Tuesday, March 25, 2008

They Can Always Go To The Emergency Room

Here's California's version of the trickle-down theory: cut social services and drive providers out of the market. That's what's happening with Medi-Cal, the safety net for the poor. In order to balance the budget without raising taxes, Governor Schwarzenegger has cut reimbursement rates to the point where doctors and clinics are now closing their doors to Medi-Cal patients. As a result, more of the poor are using emergency rooms, which are far more costly, as this story in yesterday's Los Angeles Times makes clear.

Reimbursement rates, doctors say, already are so low that a patient office visit nets only $24. Some clinics say the numbers simply don't work anymore. The result: Thousands of patients guaranteed healthcare under state law can't get in to a doctor's office, so they don't go or they sit for hours in an emergency room.

Experts warn that things may get much worse.

Chris Perrone, an analyst who tracks Medi-Cal issues for the California Healthcare Foundation, said Medi-Cal risks are becoming so unattractive to doctors that the program could soon "fall off the edge." ...

Funded jointly by the state and federal government, Medi-Cal is California's second-biggest expenditure after education. It is projected to cost $38 billion next year, with about $15 billion drawn from the state's general fund. The program serves 6.7 million poor, elderly and disabled people.

The projected savings from the cuts, say state officials: more than $500 million annually.

The Legislature's nonpartisan budget analyst, Elizabeth G. Hill, had advised against the cut because it could discourage so many doctors from taking Medi-Cal that patients would be forced into emergency rooms, where treatment is far more costly. The state will also lose hundreds of millions of dollars in matching federal funds.

Medi-Cal is an easy target because it is such a huge part of the state budget. Part of the problem could have been eased by passage of the universal healthcare proposed by the governor and championed by some Democratic leaders. Medi-Cal reimbursement rates would actually have been increased with money from some of the fees included in that plan. Unfortunately, the plan got dashed by Republicans and some Democrats because it either went too far or not far enough. This is the governor's response to that defeat.

So, because in many instances doctors actually lose money by taking Medi-Cal patients, more doctors are closing their doors to the poor. The result will be felt in the coming months and years.

"It's ludicrous that every time we have someone who needs to see an orthopedic surgeon for a broken arm, our only option is to send them to the emergency room where they have to sit for four hours," said Ramos, the Modesto-area physician. "It is a huge waste of money, it is a huge waste of resources, and it is not good patient care."


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