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Report Finds Medi-Cal Expansion Strains San Diego's Safety Net

Report Finds Medi-Cal Expansion Strains San Diego's Safety Net
Report Finds Medi-Cal Expansion Strains San Diego's Safety Net GUEST: Kenny Goldberg, health reporter, KPBS

I'm Maureen Cavanaugh. It's Thursday, July 14. Our top story on Midday Edition. More people having access to healthcare through Medi-Cal is one of the success stories of the affordable care act. That it's not without challenges. Any report from the California Health Care Foundation finds that in San Diego, the number of people seeking health care services through Medi-Cal is putting a strain on the healthcare safety net. I spoke with health reporter, Kenny Goldberg. Kenny, think you for joining us. Thank you. What exactly is the healthcare safety net made up of here in San Diego? The healthcare safety net is first the Medi-Cal program which provides low income people with health insurance. And they get the care primarily from community clinics. There is a network of different clinics all over the county that provide primary care, some mental health care and a limited amount of specialty care. How successful has the Medi-Cal expansion been here in San Diego in terms of signing up people to the expanded program? It's been very successful since Obama care went into effect. The number of people on Medi-Cal and San Diego County has doubled. There are more than 700,000 people in the county that have the decal coverage. What does this report say about how the clinics are handling the expansion? They are handling it pretty well. They have expanded to handle the increased load. And community clinics provide care regardless of someone's ability to pay. When people have Medi-Cal, it offers a little bit of reimbursement to the clinics which helps their bottom line. And as I mentioned earlier, they have expanded to handle the increased capacity. However, having Medi-Cal insurance does not necessarily guarantee that you're going to get coverage for everything you need. That is one of the problems. This report said that primary care was doing well, right? That's right. Primary care is doing well. Again, that is because of community clinics. But some specialties apparently will not see any new Medi-Cal patients. Telis about that. This has been a problem I've reported on for many years. In the rate that the state pays doctors to treat Medicare patients is so low that doctors say it does not cover their cost, let alone make a profit. We're seeing an increasing number of doctors, especially specialists who are just not willing to treat Medi-Cal patients, new Medi-Cal patients, that is, for the rate the state paid. As a result you have orthopedic surgeons, for example, none of whom in San Diego County, as I understand it, will treat a Medi-Cal patient unless it is an emergency and they are on call. Does this new population of Medi-Cal enrollees also present special challenges when it comes to their health? Definitely. Many of these people are newly insured. They have not had health insurance in the recent past or even ever. Some of them are older patients. They have had a lot of health needs that they have neglected for years. Some of them are presented themselves to the community clinic with a variety of different chronic illnesses. Some more serious than others. Have a variety of unmet medical needs that they have neglected for some time. Are the clinics that usually see people who are on Medi-Cal or can only pay so much for their healthcare -- are they now working with hospitals more closely? Yes. Some of them are, to try to get more comprehensive care to Medi-Cal patients and some of their other clients. However, there's only so much charity care that hospitals can deliver. We still get down to the problem of Medi-Cal reimbursement. Somebody has to pay the surgeon. Someone needs to pay the anesthesiologist. If Medi-Cal reimbursements are so low, there has to be a source of money to make up the difference. Some of these things are happening. Some collaborative projects -- but it's still not as good as someone with private insurance. Also, the report examined the state of San Diego's hospitals. How are they coping with the change? I read some small hospitals are struggling. Yes, they are. That's not just because of the Medi-Cal expansion of course, that has been in the works. For example, hospitals like Tri-City are still having trouble meeting their bottom line. What is looming for many hospitals is 2030 -- that is the date by which all hospitals in California must be earthquake proof. They have moved that deadline back many times but I don't know if they will move it back again. Hospitals like Tri-City, who have tried to get local residents to approve a bond on successfully -- unsuccessfully, these hospitals need to find a source of money to upgrade or they will not be able to stay in business. I've been speaking with health reporter, Kenny Goldberg. Kenny, thank you. Thank you.

Report Finds Medi-Cal Expansion Strains San Diego's Safety Net
The expansion of the Medi-Cal program has exposed some gaps in San Diego County’s safety net, according to a new analysis from the California Health Care Foundation.

San Diego's health care safety net is showing signs of strain, primarily due to the major expansion of the Medi-Cal program.

That's according to a new analysis of San Diego's health care market from the California Health Care Foundation.


The report found that over the last two years, the number of San Diegans with Medi-Cal coverage has nearly doubled to 700,000.

Ha Tu, senior researcher at Mathematica Policy Research, co-wrote the report. She said by and large Medi-Cal recipients have gotten access to primary care at San Diego's community clinics.

“But I think the area where the San Diego safety net has faced more severe challenges have been in access to specialty care and behavioral health care," Tu said.

Some community clinics now offer access to mental health providers on site. But providers in many other specialties decline to treat Medi-Cal patients because of low reimbursement rates.

The analysis also examined the state of San Diego's hospitals and health care systems, and finds a mixed bag.


For instance, Kaiser Permanente has been making major gains in San Diego. One in five insured residents now have Kaiser coverage.

Sharp Healthcare and UC San Diego Health have also gained market share over the last couple of years, while Scripps Health has lost a bit of ground.

The report finds most of the county’s smaller independent hospitals have been losing patient volume and struggling financially.