CMA Capitol Insight: March 16, 2015
CMA Capitol Insight is a biweekly column by veteran journalist Anthony York, reporting on the inner workings of the state Legislature.
The Budget Showdown Begins
It’s showdown season in the Capitol, as lawmakers and administration officials begin sparring early over the issues that will shape the 2015–16 budget.
Looming large are questions over Medi-Cal, which was back in focus in Sacramento this week.
The Assembly and Senate health committees held an oversight hearing on the growing government healthcare program. The four-hour hearing featured Jennifer Kent in her new roll as director of the Department of Health Care Services, which oversees the Medi-Cal program.
Assemblyman Jim Wood grilled Kent on the accuracy of the data about Medi-Cal networks, mentioning a “number of people on the books who are actually not providing coverage” to Medi-Cal recipients. “When I talk to providers, the number of people participating has dropped dramatically,” he said.
Wood blamed provider rate cuts for the network problem, a concern echoed by a number of different lawmakers at the hearing.
But Kent held firm to the Brown administration line, viewing the Medi-Cal issue through the lens of budget pressure before adequacy of coverage and care. The governor continues to reject calls to reverse a recent 10% cut to Medi-Cal providers, despite bills from the chairmen of both legislative health committees and bipartisan support for the higher rates.
That led to a showdown between Kent and Senate Health Committee Chairman Ed Hernandez. Hernandez asked Kent whether Medi-Cal patients have the same access to doctors as affluent tech workers in the Silicon Valley.
"Yes or no?" he said.
"Yes," Kent said.
"I don't think so," Hernandez replied.
Hernandez is authoring SB 243, which like Assemblyman Rob Bonta’s AB 366 would reverse rate cuts to doctors who treat Medi-Cal patients. It also would go further, requiring higher payments from managed care plans that contract with the state and boosting funding for hospitals.
"Millions of Californians are walking around with insurance cards that hold no or little weight," said Bonta (D-Alameda). “That insurance card should ensure access."
Network adequacy was a major issue for dental coverage as well, in the wake of a new state audit that found nearly 60% of Denti-Cal recipients do not have access to an actual dentist.
California’s Denti-Cal program promises basic oral healthcare coverage for more than 5.1 million children from low-income families, but most of those kids never actually see a dentist. The lack of access to dentists has led to a crisis in coverage for millions of Californians, placing many of our neediest children at risk.
The problem impacts urban and rural counties alike. Five counties with at least 2,000 eligible children are without any participating dentists in the Denti-Cal program; 11 counties do not have any dentists that will accept new Denti-Cal patients; and 16 counties have too few dentists accepting patients to care for children who need it.
There is no better way to move the political needle on these types of essential issues than making sure the right kinds of candidates run, and are elected to public office. Ensuing that medical professionals participate in political campaigns — be it through their financial contributions or running for office themselves — ensures that the medical community’s issues are heard in Sacramento.
Doctors won major political victories in 2014, including electing one of their own, Richard Pan, MD, to the state Senate in a hotly contested race with fellow Democrat Roger Dickenson. Doctors also mobilized to put down a cynical effort by trial lawyers that would have driven up the cost healthcare for everyone (Proposition 46).
Neither of those things would have been possible without the financial contributions from doctors and the work of CALPAC, the California Medical Association Political Action Committee.
CALPAC is already looking ahead to 2016, and looking to support physicians who are taking a hard look at public office. In Fresno, emergency room doctor Joaquin Arambula, MD, a Democrat from Kingsburg, is considering a run, and making a medical school in Fresno one of his top political issues.
The fight for issues like Medi-Cal provider rates is often won or lost in the elections before the legislative session. We’ll see if this is the year that the state begins to reverse some of the devastating cuts from the great recession, and ensure that all Californians with healthcare coverage have meaningful and adequate care.