Opinion: If expanding quality health care access is California’s goal, Medi-Cal is not the solution

If expanding quality health care access is California’s goal, Medi-Cal is not the solution

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medical provider and patient at desk with papers between them, both wearing masks

Benefits counselor Perla Lopez assists an undocumented adult at St. John’s Community Health in Los Angeles on Dec. 19, 2023. Undocumented individuals will become eligible for Medi-Cal health care coverage in the new year. [Photo by Lauren Justice for CalMatters]

In January, California became the very first state to open its Medicaid program, called Medi-Cal, to every undocumented immigrant within its borders. Some 700,000 adults between the ages of 26 and 49 now qualify for publicly funded health coverage.

It’s the fourth expansion of the program to undocumented immigrants, after kids became eligible in 2015, young adults in 2019 and those over the age of 50 in 2022.

No other state has gone as far as California – yet. Others have partially expanded public health coverage for undocumented people. At least one – Minnesota – is planning to follow California’s lead and offer coverage to low-income undocumented immigrants in the state next year.

These initiatives rest on an underlying belief that opening Medicaid up to more people is a cost-effective way to get them quality care. That’s misguided. There are far better and less expensive ways to expand access to quality health coverage.

First, some background. Medicaid is the public health insurance plan for low-income residents. It’s jointly administered and funded by the states and the federal government. The feds provide at least $1 for every dollar that the states spend on the program.

This past year, California spent $152 billion on Medi-Cal. One-quarter of that amount came from the state’s General Fund.

The new Medi-Cal expansion could cost more than $2 billion every year, according to the state’s Legislative Analyst’s Office. And that could be a significant underestimate.

More than 300,000 undocumented individuals crossed the border between Mexico and California last year alone. If that trend continues, taxpayers, who already subsidize Medi-Cal coverage for 14.6 million Californians, could eventually be on the hook for more.

California can ill afford the additional expense. The state is already grappling with a budget deficit of $38 billion, by the governor’s math. The state Legislative Analyst’s Office pegged the budget deficit at $73 billion.

Yet Gov. Gavin Newsom is doubling down, saying recently that he’s “committed” to expanding Medi-Cal. He may come to regret that commitment. States are set to pick up a greater share of their overall Medicaid bill as COVID-era federal aid expires. This year, state Medicaid spending is set to increase 17%.

Adding more people to Medi-Cal won’t just strain the state’s coffers – it’ll make it harder for the program’s legacy beneficiaries to secure care. Already, there aren’t enough providers available to care for Medicaid recipients. According to a 2021 report from the Medicaid and CHIP Payment and Access Commission, just 70% of physicians accept new Medicaid patients. That’s compared to the 90% of providers who reported accepting new patients with private insurance.

The reason for this disparity is clear: Medicaid doesn’t pay providers enough. The program reimburses physicians 30% less than Medicare does. And Medicare pays 30% less than commercial insurance.

As a result, Medicaid recipients are 1.6 times less likely to successfully schedule a primary care appointment and 3.3 times less likely to successfully schedule a specialty appointment when compared to individuals with private insurance.

When Medicaid recipients can’t access a regular provider, they’re more likely to go to the emergency room. A study of Oregon’s 2008 expansion of Medicaid found that coverage was associated with a 40% increase in emergency department visits per person – including visits for conditions that could have been treated by a primary care provider.

Adding millions more people to Medi-Cal’s rolls may well exacerbate these problems for all beneficiaries.

If improving access to quality care is truly what California – and all other states contemplating similar moves – is after, there are better ways to do so.

California could start by lifting its ban on the sale of short-term plans. These plans can cost up to 70% less than unsubsidized options on the Obamacare exchanges. And since undocumented immigrants are ineligible to enroll in Obamacare or receive premium tax credits, short-term plans may be a particularly good option.

Private insurance options can deliver the affordable care state residents want and need. Lawmakers in California and across the nation would do well to start expanding access to them – instead of their failing Medicaid programs.

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D'Tucker Jebs
Member
2 months ago

Nationwide universal single-payer is the best way to go.
Attempting to deal with things in a piecemeal fashion is rarely successful.
This can cause some people to then incorrectly state that a solution has already been tried and that it didn’t work.

c u 2morrowD
Member
2 months ago
Reply to  D'Tucker Jebs

single payer, do you mean the government ?

