S1: Welcome in San Diego. It's Jade Hindman on today's show. The latest with Medi-Cal cuts and raw sewage pollution gone airborne in the Tijuana River Valley. This is KPBS Midday Edition. Connecting our communities through conversation. For people who live and work near the Tijuana River , raw sewage has actually turned airborne. Um , if you can believe that , it's airborne pollution and it is a facet of daily life , a foul gas , it seeps into homes. Many suffer from chronic illnesses. And they're not just sick and tired. The people who live there , they are frustrated. I knew source spent months talking to more than 100 people living this reality. People like Gabriel Uribe. Take a listen.
S2: Hydrogen sulfide got to a point where , you know , we had to use respirators. I had to sleep with all my windows sealed inside my little cabin there. And , uh , even like that , the stench would just find its way in. Then I was stuck inside a room. I didn't know whether to open up the windows and get the breeze of of all the terror just fester in it. It definitely wakes me up. My body's telling me , go put on that respirator.
S1: Gabriel's story is one of many featured in a new reporting series from a news source. It's called homesick. And joining me to talk about it is Philip Salata. He's energy and environment reporter for a news source. Philip , it's great to have you here in studio.
S3: It's really great to be here , Jade.
S1: Thanks for coming in. You know , public health in the Tijuana River Valley has been an issue for quite some time.
S3: And he pointed out that there are no long term studies about chronic health impacts and long term exposure to hydrogen sulfide , let alone all the other pollutants they were finding. And he said , in fact , there are none because it would be an unethical experiment , which really impacted me. And yet that experiment was taking place before our very eyes. So I saw and our team at a news source , we saw a gap to fill in terms of kind of threading together the stories of those impacts to start to begin a kind of narrative approach to that study. Right.
S1: Right. You mentioned those threads and the stories of chronic illness , they come together in that way.
S3: Almost all people either had or knew of people who have had symptoms related with exposure to these chemicals. So , you know , respiratory and gastrointestinal issues , skin infections , sinus infections , chronic diarrhea , burning eyes. There is , for example , one resident , Alana Shapley , who who I believe we have queued up here today.
S4: Certainly changed my quality of life. No doubt when you're ill every single night and you don't know what it is , and even when you do know what it is there , you can't stop it. Hmm.
S1: Hmm. I mean , go ahead.
S3: I'm sorry. Yeah. It just , you know , I think a very powerful aspect of talking to so many folks is to see how many experiences were similar , and yet many didn't know that other folks in the community were experiencing the same kinds of symptoms. And there was also this question of the change of life itself. Right ? These issues have become normalized for many years , and yet the reality of day to day in the South Bay has been completely transformed. People talk about a certain kind of loneliness. Also , people who stopped coming to visit them and the kind of , you know , both having a love for their home. But then a shame that it has become a place where they cannot be the hosts to a river valley that they call home. Wow.
S1: Wow. Well , I want to talk about the way you even write about the stench of the pollution.
S5: As if it's , you know , a.
S1: Living creature. And that's clear through the quotes you incorporate describing the smell like a hand or a monster coming inside the house.
S3: These are the words of the residents themselves. They would describe them in these very physical and image image forward ways , and in many cases also describing how that physicality then manifested through their symptoms , but also in their lived experience and their perception of being in that place and having to live with it on a daily basis. And so it had a kind of psychological impact as well. So that very much fascinated me. But I think it's also important to understand that it's not the river that is the monster , right ? The monster is a it is the the policies and all the human errors that have brought us to this position that the pollutants are now poisoning that river and affecting and transforming the lives of people.
S1: Well , exactly. And when you said that , you know , scientists say it would be unethical to sort of track the data in terms of how people are being sickened by this airborne pollution. That is shocking.
S3: Absolutely right. We have data in terms of kind of more acute exposures that are used in working situations , for example , like working inside a sewage treatment plant. But we don't have the data around these kind of long term impacts. And I know some of some experts also talk about how that's maybe because a lot of these kinds of pollution crises take place in place in places where a lot of people live who don't have resources. And that that if it were happening anywhere else , right , perhaps that problem would not be going on and we'd know more about it. Wow.
S1: Wow. Well , you know , we've certainly covered this. The impacts.
S5: Of that airborne pollution in the South Bay for.
S1: A while. And I'm curious , I mean , what do local doctors.
S5: Say about.
