Health Advocates Debate Possible Effects of Medi-Cal Redesign Proposal
The San Diego Union-Tribune on Wednesday examined Gov. Arnold Schwarzenegger's (R) proposal to redesign Medi-Cal. Although the proposed Medi-Cal redesign would "dramatically change health care services for the poor," it has "received little attention," in part because it is not "as draconian as some public health advocates had feared," according to the Union-Tribune.
Some Democrats and health care advocates said the proposed redesign could limit Medi-Cal beneficiaries' access to specialists, primary care doctors and dentists, while increasing the number of uninsured residents.
Advocates said they were "skeptical" that managed care plans would participate in the Medi-Cal redesign and added that moving more beneficiaries into such plans, which "some doctors dislike," could result in beneficiaries having to switch physicians, the Union-Tribune reports.
Robert Hertzka, president of the California Medical Association, said, "Many of the traditional providers are deeply distrustful of managed care. If the patient is forced into the program and the doctor doesn't want to go, that could disrupt the doctor-patient relationship."
Critics of the plan also said that some Medi-Cal beneficiaries who would be switched under the redesign need frequent visits to specialists, which are limited by some managed care plans.
Cheryl Bergan, a policy analyst for the California Foundation for Independent Living Centers, said, "We want to make sure that disabled people continue to have access to specialists."
Dentists said they did not support limits on dental services but noted that the governor could have chosen to eliminate the benefit completely.
Harriet Seldin, a San Diego dentist and vice chair of the San Diego County health services advisory board, said, "We don't want the cap, but we appreciate their commitment to preserving a comprehensive program."
Sen. Denise Ducheny (D-Chula Vista) called the plan a "good starting point" but noted that the cost of collecting Medi-Cal premiums could exceed the funds they would generate. "We may be spending $10 a month to collect $5," Ducheny said, adding that by implementing premiums, "you could end up with people not getting regular care and then going to the emergency room."
Bergan added, "If I'm a disabled person living in California on $1,000 a month and paying a lot for housing, $10 a month can be a lot."
Health and Human Services Agency Secretary Kim Belshe, who introduced the plan at a budget briefing, said the proposed premiums would keep Medi-Cal consistent with Healthy Families. Belshe added that the dental cap is similar to those offered under many employer-sponsored health plans.
"Our goal is to move in a direction that will promote better access, better coordination of care and, over the long term, contain costs," she said (Ainsworth, San Diego Union-Tribune, 1/19).
Taxpayers in 2005 should not "be hostage to an entitlement program stuck in the Summer of Love," and Schwarzenegger should be given credit "for using the budget to push reforms that would modernize Medi-Cal," a Riverside Press-Enterprise editorial states. According to the editorial, although it will take "years to achieve significant thrift" under the governor's plan, it is "crucial to impose marketplace discipline on the program now" so that it will not "become such a drag on taxpayers that it won't be able to serve anyone."
The editorial concludes that lawmakers "should use these initial changes to launch a series of taxpayer-friendly efficiencies" (Riverside Press-Enterprise, 1/16).