Festus Haggins
Member
Festus Haggins
2 months ago
Reply to  c u 2morrow

That’s what it means, You and I and the other people are going to get taxed even more to pay for this. Illegal law breakers get it for nothing, I get to pay for theirs and mine. I am mandated to have health insurance or I get spanked with a fat fine. If I just hop the border, FREE!!! WTF

D'Tucker Jebs
Member
2 months ago
Reply to  Festus Haggins

Universal single-payer would eliminate the need for health insurance,
and would save you huge amounts of money.
Even more if it were funded by tax increases on the rich.

Festus Haggins
Member
Festus Haggins
2 months ago
Reply to  D'Tucker Jebs

Socialism’s not my idea of fun, no thanks.

hmm
Guest
hmm
2 months ago
Reply to  Festus Haggins

It works for all the nations that are doing better than we are in education, quality of life, and happiness.

I am a robot
Guest
I am a robot
2 months ago
Reply to  hmm

Exactly

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Lee Russell
Guest
Lee Russell
2 months ago
Reply to  I am a robot

This has been one of the best discussions I have seen in a long time concerning health care. I truly believe a Single Payer system is the solution. It is not free we all pay for it. So many benefits beyond just health care. People will be able to retire and open up jobs for others. People will be able to start their own business without worrying about health Insurance for themselves or their employees. More new jobs. The list goes on.
The Socialism argument is bull. We are a country of capitalism and Socialism. Otherwise we would not have public schools, firefighters, highway’s and many more government ( we the people) projects and programs.

I am a robot
Guest
I am a robot
2 months ago
Reply to  Festus Haggins

So, no more public school, fire department, paved roads or police is your ideal?

Earthquake weather again this morning
Guest
Earthquake weather again this morning
2 months ago
Reply to  Festus Haggins

Anarcho-capitalism is more fun. For some.

Jed the coffee makerD
Member
Jed the coffee maker
2 months ago
Reply to  Festus Haggins

You’re one of those people that just doesn’t understand socialism, and believ it to be some boogeyman that comes
For everything you got… that’s too bad…

Yabut
Guest
Yabut
2 months ago
Reply to  D'Tucker Jebs

Right… it’s magic where no one has to pay for anything.
One of the many stupid ideas that Progressives love is that housing, medical care, food can be paid by taxing the rich. It’s stupid on so many levels. There aren’t enough rich to do it so inevitably it’s the non-rich that do most of the paying. Then the rich just move their money- sometimes with their persons, sometimes just the money- to a location that doesn’t tax so much. This fits nicely with the progressive idea of globalization to facilitate it. Then of course, lawyers, both in and out of government, who can out legislate any Progressive push for anything because of course Progressives never bother with details. Only sweeping ideas. Progressives are always too slow to notice until it’s already happened. And are always surprised when their deeply desired regulations lead to the usual reality of the rich getting richer and everyone else getting poorer. Heck, Progressives defend fellow Progressives getting rich from legislation but everyone else is an evil capitalist.
The light never dims in the Prgressive world, never illuminates anything for them either, but you do have to admire their ability to ignore endlessly their own person greed while damning everyone else’s and keeping believing.

D'Tucker Jebs
Member
2 months ago
Reply to  Yabut

It’s not the number of rich, it’s how insanely rich they are.
The top 1% holds $38.7 trillion in wealth. That’s more than the combined wealth of America’s middle class…” https://www.usatoday.com/story/money/2023/12/06/top-1-american-earners-more-wealth-middle-class/71769832007/
All earnings in excess of $1 million should be taxed at 50% with that money being used to make life better for the rest of us.

willow creekerD
Member
2 months ago
Reply to  D'Tucker Jebs

Yes, but it’s ok to tell people that it’s a good deal to pay more in taxes and get health care paid for. You don’t have to put all the burden on the super rich. It’s part of building a healthy society, and we should all put in. It would take the money out of the big pharmaceutical and big insurance companies, and that would benefit our society in quite a few ways. If my taxes got raised and I had the equivalent of medi-cal, I’d be ok with that.

willow creekerD
Member
2 months ago
Reply to  willow creeker

Rfk Jr is in favor of single payer. He’s getting my vote, for a variety of reasons. I am not an anti-vaxxer, or much of a vaccine skeptic either.