S1:
S3: And what they found is that there was a correlation. And so it basically the point was that they are calling on further studies to be done , because they are seeing those correlations already taking place. Right. So they've started doing some of their own work. But but to really understand the depth and the extremity and the length of this problem , a lot more work is going to need to be done. Hmm.
S1: Hmm. It's weird.
S3: I mean , the the moment when former supervisor Nora Vargas had come out and said during a press conference that the air was smelly but safe , it's really become an infamous statement that I've heard many people in the South Bay talking about in , in with still with a lot of shock. I mean , it is important to say that now there is a new supervisor in place who is the former Imperial Beach Mayor Supervisor Paloma Aguirre , and there's a change of narrative now , but that still means we're playing catch up from , you know , decades for decades of of of neglect.
S1:
S3: There's a lot of money flowing billions and billions of dollars. Right ? And there has to be the political will to actually resolve the problem. We're kind of in an interesting situation right now. We do have money from the federal government that was secured under the Biden administration to fix the South Bay water treatment plant , and there is continued impulse under the Trump administration to speed up the timelines on that. But we also see , you know , a precarious global international situation. And this isn't an international issue here at our border. So it's going to take very important steps to have a good relationship across the border for that. For the problem to be resolved. Yeah.
S1: Yeah. Some collaboration there. Exactly.
S3: Exactly.
S1:
S3: The Environmental Protection Agency's Lee Zeldin did actually come to San Diego and has begun conversations with Mexico to try to speed up timelines. And there has been now a new agreement released just last month that also looks at potentially doing some studies on taking into account how Tijuana will grow , to see what kind of future infrastructure is needed. But it's really a wait and see kind of game. A lot of the the organizers I've been speaking with are looking at whether those timelines are actually going to be met , and we are still years , years out from from any actual solutions.
S1: The wheels have been turning so slowly on this as people who live there are getting sick. You know , another avenue residents have turned to is lawsuits against the federal government and the company that runs the wastewater treatment plant on the on the border there. How successful have the lawsuits been ? Just generally speaking.
S3: The lawsuits are all in the state of growth , right ? They have they have. Now , one of the lawyers I spoke with talked about having over 2000 clients signing on to these lawsuits , and that's just one of them. But that is also a process that is still years. It's years in the in the making. So there are still residents joining them. And we're going to see what that's going to that's going to mean. But I think that a lot of residents are looking less at what the lawsuit may bring to them. Financially speaking. They're thinking more about whether the pressure from the lawsuits will actually result in solutions. I mean , I believe we also have cued up mr. Tony McGee.
S6: And what they're waiting on is this devastation to happen. That doesn't make dollars nor sense , in my opinion. So what are we , the subjects.
S3: Right ? Dollars. Dollars nor cents. Right. And this. This particular person , Tony , he's living with a view of the estuary. He moved down to the South Bay and really cherishes this river valley. I mean , he talks about , like , this National Geographic scene in front of his window , but now he's , you know , with his window open and all this air seeking in all of his health issues have compounded. He's even talked about the the smells of the sewage seeping into his skin and being able to smell it in his own skin. Right. And he pulled out , actually , he walked over to the kitchen and brought to me a stack of papers that he folded out like a deck of cards , and there were all of his prescriptions. And you can actually see that photograph in the project. And he spoke to me. I have not been taking medicine like this in all of my life. And now I'm I'm having to do and deal with all of this.
S1: Yeah , yeah , it's a sure injustice for people who live in that area. I mean , you know , and many of the folks like Tony , you know , they expressed a lot of love and appreciation for their home in the Tijuana River Valley despite the ongoing pollution issue.
S3: Right. And it has gone largely unscathed. And in the last 100 years , we have compounded these problems to an extent that you are now seeing all of these chronic illness symptoms And there are people in the South Bay now who have been there for generations. They have seen their families grow. They're farmers , dairy farmers , all sorts of folks who have seen generations and generations of their own be raised there , and they don't want to leave. They have a connection to that place , and some don't have the means to leave. And that sentiment of being so connected to a place and so hopeful that that there is something on the other end of this man made pollution crisis. It was something that really impacted me throughout the project. And there are many projects now going on on both sides of the border to try to rehabilitate the river. I think one that really struck me was a deep right below the Rodriguez Dam in Mexico. There's a short section of the river that's not channelized , and there a group has started to replant the valley with native plants. And that was the first time that I could see what that river valley would look like in the future , if we were able to really harness this problem and have our estuary here in the United States blossom into the place that it has been for millennia.
