Published by the San Jose Mercury News on June 23, 2014.
Health care challenge: Medi-Cal insurance doesn't guarantee access
On March 23, 2010, President Obama signed into law the Patient Protection and Affordable Care Act. Expanding Medi-Cal is one of the important ways the ACA increases access to health insurance, but providing insurance does not ensure health care will be available. It's important to understand the facts related to access to health care in our state.
Thankfully, California is one of the states that committed to expanding government coverage for the poor and uninsured. At this time, the number of Californians served by Medi-Cal is increasing and approaching one-third of our population, or 10 million. Unfortunately, reimbursement rates for providers who serve the poor are declining drastically.
For this and other reasons, the number of primary care and family practice physicians who accept Medi-Cal is decreasing. Private and community hospitals are also consolidating or closing, reducing the supply of Medi-Cal beds. Emergency rooms in the remaining facilities are filled, frequently with nonemergencies. All of this underscores the fact that providing insurance does not guarantee access to health care.
We have the perfect economic storm of increased demand and reduced supply. In normal environments, this would lead to higher prices. However, that option clearly does not exist as the primary payer, the government, is not prepared to pay more.
It's also important to note an estimated 13 to 15 percent of Santa Clara County residents, or approximately 220,000 people, will not qualify for government or other insurance, including Covered California plans.
Community health centers are an essential part of this impending crisis. They have always made serving underserved communities their primary focus.
Centers in Santa Clara County provided approximately 450,000 patient visits to 166,000 patients in 2012. The vast majority of those patients were covered by Medi-Cal.
Gardner Family Health Network and other centers don't turn down patients who use Medi-Cal or lack coverage. Rather, we welcome all regardless of income, immigration status, or ability to pay. We are, however, limited by capacity.
In Santa Clara County, we must increase awareness of the essential role of community health centers and improve our ability to meet the growing demand for services.
To expand and improve service delivery, we intend to strengthen our partnership with Santa Clara Valley Health and Hospital System to coordinate and implement a system of care for our most vulnerable. This includes sharing data and helping to develop a patient-centered "medical home" concept, which is designed to coordinate a patient's care among multiple providers.
We will also collaborate with government and community partners to expand access and improve quality of care for medically underserved communities. These include immigrants, the working poor and the large homeless population of Santa Clara County.
We also will continue efforts to educate decision-makers, community-based organizations, and the general public about the impact of the ACA.
Community health centers such as Gardner are working to reach more underserved communities and continuing to improve already high-quality care, while saving taxpayer dollars. They are a proven solution for a nation searching for better returns from the health care delivery system.
As such, they deserve greater recognition and community support.
Reymundo C. Espinoza has been CEO of Gardner Health Services for 24 years.