How California’s Health Care Landscape Is Shifting

At a panel discussion in Sacramento yesterday, the line of the day belonged to Louise McCarthy, head of governmental affairs for the Community Clinic Association of Los Angeles County.

The phrase “elephant in the room” kept coming up throughout the discussion, and usually it referred to some health care money owed and not being paid by the state.

“It’s not an elephant in the room we’re dealing with,” McCarthy said. “It’s more of a pachyderm party right now.”

It’s an interesting time for health care in California. On one hand, the anemic state budget has meant widespread slashing of state health services, and on the other, the state is far ahead of the rest of the nation in implementing health care reform and corralling the federal dollars that come with that.

So the experts who gathered for a California Health Policy Forum staged by the Center for Health Improvement brought a mix of exasperation and hope to the table. They talked about how California’s safety net of health care services will change in the next few years, and how it needs to change beyond that.

“We ought to be thinking about today, tomorrow and the day after tomorrow — if you think of tomorrow as 2014,” Lucien Wulsin of the Insure the Uninsured Project said.

“County health is in a whole world of hurt,” he said. “You’re looking at 6 ½ to 8 million uninsured in California. The number of Medi-Cal patients went up like crazy, and state money went down.”

That’s where the recently approved Medicaid waiver can make a big difference, according to David Maxwell-Jolly, head of the California Department of Health Care Services.

“The key challenge is adding people to Medi-Cal, as many as 2 million,” he said. “Now, a lot of these people won’t have health problems, that’s one reason why they’ve been uninsured. But there also will be a substantial number of people who have serious health and behavioral issues, and that presents a major challenge.”

The idea, he said, is to prepare for covering so many more Californians in 2014 by trying to take on a lot of those people now, to get them incorporated into the Medi-Cal system so that the huge shift in medical care in 2014 goes smoothly.

“That’s the key to making sure we do things efficiently,” he said.

The other key is to beef up primary care, according to Kelly Pfeifer, director of the San Francisco Health Plan.

“The main message, yes, we’re in a tremendous mess, but there’s hope,” Pfeifer said. “And the hope lies in primary care.”