of polls on this point and basically concluded that even though about 1/2 of the country supports repeal, responses vary widely with the way "repeal" is defined and how the polling questions are asked, and that it's impossible to judge the intensity of the public's sentiments from the polling that's been done so far.  

Second, the political math of repeal is fuzzier than a new crew cut.  It's hard to see the Democrat-controlled Senate or the President acceding to any "repeal" that goes beyond some tweaks around the edges.  In the House of Reps itself, the big news is that San Francisco's Nancy Pelosi will seek election as the minority leader, and if she retains her leadership position you can be sure she'll work overtime to stop any rollback of one of her most significant policy victories.  

Also, let's not forget that the public basically doesn't know what's good about healthcare reform.  That's in large part because most of the awesome provisions of the law have yet to kick in.  The difficulty of repealing a law that becomes more and more popular as time goes on (and as benefits kick in for seniors and others) may be insurmountable.  A good discussion on the politics of taking away benefits from key constituencies played on PBS this week and is worth a gander.  

Our own take is that healthcare reform is - in the minds of many in this country - a symbol of what is perceived to be too much government control over the private sector.  

Maybe with this week's election the voting public has blown off some steam, feels more secure about its representation in DC, and no longer needs a symbol of government over-reach to rally around.  

But just in case that's not the case, it may be time that we supporters of the law start purposefully stripping it of any symbolic importance whatsoever.  That means filling in details where now there's only broad abstract ideas.  

And it means ceasing to talk about "the healthcare law" as a single Thing altogether.  Skeptics always assume that "the reform law" is an enormous, Godzilla-like creature bent on destroying mom and apple pie.  So let's start talking about one specific part of the bill at a time.  We're excited about how comprehensive it is, but that's because we're health policy nerds.  Normal people are somewhat less stoked on thousands of pages of statutory modification.  

So, no, it's not "healthcare reform."  It's "Help Paying for Prescription Drugs" when talking to seniors.  It's "No More Exclusions for Children" when talking to parents.

The more that we as supporters of reform can shine light on specific parts of the law, the less it serves as a symbol and the more it becomes an unrelated set of common-sense, average-Joe friendly rules of the road.  

Much easier to understand.  Much easier to embrace.  

So here's to the death of a symbol, and to the long, long life of a hundred really good ideas to fix healthcare in this country.  

What do you get when you subtract 6 from 27?

...do you get an on-time state budget that's good for community health?

Proposition 25, which goes before the voters on election day (Nov. 2nd), would cancel the supermajority requirement for passing the state budget out of the legislature and replace it with a simple majority rule.  Thus, 21 State Senate votes needed, rather than 27 - and 41 Assembly votes rather than 54.  

Community clinics serving Medi-Cal patients are in full support.  

We're sadly used to the inertia that curls like thick clouds of cigar smoke around the Capitol every summer, delaying passage of the budget for weeks and even months beyond the start of the fiscal year (nevermind the June 15 constitutionally-mandated deadline).  

We watch the special fund set up for Medi-Cal contractors run dry, and then we brace for the payment delays (which shuttered several smaller community clinics this past year).

So it's attractive, this Prop 25.  It would pull loose one of the biggest stops to efficient government.  

Of course, not all the stops. It would leave in place, for example, the 2/3 supermajority requirement for passing new taxes.  Meaning the legislature could, in a Prop 25 world, pass budgets more easily, but only if that budget didn't send taxes up.  

Given that the tax-versus-cuts conversation (debate, struggle, partisan death match) is generally what holds up our state budgets past their due dates, we endorse Prop. 25 in the hope and expectation that it's just one step toward more comprehensive political reform in Sacramento - reform that would enable budgets balanced like the scales of justice rather than the seesaws of misplaced values.  

In acknowledging that Prop 25 is good medicine but not a panacea, we're echoing the ballot analysis prepared by the California Budget Project, which adopts a sort of shrugging tone and essentially boils down to, "This proposition would really change things in years when there's lots of money to spend and the legislature can't agree how to spend it."

We did some checking, and the last time having too much money was a problem for the state was 1849, which is technically one year before California was a state, and also the same year gold was discovered in the Sierra Nevadas.  

So we're saying, vote for Prop 25.  It promises to break part of the governance logjam that threatens the solvency of community clinics every year.  

We're also saying, if Prop 25 passes, don't think that the long push for political reform in Sacramento is over.  As Churchill said, it's not the beginning of the end; but it may be the end of the beginning.  

Immigration on the mind

For many of us nervously eying the state budget negotiations, perhaps the most unsettling proposal on the table is an elimination of Medi-Cal benefits for recent, legal immigrants.  That's L-E-G-A-L immigrants.  Permanent residents, actually.  Here in the US for less than 5 years.  Playing by all the rules.  

Except, of course, for Rule No. 189A-2 of the Federal Arbitrary and Inequitable Statutes of 1996, which says, in relevant part, that "unless you've been here for 5 years it's probably not a good idea to be poor because you're not likely to get any help with your healthcare."  

Okay, as savvy readers know, technically there's no such rule.  But essentially there is.  And it's the unfair singling out of immigrants that's so unsettling to those of us in the community healthcare world.

Because obviously there's no public health rationale for segmenting out recent immigrants from otherwise identical not-so-recent immigrants (or anyone else, for that matter) and blocking them from primary healthcare.  And the whole thing smacks of the same anti-immigrant fervor that's characterized legislative ridiculousness in Arizona and rhetorical ridiculousness on the California gubernatorial campaign trail this year.  Which is concerning.

Which is why this blog post from Henry Fernandez of the Center For American Progress Action Fund - which discusses the political Downside of beating up on immigrants - was so encouraging to read.

So there's your shot of optimism for the day.  Enjoy!

$7 Million Cut to CCHS

At Supervisor Susan Bonilla's budget town hall last night, Health Services Director Dr. Bill Walker gave the total tally for his department's cutbacks in the 2010-11 budget year: $7 million.

That's of course not the final number - just the initial target from the county administrator's office.  Final numbers come after the Board of Supes deliberates on April 20th.  And then a second round of cuts are probably in the offing - after the State passes its budget cuts sometime this summer (or fall, or winter, or, you know, whenever 2/3 of the legislature can agree on Anything). 

This year's $7 million cut target (out of a total County deficit of $50 million) appears to be less than last year's actual cuts.  By early March 2009, the department had already proposed $10 million in service reductions through a Beilenson notice, which included $6 million in savings from cutting services to undoc. immigrants. 

Not that $7 million is anything to shake a stick at; it's real money.  What programs will Health Services scale back?  The public won't know until - I assume - shortly before the budget hearing April 20th. 

But I wouldn't be surprised to see something about an attempt at greater efficiencies/governance changes for the County hospital.  County Administrator David Twa made clear last night that the $43 million/year in support that the County gives to CCRMC operations is unsustainable.  He also made clear that something's got to be done about it between now and 2014, when national health reform arrives in earnest and the uncompensated care burden for the County (presumably) plummets.  

To which Dr. Walker suggested, "Maybe the County can just give us a loan until then."  To which Twa and the audience responded by laughing. 

To which I say, the best jokes are funny because they're true.