Yabut
Guest
Yabut
2 months ago
Reply to  willow creeker

But that is what you will elect if you think your vote is any more that a protest because he can’t get elected? Have we really come to this?

CsMisadventures
Guest
CsMisadventures
2 months ago
Reply to  D'Tucker Jebs

Before or after all the taxes I’ve already paid? If I cleared $600k on $1m gross wages, after all is said and done are you going to take 50% of $600K, or 1/2 of the first million? If the latter, the remaining $100k a year is really not a lot of money. You still have your own living and family expenses. If you live in the larger metros, $100k isn’t even the median household income. If that’s the case, then damn skippy I’ll make it difficult to find what I busted my ass for so you can get something for doing nothing. You won’t find altruism through government mandates and taxation.
Also, if the 1%ers or 0.1%ers are paying 90% of all the social services, what makes you think they don’t have a small army of people in government and the legal world already working to keep their liabilities to a minimum? Hint: they already do. Good luck getting at their money when that taxable $100 million paid for a new museum wing instead of healthcare for 10,000 people.

willow creekerD
Member
2 months ago

Yes, you have a point, which is why I think we should all be ok with shouldering it. It’s a bit cynical for the far left to message that, don’t worry, the ‘super rich will pay for it all’. Yes there are imbalances in our prosperity, but if we all pay in we all have a stock in the outcome, and we should all want to get out of the mess we are in now. Government can do the job better than what we have now. Medi-cal is awesome. Our family had it for a few years. Great system.

Michael M
Guest
Michael M
2 months ago
Reply to  willow creeker

The Koch brothers’ own study showed that Single Payer Medicare for all costs less money when you include premiums and copays people pay as the taxes they are and covers all people. That is before all the issues of profit seeking that cause our system to provide the worst outcomes of any OCED country. Of course the media spun that study by only mentioning the yearly cost without pointing out that it is less than the total yearly cost of the current system.
I do agree that people should have some skin in the game, if you want to have an unhealthy lifestyle or engage in risky behavior then you should pay more instead of your choices being subsidized. One way to do that would be to have “sin” taxes on unhealthy products and ‘pay at the pump’ auto insurance which strongly reflects your safe or unsafe driving record.
Not a perfect system but far better than our current one with twice the cost and worse outcomes than civilized systems. But no outrageous profits and incentives to push questionable, profitable new drugs when old one work fine so there is a ton of money spent convincing the marks that reforming the system will hurt them or cost them something.

hmm
Guest
hmm
2 months ago

We would also need to close tax loopholes.

D'Tucker Jebs
Member
2 months ago

I never said anything about taxing the first million at 50%.
I specifically said that earnings in excess of $1 million should be taxed at 50%.

CsMisadventures
Guest
CsMisadventures
2 months ago
Reply to  D'Tucker Jebs

Still have to do the math, as I pointed out. Are those earnings gross or net wages? Huge difference there. I would say, to make the tax scheme work in your favor, tax those above $10-15m. If they can’t live and run businesses on $5-7/12 million on take-home pay, then too damn bad. Those below can stay on a graduated bracket rate as they are now.

Oh, and you have to get all that voter approved, or at least get your tax-happy buy elected. Or most of them.
Interesting though, some of the best wages in the county, if it not in health care, are in government itself. The government giveth and taketh away.

ataloss
Guest
ataloss
2 months ago
Reply to  D'Tucker Jebs

Hey! Here’s an idea they didn’t get rich by waiting for government handouts. They worked for it. They got up at ungodly hours to go to work, got home late from work, worked weekends and holidays sometimes. The concept of free is – it’s not free someone pays for it.
If one works one should have right to choose how to spend their money.

hmm
Guest
hmm
2 months ago
Reply to  ataloss

Don’t be stupid. The rich are not harder working. They are almost without exception born with wealth.

D'Tucker Jebs
Member
2 months ago
Reply to  hmm

And they get lots of government handouts.