S1: Yeah , well , you know , this is really an environmental justice issue.
S3: Every person I can actually say pretty , pretty much every person said to me , if this were happening anywhere else , it would not be. It would not be a problem. And having to.
S1: Be specific , when you say anywhere else , what do you mean.
S3: Right ? I mean , if it were happening in , well , well-to-do communities in North County , they specifically said this would not be a problem. And also white communities specifically. And and they have to live with this problem on a daily basis. And I think another very important point here is the mental health impact of not being able to leave. Right. What does that mean ? Also not being able to go outside for many days of the year , or not even being able to go to your own coast while living two blocks away from it. You know , it's become so normalized that a very elementary elementary school now has what they call a smell days instead of rainy days where they go into a rainy day schedule and the kids have to stay inside. So this is something that I think we have to be aware of. Wow.
S1: Wow. And that mental health aspect is something I'm sure a lot of people hadn't even thought of. Philip , thank you so much. I've been speaking with Philip Salata. He's energy and environment reporter for eNews source. You can check out his eNews source series , Home Sick on the website eNews SourceForge. Philip , thank you so much again.
S3: Thank you so very much. Jade.
S1: Up next , how San Diego health care providers are bracing for Medi-Cal cuts. KPBS midday edition returns after the break. Welcome back. You're listening to KPBS Midday Edition. I'm Jade Hindman. With cuts to Medi-Cal looming , providers across San Diego are bracing for the impact. Here with all the details , is Paul Sison. He's a health care reporter for the San Diego Union Tribune. Paul , welcome.
S7: Thanks for having me.
S1: So glad to have you here. So , you know , before we get into the the specifics , break down some of the biggest changes to Medi-Cal so far.
S7: As has been covered a lot , the enhanced premium subsidies that they have been receiving have now expired. Congress has chosen not to renew them. So that creates an immediate effect for , uh , you know , about 120,000 people in San Diego County and many more than that statewide and nationwide. And then the big Medi-Cal cuts are coming , but most of those are going to take effect next year. For example , requirements that a certain group of folks who are currently on Medi-Cal meet work requirements and prove that they're trying to find a job if they if they don't currently have one. Those requirements are due to take effect at the start of the next year , and many of the providers now were sort of looking at what the the impact will be when those take effect. You know , I mean , this these are , these are , you know , a big multimillion dollar question. So they are scrambling to try to figure out how they're going to fill gaps. You know , some of these requirements are expected to reduce overall Medi-Cal enrollment. And so those folks will end up coming in to emergency departments they suspect in greater numbers. And the care won't be compensated. Hmm.
S1: Hmm. Um , before I go to the next question , I wonder if you have any sense of how hospitals will manage that.
S7: Uh , you know , what economists say is that they shift a lot of those costs to , uh , third party commercial payers that a lot of us get coverage from our from our employers , you know. And so traditionally they have shifted some of that cost to the commercial side of the house. They're saying , you know , it's going to be tough for us to do that much more than we're already doing it. And so we are you know , we are looking at maybe having to pare back the locations where we are able to provide care to Medi-Cal enrollees. We , you know , we're taking losses on certain locations that have a high enrollment of Medi-Cal. You know , they're being a little circumspect in terms of exactly how services might be reduced in what locations. Um , but that does certainly seem to be on the table. You know , and that would be , you know , devastating if we saw a loss of of certain facilities in certain areas , you would see patients traveling further for care. If they did do that. Nobody's quite going that far yet. They're sort of just sending out a warning shot to let people know that , uh , that they really are struggling to figure out exactly how they're going to fill this gap. Hmm.
S1: Hmm.
S7: We have about 108,000 people who are enrolled in those plans. And then we have , uh , closer to a million folks who are covered by Medi-Cal. Hmm.
S1: Hmm. And how much more will they be paying per month ? Under. Under the increases.
