COPA Healthcare Forum March 15, 2008

County level part

 

A group of COPA leaders did a research action recently, and spoke with the Director of the Monterey County Health Department, Len Foster.

 

He told us that having a health insurance card in Monterey County is the equivalent of having a hunting license: it allows you to hunt for a doctor who will accept the kind of insurance you have.

 

He told us that many healthcare providers are leaving this area, for at least 3 reasons:

• it is too expensive to practice medicine here
• the cost of housing is too high for them to live here, and
• doctors already have high debts from medical school, so they have to settle in a place that allows them to make the money they need to pay off their loans.

 

Result: there are too few primary care physicians here for the size of the population.

 

In addition to not having enough doctors to begin with, twenty-five percent of primary care doctors in this area do not accept Medi-Cal patients.

 

Many are also refusing to take patients with Medicare, because they think the reimbursement rates are too low for them to cover their costs.

 

As a result, finding a doctor who will take your insurance, or your Medi-Cal or Medicare insurance, is a constant pressure on everyone in our two counties.

 

California law requires that counties meet responsibility for basic medical care for all, regardless of ability to pay.

 

Santa Cruz and Monterey Counties meet this responsibility and offer care for low-income persons in different ways.

 

Monterey County is one of 12 counties in California that runs its own County Hospital, which is Natividad Hospital in Salinas. The County also offers clinics for primary care: there are five in Salinas and two on the peninsula in Seaside and Marina. Community Hospital of the Monterey Peninsula, fondly known as CHOMP, contributes $125,000 per year to help support these clinics.

 

In the last 18 months, Natividad Hospital has undergone wholesale reorganization using outside consultants to try to become more efficient and cost-effective. Being the hospital of last resort, Natividad cannot cover all its costs with paying patients, and lately its debts got bigger.

 

Before this recent reorganization at Natividad, the Monterey County Board of Supervisors directly supervised the hospital, and they each appointed their personal representatives to the Hospital Board of Trustees. Complaints about micromanaging and poor oversight were common.

 

The consultants are recommending that the hospital’s trustees be professionals, not Supervisor’s cronies, and that an administrator be hired who is trusted by the Supervisors, so they will let this person actually manage the hospital.

 

This summer the new Natividad administrator will be chosen, so this is a turning point for the County hospital.

 

Santa Cruz County provides low-income medical care in a different way.

 

It is one of 12 California counties that are “payor” counties.

 

This means they pay out of county general funds, supplemented with an annual allotment of state funds, to the medical providers.

 

These county providers are two designated clinics for primary care, and two public hospitals, Dominican in Santa Cruz and Watsonville hospital, for emergency services and specified inpatient care.

 

Santa Cruz’s program is called Medi-Cruz. It has received the same level of funding from the state, $4.2 million, since 1983, so over time it has cost the County’s general fund more.

 

Therefore, Medi-Cruz has steadily cut back on what it can offer.

 

Its target population is persons 21-64 years old who are not in another insurance program, and whose income is 200% or less of the Federal Poverty Level.

 

No surprisingly, much effort in Medi-Cruz is devoted to getting people onto MediCal, so the County is no longer responsible to pay for them.

 

Excluded services that Medi-Cruz cannot afford to pay for now include: routine physicals, preventative services, dental care, skilled nursing, psychiatry, optometry, and non-traditional or alternative medicine.

 

In both Santa Cruz and Monterey Counties, a large proportion of people are uninsured. A recent report by the Health Department on Monterey County says that 63,590 people were uninsured in 2005.

 

The table on your handout shows information from another study done by UCLA, which  puts the number of persons in Monterey County uninsured all or part of the year in 2005 at 92,250, almost 25 percent of the population.

 

You can see that in Santa Cruz County, the number of uninsured for all or part of 2005 was almost 20 percent, or 45,200 people.

 

These are the people that have to rely on the county-funded and operated clinics or the hospital emergency rooms for their care.

 

To summarize: 

• At the County level, care for low-income people is done on a shoestring of funding, and services are shrinking.
• Providers are fleeing this high-cost area, so there are not enough doctors for the people who live here.
• Costs to patients are rising as doctors try to recover their own costs.
• Insurance companies and federal Medicare and Medi-Cal programs are reducing reimbursements to doctors.
• Insurance companies have incentives to resist paying for covered services since this is where they make profits, and the constant fighting over claims increases paperwork costs and puts further pressure on the medical providers.

 

People who have employer-provided insurance with good coverage policies may not realize that a healthcare whirlwind is looming over them. 

These lucky people may only see that their insurance is getting more expensive each year.But a rude awakening even for people with insurance comes when they suffer an illness or injury, when they actually need to use their insurance. Suddenly they find coverage is denied, their policies are canceled, or other scrimping “risk management” strategies are used against them and their doctors. They may face medical bills of many thousands of dollars.

 

It’s not just low-income people in our two counties who have a problem accessing quality healthcare. We are all in this crisis together.