Karl Verick
Guest
Karl Verick
2 months ago
Reply to  Yabut

Yes! Naked laissez-faire capitalism is the way, Jesus agrees. Free Markets will solve all problem. It’s a rat eat rat world. The working class should eat rats and stop expecting cake! Thanks for enlightening me.

I am a robot
Guest
I am a robot
2 months ago
Reply to  Yabut

You are already paying…and way too much. If EVERYONE is covered, costs go down because people stay healthier. With M4ALL no more premiums and the tax is about half of what your insurance is actually costing you.
You think if your employer is providing your coverage it isn’t costing you. 😂😂😂😂😂😂😂

CsMisadventures
Guest
CsMisadventures
2 months ago
Reply to  D'Tucker Jebs

Until the rich hide their income, or simply move it from one state to another. Or bury it in accounts nobody can touch until they’re dead, because that never happens.

That said, everyone deserves healthcare. And healthcare providers aren’t going to work for free either. That and with increased cost, MediCal has been slowly implementing new policies too, such as more limits on what they do and do not cover. They will not be 100% coverage on everything.

hmm
Guest
hmm
2 months ago

Those issue should be addressed either way.

Karl Verick
Guest
Karl Verick
2 months ago
Reply to  Festus Haggins

Indirect benefits in cheaper labor costs by a large group of people that are, for the most part, paying payroll taxes, paying into Social Security and Medicare, without any ability to recieve benefits. There are many strategies to fix the shamefully inequities in a system where the rich get rich healthcare and the poor get poor Healthcare. Rich people are not more deserving and poor people are not lazy dead beats.

I am a robot
Guest
I am a robot
2 months ago
Reply to  c u 2morrow

The government of, by and for the people, yes indeed

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Yabut
Guest
Yabut
2 months ago
Reply to  I am a robot

Expecting people to work productively for what they get is not a radical idea either. But that is never something to be demanded in the Disneyland of Progressive ideology.
It probably will happen in some form. In fact California is pretty much doing it step by step now. First for the poor, then ACA, then for illegal immigrants having already decided to treat illegal status as meaningless . People will find themselves in a world which there there is no option but voting for universal taxing to pay the government to run health care because everything else has been ruined. Already the availability to health care has dried up for most rural Californians. The government has arrived for the most favored.

Truth Be Told
Member
Truth Be Told
2 months ago
Reply to  D'Tucker Jebs

Agree. It’s especially stupid for California to burden the system with additional costs when the state is facing a budget deficit of 38 to 73 billion. And equally stupid to extend coverage to all undocumented people when there aren’t enough providers to serve the people who are already eligible.

Michael M
Guest
Michael M
2 months ago
Reply to  Truth Be Told

How about we make the people who profit from the cheap labor they are exploiting pay for the social costs they are foisting on everyone else? Make a large number of work permits easy to get but require they are paid a large minimum wage with large extra fees to support a pension system in their home country where they are able and required to vote. If you are busted hiring an unregistered foreigner you pay a huge fine like in many civilized countries. If an American is really unable to do the job then your needs are covered but not at the expense of using the desperation of migrants to undercut American workers.
Not overthrowing governments who don’t sell their people out to international corporations would be a help too.

spamned
Guest
spamned
2 months ago
Reply to  Michael M

see article for ‘new providers’ at Providence for a great example of this

Yabut
Guest
Yabut
2 months ago
Reply to  D'Tucker Jebs

Somehow everyone who touts for universal single-payer health insurance envisions unicorns farting out rainbows. In other words some mystical creature that never existed providing useful benefits in the shape of noxious greenhouse gasses to all without any effort for the recipients who are supplied with every need. The details don’t matter as long as the visionary can dream of schemes that benefit mostly themselves but they graciously think will help the poor, they will think themselves the better human.

The lucky consequence of such beliefs is that they can always blame the contrarians who point out the insanity of those ideas by calling them out as Trump lovers or racists or Nazis or similar. What a lucky choice of belief- no personal responsibility even when having screwed up so thoroughly and dragged everyone down with them. In such a world, having created a health insurance system that employment provides only government workers with great health insurance while everyone else is thrown onto government subsidized plans that are still too expense for all but the poorest to get, it is called “corporate welfare” when Walmart employees are on MediCal but called a right when everyone but government employees are pushed into it.

