There’s a Simple Prescription to Fix Medi-Cal: More Money

Gov. Gray Davis has shown signs recently that he recognizes the sorry state of affairs of the state’s health care program for the poor, Medi-Cal. In his revised budget proposal, released last month, the governor asked the Legislature to approve increases in Medi-Cal payments to physicians by 16.7% overall, with some areas, such as emergency services, getting a higher percentage.

That’s good, but we can do better. Our state has an almost $13-billion surplus, and there are many important reasons why we should use part of it to further shore up the Medi-Cal program.

For one thing, there has been no increase in the past 15 years for the vast majority of care given. Even with the increases in fees that Davis has suggested, California will rank in the bottom fifth of states in terms of funding for federal-state Medicaid programs. Adjusting for inflation, there has been a 54% cut in payments to physicians during this same period. The governor’s proposal would raise fees slightly--from $14.89 to $17.38 for suturing a facial laceration, for example, or from $43.25 to $50.47 for setting a broken arm--but that is not enough.

Raising the Medi-Cal fees somewhat more would provide at least marginal relief for doctors who care for the state’s 7.3 million uninsured who are under 65, of whom 2.7 million reside in Los Angeles County. These people rely on doctors who participate in the Medi-Cal program for care when they are sick or hurt. And if they can’t get it in a doctor’s office, they end up in hospital emergency departments or hospitals. Obviously, this costs far more, and it diverts emergency care physicians from true emergency cases.

We must do more to make the Medi-Cal program economically viable. Last month, more than 300 doctors wearing white coats and stethoscopes, accompanied by nurses, dentists and other health care providers, marched on the state Capitol to call for a 25% across-the-board increase in Medi-Cal rates. Many legislators--both Republicans and Democrats--joined them. Doctors participated in this rally, which was organized by the California Medical Assn., because they wanted to let legislators know that their goal is to provide quality care to the state’s neediest people, more than half of whom are working poor. Raising rates by 25% would bring California up to the national average, which is $3,789 per patient per year.

The Assembly already has approved legislation to augment the governor’s proposal in the areas of dental services and children’s specialty physician services. In the next month, as the Legislature moves to reconcile the Assembly and Senate versions of the budget, there is an opportunity to make a significant commitment to the strength and viability of California’s health care infrastructure for the needy.

Failing to do so could cost the state much more. Currently, only about 30% of physicians accept new Medi-Cal patients because doctors cannot afford to supplement the true cost of these patients’ care, which can range from 61% to 95% more than the Medi-Cal reimbursement. Many physicians who find it difficult to keep their practices operating in California because of low Medi-Cal reimbursements are leaving the state to practice in states where reimbursements in both managed care and Medicaid are based on the actual cost of care. California’s health care system cannot afford to lose any more of these doctors.

We can no longer ignore our state’s bottom-rung health care funding. Not when less than a third of our children receives essential preventive care. Not when Medi-Cal patients often have to travel great distances to see a specialist who can afford to treat them. Not when medical care is so undervalued that a manicure is priced twice as high as what Medi-Cal pays for stitches on a complex wound, and major surgeries are valued at less than a car tune-up.