Health Care In The States

Is California Headed For State Vs. Counties Health Budget Battle?

By Sarah Varney

January 11th, 2013, 8:56 AM

SAN FRANCISCO – After four years of massive budget cuts to California’s public health insurance programs – and the voters’ approval of a tax increase –  Gov. Jerry Brown is laying down his scalpel.  Brown presented his proposed budget for the coming year on Thursday, including an additional $350 million in funding for the state’s Medicaid program and a cautiously emphatic endorsement of President Barack Obama’s health care law: “What President Obama did was historic and heroic,” said Brown, a Democrat, during a press conference in Sacramento, Calif., “and I will be a good partner.”

California was an early supporter of the law, and indeed it was the first state to pass legislation authorizing a state-based health insurance exchange, but Brown had never declared definitively that the state would open its Medicaid program, known as Medi-Cal, to poor adults with no dependent children, as prescribed by the Affordable Care Act. At his budget unveiling, Brown floated several options for following through on that pledge: California’s 58 counties which, by state law, are required to provide health care to the “medically indigent” could administer their own programs or, Brown seemed to strongly suggest, the state could relieve them of their duties for a price.

California’s counties receive some $3 to $4 billion a year from vehicle registration fees and the state sales tax to provide health care to impoverished residents. If the counties cede that duty to the state, Brown suggested, they will have to forgo at least some or all of that funding. (Or in one novel alternative: swap providing health care for footing the bill for child care for poor families.)

Just how much revenue counties would have to give up will be the topic of negotiations in the coming months, and counties that operate their own public hospitals will have much to say. Public hospitals are often the only source of medical care for the uninsured, and they – and other hospitals that provide unreimbursed medical treatment to poor patients – are already facing a reduction in federal payments under the health law. The Golden State is expected to have 2 to 4 million so-called “residual uninsured” in 2014 when the health law takes full effect. Those residents, many of whom are undocumented and barred from buying their own insurance coverage through “Covered California,” the state’s online marketplace, and are ineligible for any public insurance programs, will continue to rely on county-run facilities and safety-net clinics.

If the state drains the counties of health care funding, says Anthony Wright, executive director of Health Access, an advocacy group, “You run the risk of losing public hospitals and clinics at exactly the moment we need all the capacity we can get.”

Brown’s summons to the negotiating table was not unexpected, says Farrah McDaid Ting, a senior legislative analyst at the California State Association of Counties. “We knew there was going to be a conversation this year about how counties spend money on health care,” says McDaid Ting. But she says many California counties have made an enormous effort over the last few years enrolling impoverished residents into county-run, Medicaid-like programs with considerable funds from the federal government and those newly enrolled residents “were supposed to flip the switch in January [2014] and go straight into Medi-Cal.” Indeed, the program, which required a waiver from federal Medicaid laws, was called “Bridge to Reform.”

For supporters of the health law here in California, the clock ticks too quickly. While the legislature will begin a special session on health care concerns later this month, Wright says he is keenly aware that there are only nine months until residents are expected to enroll in health insurance plans: “We need to do this with all speed and urgency.”

8 Responses to “Is California Headed For State Vs. Counties Health Budget Battle?”

  1. larry says:

    Face facts! Insurance companies have screwed up America’s healthcare system so that we pay twice as much as any other nation in the world and we still have a failed system that excludes 50 million uninsured and another 25 million more that are underinsured. Some say America has the best healthcare system in the world. Oh yeah? Only if you can afford it! Nearly one in four Americans can’t! California legislators have said that they are thinking about going to a single-payer healthcare system like Vermont is trying to do. The sooner all of America goes to a single-payer universal system and eliminates the insurance companies, the better our healthcare system will be. The only good insurance company is a bankrupt insurance company.

  2. I’ll be interested to see how many Co-Ops are created.

  3. That is to govern for the people, the rationale of every nation, with a basic welfare state would avoid overspending and could increase prevention.

  4. Mai says:

    Ca. currently spends more dollars on welfare than any other State. How much is too much and how does the State keep out the “freebie” jumpers from other States as well as other Countries that want to come onboard the Ca. Health Care welfare train of the future? What is there in the comming health care statutes that determines eligibility and fraud?

  5. rich says:

    “What is there in the comming health care statutes that determines eligibility and fraud?”

    No much! That’s because the greedy people who wrote law, the private health insurers, are making huge profits as long as they stay in complete control. The only way we will end the fraud and abuse is to go to a universal single-payer system. In a universal single-payer system, everyone in America will be assured access to quality and affordable healthcare from the government. As long as there is a profit motive involved in healthcare, like we see today, the greedy providers and the greedy insurance companies in the healthcare industry will find a way to scam the system. When the health insurance companies are totally eliminated and when the providers are all government employees, the consumer will get what we deserve for our tax dollars. What do we deserve for our tax dollars? Quality and affordable healthcare for everyone, just like in Canada and Europe and in all of the other industrialized nations of the world. Will it be perfect? Nope! But it will be “equal” and it will be “accessible” and it will be “affordable” and nobody will be turned away and nobody will go broke just because they can’t afford the kind of corruption and discrimination in treatment we see today.

  6. I firmly believe that the only way to end the fraud and abuse is to go to a universal single-payer system so that everyone in America will have an access to quality and affordable healthcare from the government like Europe, Canada and all the other industrialized nations of the world.

  7. Marie says:

    You speak of a universal-pay system that will be affordable to all. Does that mean a sliding scale per income? A set per cent of income? Does that mean you trust the government to determine how much you can afford? Do you think fees, fines and taxes will disappear? Do you think this would NOT be another form of revenue geneation that will be used in other budget items? There are no lock-boxes for funds. You saw that with the movement of money out of social security decades ago. Whether it is the city, county, state or federal government, are you sure you are willing to give every choice (freedom) over to it? The laws regarding health reform should have been written long ago to reign in the cost, not to reign in the citizens.

  8. rich says:

    Marie asks a lot of “Do you” questions that are clearly answered in the Affordable Care Act (ACA). The sad part is, most Americans either can’t read or they wont read even a summary of the ACA. The HHS website has great summaries and timelines regarding the ACA. The new law begins to reign in the costs and it sets guidelines for realistic expectations. Is it perfect? Nope! But it beats anything that Republicans have ever proposed in the past or will ever will propose in the future. In fact, the ACA embarrasses Republicans because their own ultra-conservative Heritage Foundation had the basic idea of a mandate in the first place, that is until the tea party ordered moderate Republicans to abandon it. Even former moderate Governor Mitt Romney liked the Heritage Foundation’s mandate idea so much that he enacted it in Massachusetts. For some strange reason, hypocrite Republicans simply will not accept any ideas that come from President Obama, even if they had the same idea in the first place.