That is how people were convince that smoking cigarettes was actually good for them. People will by into anything that sounds like easy .

1000000353
I am a robot
Guest
I am a robot
2 months ago
Reply to  Yabut

You obviously don’t understand single payer

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Yabut
Guest
Yabut
2 months ago
Reply to  I am a robot

You don’t understand that almost nowhere has what you call universal single payer health care. Only 17 countries have it- There are currently 17 countries that offer single-payer healthcare: Norway, Japan, United Kingdom, Kuwait, Sweden, Bahrain, Canada, United Arab Emirates, Denmark, Finland, Slovenia, Italy, Portugal, Cyprus, Spain, and Iceland. Making pretty little graphics does not make it true.
https://worldpopulationreview.com/country-rankings/countries-with-single-payer
You obviously don’t understand paying for what you use. Then Progressive Peter Pan Syndrome.

D'Tucker Jebs
Member
2 months ago
Reply to  Yabut

Every one of the countries you mentioned has a healthcare system that ranks higher than the US. https://www.statista.com/statistics/1376359/health-and-health-system-ranking-of-countries-worldwide/
They also spend much less per capita than the United States does. https://www.healthsystemtracker.org/chart-collection/health-spending-u-s-compare-countries/

Al L Ivesmatr
Guest
Al L Ivesmatr
2 months ago
Reply to  D'Tucker Jebs

So?

spamned
Guest
spamned
2 months ago
Reply to  Al L Ivesmatr

You LIKE dying years before your counterparts in the rest of the (civilized) world? You LIKE paying thousands of times more for your medications?

I want health care that I can ACCESS AND AFFORD but I ain’t gonna get that here…only get to be revenued off of until I kick the bucket BEFORE MY TIME…

Yabut
Guest
Yabut
2 months ago
Reply to  Al L Ivesmatr

Of course they are. Using the tax base is a large part of the rating system. It’s rigged for that result. When you start doing a deep dive, what you find is that all sorts of categories are twisted too and not actually comparable even inside Europe much less with the USA. The social ills causes much of the discrepancy are just ignored. You think that Iceland ir Japan has a multiracial demographic or Bahraine or Kuwait subsidized it’s immigrantswho are only there to eork or Turkey has a diverse religious medical system? Do you think that they even count everyone in the same way?

ataloss
Guest
ataloss
2 months ago
Reply to  D'Tucker Jebs

Smaller populations and limited to non existent illegal immigration issues except for maybe Sweden. In Sweden people pay 60% income tax – so every krona that they earn .6 goes to government and personally they get to keep.4. Might I add Sweden’s cost of living is high.

D'Tucker Jebs
Member
2 months ago
Reply to  ataloss

Every one of those countries have high immigrant populations.

Yabut
Guest
Yabut
2 months ago
Reply to  D'Tucker Jebs

That’s not true. But even if it was, their idea of an immigrant is someone from the Netherlands or Croatia with a college degree. Not from Central or South America with none and gang tattoos.
” One of these included Stuart, a humanitarian volunteer in Gothenburg, who said that he believes Sweden “has always been [racist] under the surface, but I still think it’s not all Swedes”.
“It is not always hardcore racism,” he said. “Just that Swedes prefer to hang out with other Swedes.””
https://www.thelocal.se/20221026/survey-sweden-is-decades-behind-on-racism-and-diversity
You need to get out more.

ataloss
Guest
ataloss
2 months ago
Reply to  D'Tucker Jebs

Nope primarily Sweden everyone else not so much…

Mendo Known 50 years
Guest
Mendo Known 50 years
2 months ago
Reply to  D'Tucker Jebs

California Free Clinic

1000002495
D'Tucker Jebs
Member
2 months ago

Isn’t that a show about a guy who starts dealing drugs because he can’t afford his medical expenses?
Sounds like a perfect argument for Universal Single-payer.
Thanks.

Al L Ivesmatr
Guest
Al L Ivesmatr
2 months ago
Reply to  D'Tucker Jebs

There is a voluntary donation line on your income tax form. I suggest you start a movement by donating first followed by a tik tok campaign to garner national attention. Who knows, you to could become Surgeon General! Yeeee hawwwe!

