Not likely, even though having insurance usually = better health
Most studies show that just having health insurance not only increases the affordability of health care, it improves one’s health status. For example, a recent Health Affairs study found that:
Low-income people with diabetes are better able to afford their medications and manage their disease in states that expanded Medicaid under the Affordable Care Act . . . .
The study found a roughly 40 percent increase in the number of prescriptions filled for diabetes drugs in Medicaid programs of the 30 states (including Washington, D.C.) that expanded eligibility in 2014 and 2015, compared with prior years.
By contrast, states that didn’t embrace the Medicaid expansion saw no notable increase.
Medicaid Expansion & California
A key component of the Affordable Care act was the expansion of Medicaid to populations who were previously ineligible. And California enthusiastically embraced the expansion. California Healthline reports that nearly 4 million Californians gained coverage during the 2014 Medi-Cal expansion.
No one can deny that Medi-Cal is saving lives every day. Here’s one story from the California Healthline article:
…James Warden, 62, a retired rancher near Fresno, Calif., said he was forced to stop working because of a back injury several years ago.
Warden enrolled in Medi-Cal in 2016 and was diagnosed with diabetes last year after a urinary condition landed him in the hospital, he said. Without the coverage, he said, he wouldn’t have the insulin his body needs.
“Medi-Cal saved me,” he said. “I wouldn’t have the money to be able to pay, or go to the doctor or anything.”
So what about “Medi-Cal for More?”
If state Medicaid programs (like California’s Medi-Cal) have helped so many, why not expand them to everyone? After all, states have more control over their Medicaid plans, whereas tinkering with Medicare means having to deal with the healthcare-hostile Trump administration.
According to an 8/2/18 article in the Washington Post,
The idea in concept is simple: Allow states to open up their Medicaid programs to anyone regardless of income. Those people could buy in to the social safety net and have access to Medicaid’s provider network and benefits.
And in fact, a federal Medicaid buy-in program, S.2001, was introduced by Senator Brian Schatz (D-HI) in late 2017.
Is incremental better?
Many politicians and policy makers are drawn to incremental steps like “Medicaid for More” because they believe it could be politically attractive to conservative voters, for several reasons:
- Voters who support state’s rights would see expanding Medicaid as “state flexibility.”
- The program could be viewed as a “compromise.”
- Moderate Republicans could find much to like about it.
Could Medi-Cal for More work in California?
Depends on what you mean by “work,” and if you think Medi-Cal is working now.
Because to gain universal coverage using Medi-Cal, we’d have to add over 3 million more people to the program. It’s daunting when one considers that Medi-Cal is already budget-starved, with the third lowest physician reimbursement rates in the nation.
In fact, Medi-Cal reimbursement rates are so low, the State of California has been sued by the Mexican American Legal Defense and Educational Fund (MALDEF) for discriminatory practices.
The suit alleges that:
. . . as California’s Medicaid recipients have become increasingly Hispanic, the state’s reimbursements for Medi-Cal have fallen over time compared with reimbursements for Medicare, the federal program providing health care for those over 65.
Beneficiaries of Medi-Cal fail to receive timely access to quality care compared with the largely white populations that use Medicare or private insurance, they say.
“Medi-Cal participants suffer from greater pain, illness, and undiagnosed and untreated serious medical conditions — with significant impact to their overall health — than do their fellow Californians with other insurance,” the plaintiffs argue in the lawsuit, Perea v. Dooley.
What about quality?
It’s a little-known fact, but Medi-Cal programs are being run by health insurance companies with virtually no oversight on performance.
You read that right. No quality scorecards currently exist for insurers running Medi-Cal’s Managed Care plans, and a recent report from the Center for Health Journalism indicates that state officials have no plans for performance measures.
It’s been over a decade since the California Health and Human Services Agency began publicly posting quality scores for commercial health provider groups. When they went live in 2007, many expected a scorecard for the state’s Medicaid providers would soon follow.
But more than a decade later, consumers, policy makers, and others still remain without a scorecard to track the performance of Medicaid provider groups, which now serve more than one in three Californians. And if the reply we recently received from top state officials is any measure, don’t expect one anytime soon.
Bottom line
For all the good it does, the Medi-Cal program has a number of problems. Expanding it to more people the way it is now is not the answer.
Without dependable funding, higher reimbursements for providers, and adequate performance oversight, expanding Medi-Cal will threaten a safety-net program that is already overburdened and unstable.
–Georgia Brewer
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HEAL California is an independent news and information hub focused on the California Medicare for All movement. We feature non-partisan news, views, podcasts and videos that highlight the continuing failures of our broken healthcare system and elevate the voices of advocates and organizations fighting for change.
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