S7: Uh , under the , uh , the ACA increases. It really breaks down differently based on your income level. Uh , the hardest hits come to about 160,000 people across the state. About 12,000 of those live here in San Diego County. And these are folks who are in a household that makes greater than 400% of the federal poverty level. I look that up for you. That's $62,600 per year for a single person , or $128,600 per year for a family of four. So I looked under covered California's impact tables. Uh , for this group , they're going to see their average premium go from about $501 per month to $855 per month. So that's an increase in San Diego County of $354 a month , which is , you know , quite a quite a lot of money. Um , you know , it's it's a lower amount for people who make less than 400% of that federal poverty amount. Uh , covered California says the average average premium increase is going to be about 76% for folks who make less than those amounts that I just gave you. That's about $125 per month in additional premium costs for folks making a little lower on the income scale. So it hits everybody just , you know , the higher income earners that have gotten these subsidies since 2021 , those will go away and they will see the largest , increase by far.
S1: Yeah , well , you touched on this a little earlier , but I know you talked to several medical providers across San Diego like sharp , Scripps , UCSD health.
S7: So I you know , I recall that their that their increase cost. If all of this Medi-Cal stuff goes through is is north of $150 million a year. Uh , Scripps is also saying that that they will be north of 100 million. UCSD is saying somewhere between 50 and 100 million per year , depending on certain nuances of of these changes that that are , um , a little more arcane in terms of how , uh , different medical providers are compensated for , for people who don't have health insurance when they care for them. Uh , so some of these are kind of esoteric.
S1: You know , and you may or may not know the answer to this , but , you know , with so many health care workers that have recently gone on strike for higher pay , better working conditions.
S7: And definitely health care labor costs have increased a lot. Um , you know , I think it's fair to say that health care workers have kind of learned their value in the marketplace. We had a lot of people exit health care during the pandemic , and those that remained , uh , you know , can command a higher price for their services. So , so , I mean , if you look at their budgets online , you can see that their , their health , uh , their employment costs and health care have definitely increased. And , you know , and that has really brought some of the margins that , that a lot of these , uh , nonprofit Providers are able to support , uh , doing their work. Um , I don't know exactly how. Um , pay raises necessarily for for individual classes of employees. Um , rub up against these Medicaid changes ? Um , that is a little less clear. I mean , I think you could say generally , I think probably a lot of the CEOs , uh , in health care would say generally , overall , the less money we have at coming through the door and reimbursement , uh , challenges our ability to to agree to additional contracts and increases for , for health care employees. You know , and it may be that this current situation and it is cited in a lot of these negotiations , the healthcare providers do seem less willing to sign large increases knowing what's coming with Medi-Cal. Mm.
S1: Mm.
S7: All the all the medical providers in the , in the state are required for , you know , report quite a lot of information to the state. And one thing they report is the percentage of Medi-Cal patients that they see. And so , you know , Scripps Chula Vista , uh , sharp , Grossmont Rady Children's Hospital has a very high percentage of Medi-Cal , uh , recipients that they serve. And so , you know , those are some of the ones that are sort of in the crosshairs here. Uh , you know , those are the ones that I saw that had , you know , north of 35% , uh , patient load coming from Medi-Cal. So , yes , you know , I mean , that's a question. Will this be an existential threat ? Uh , it's hard to to fully understand that , you know , a big hospital at Grossmont Hospital. out in la mesa. I mean , that's a massive operation. They do see a lot of non-medical as well. It's a cornerstone facility. So , you know , you start to wonder , is it going to be the hospital's shutting down ? Probably not. But it may be paring back certain programs that people have come to rely on. Yeah.
S1: Yeah. Well , when we think about that , I mean , there are some organizations that are also using this as an opportunity to talk about how they can restructure Medi-Cal.
S7: You know , there are all kinds of different ideas on how Medi-Cal and Medicaid , generally in the United States might be changed to operate more efficiently. Uh , you know , there's there's talks about capping the amount of spending per enrollee. And , you know , that that can be seen as a really a difficult idea in some places. But other states , like Oregon have recently found ways to use these caps to to help control spending and still put out a lot of service. So it's a little it's a little nebulous right now , but they're just getting started in terms of doing this work. They're going to start meeting this month at the California Healthcare Foundation to really go through a whole bunch of proposals that they've sought from the community. And so I think we're going to hear more about that in the coming year. Wow.
S1: Wow. Well , I know people can follow your reporting at the U-T to stay up to date on this. I've been speaking with Paul Sison , health care reporter with the San Diego Union Tribune , will link to the full piece at KPBS. Paul , thank you so very much.
S7: Thanks for having me.
S1: That's our show for today. I'm your host , Jade Hindman.
S8: Thanks for tuning in to Midday Edition. Be sure to have a great day on purpose , everyone.