CsMisadventures
Guest
CsMisadventures
2 months ago
Reply to  D'Tucker Jebs

He’ll get that healthcare for free while in prison for dealing drugs. Or not, you just about have to decapitate someone nowadays to be incarcerated for any real length of time.

hmm
Guest
hmm
2 months ago
Reply to  D'Tucker Jebs

I agree, except illegal immigrants (those who immigrated illegally) should not be enrolled.

Humboldt
Member
Humboldt
2 months ago
Reply to  D'Tucker Jebs

Yes. You are right.
One of the main aspects that cause medical rates to be so high is all the paperwork.
Single payer could eliminate a large portion of that.
Also, the ability to set prices for pharmaceuticals is essential. A single payer system would allow for that.

I asked my doctor, some time ago, why healthcare was so expensive.
I thought it was because doctors had to recoup the large amount they pay for school.
She said it was not the doctors; doctors are not getting rich; it was drug prices.

One person commenting below complained about higher taxes. Saying that there were not enough rich people to tax to make socialized medicine possible.

Another pointed out the plutocracy.

That is the actual fact.

Most of the wealth of the one percent is hidden.

Very little is done to address their imbalanced control of the resources and wealth in this country and in the world.

A true revolution, that is needed, is not left versus right, as we are lulled into believing, but, rather, a vertical balancing of the masses and the overly wealthy.

Pharmaceutical companies, as well as providers need to be state controlled. That is the only way healthcare costs can ever be contained.

William
Guest
William
2 months ago

It’s actually $3 billion for coverage the first year with another $3 billion set aside for incidentals, which is included every year. So it’s $6 billion for the 1st year. For the 2nd year it goes up to over $4billion for coverage plus the $3billion incidentals. From what I read they think the cost of coverage only will go up over $1billion every year.

Bozo
Guest
Bozo
2 months ago

In Big Rock Candy Mountain… the health care is for free.
With a cigarette bush and springs of booze.
Jails are made of tin, you walk right in and walk right out…

Yup. Yup. Yup.

I am a robot
Guest
I am a robot
2 months ago

You are wrong about the solution.

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Yabut
Guest
Yabut
2 months ago
Reply to  I am a robot

Being wrong seems to include a whole lot of people who can’t manage their own lives. Why should anyone listen to them?

Kicking Bull
Guest
Kicking Bull
2 months ago

C’mon man- the federal reserve can’t just print money willy-nilly for the people- just for the military, the banks, pharma, holy-wood, and some spaceman psy-ops. Get real jack!

Last edited 2 months ago
spamned
Guest
spamned
2 months ago
Reply to  Kicking Bull

YEP–always money for war and for bailing out banks/corps

ataloss
Guest
ataloss
2 months ago
Reply to  Kicking Bull

They but that takes down the value of the money. It becomes Monopoly money basically.

Old SchoolD
Member
2 months ago

Check out the VA for those that think a national government health care system is the answer.

Yabut
Guest
Yabut
2 months ago
Reply to  Old School

It has it’s ups and down. Great place to get free meds. Not so much for other things. Part of that is the way the VA gets medical doctors. They have a program to pay for medical school in exchange for a number of years of service. Which the new doctors seem to resent a lot and find ways out of.
https://va-ams-info.intelliworxit.com/hpsp/service-obligation/

MariahgirlD
Member
Mariahgirl
2 months ago
Reply to  Old School

My husband has va insurance and when he needed to see a doctor he was told it would be 3 days to get in which would not have helped him at the time. Then they told him he could go to urgent care and it was only 28.5 miles from home but the hospital which is closer is over 50 miles away, one being direct and the other as the crow flies. VA keeps getting worse, my husband is a disabled vet and doesn’t have to pay for his healthcare so now newsome wants him to pay for illegals healthcare .

MariahgirlD
Member
Mariahgirl
2 months ago

I don’t want to have to pay for healthcare for people that are here illegally. If we go to another country are they going to provide us with healthcare for FREE? Gruesome newsome is great at spending someone else’s money when he doesn’t have to pay for his health insurance.

justsayin
Guest
justsayin
2 months ago

This shouldn’t even be a discussion. They don’t belong here and deserve NOTHING.