One in three Californians are insured via Medi-Cal — the state’s medical insurance program for low-income residents. But only a few of those sufferers are in a position to get care via the College of California’s well being techniques.
Solely a tiny fraction of main care sufferers seen at UC clinics have Medi-Cal protection. In some websites, it’s as little as 1% — even in areas with excessive numbers of Medi-Cal enrollees. The rationale for this lack of entry, based on UC directors, is as a result of state reimbursements for Medi-Cal sufferers don’t cowl the price of treating them.
It’s even worse for Medi-Cal sufferers in search of medical specialists, resembling neurologists, orthopedic surgeons and cardiologists. Most UC specialty clinics gained’t take Medi-Cal in any respect.
Right here’s an instance from our expertise as UC medical doctors: A forty five-year-old lady will get a breast most cancers prognosis at a neighborhood clinic close to a UC hospital or in a UC hospital emergency division. The lady is insured by Medi-Cal. The subsequent step requires a session with a surgeon and a most cancers specialist.
What are her choices? After she has obtained her prognosis, she will be able to’t be seen in a UC surgical procedure or most cancers clinic since they don’t settle for her insurance coverage. Basically, a state-owned hospital isn’t accepting her state-funded medical insurance. So, she or her main care supplier might want to discover appointments with specialists at a spot that accepts Medi-Cal. Generally these suppliers have much less experience than could be accessible at a UC hospital.
Since revenue ranges and race are sometimes correlated, this additionally signifies that the UCs are disproportionately excluding folks of colour. How can this de facto racist coverage be acceptable?
Our six nice UC medical faculties have three guiding missions: to boost the well being of the general public via analysis, to coach tomorrow’s healthcare suppliers and to supply well being providers to Californians.
Whereas the UC system performs admirably on the primary two, it has shirked its duty on the third. Most UC-affiliated well being services present little to no care to poor sufferers whose medical insurance is offered by Medi-Cal.
What message does this ship to taxpayers who fund these medical faculties, when a big proportion of them can’t get care at UC-affiliated medical facilities? What message does it ship to tomorrow’s medical doctors, nurses and pharmacists? We’re instructing them that it’s OK to cherry-pick worthwhile sufferers and hope others in the neighborhood will present take care of the remainder.
Within the late ’80s, after we had been starting our tutorial careers within the UC system, it will have been thought of extremely unprofessional and inappropriate for a physician-in-training or a school member to inquire a few affected person’s insurance coverage standing. Any doctor who did this may have obtained stern counseling from supervisors, however now such a query is frequent and displays a tradition that accepts revenue over compassion.
The UC well being management has lengthy argued that it needs to deal with Medi-Cal sufferers however can’t negotiate contracts that may cowl the associated fee. They level to UC partnerships with county services and free or low-cost clinics to take care of these sufferers. Nevertheless, these main care clinics can do solely a lot with out backup from medical specialists.
The actual fact is, annual revenues at some UC well being campuses exceed bills by greater than $100 million. The directors argue that this extra cash subsidizes medical faculty and primary campus operations, and in the event that they had been to allocate a few of that quantity towards making up any price range shortfall incurred when treating Medi-Cal sufferers, the system could be in a weak place.
However non-public hospitals in California take Medi-Cal sufferers with the identical reimbursement and make it work financially — even when Medi-Cal compensates the hospital poorly. Then why are UCs not accepting these sufferers? Why can’t the UCs undertake among the methods that permit different hospitals to take action, or use a few of their extra earnings towards masking Medi-Cal enrollees, or ask the state for extra money to take action?
Because it stands now, the UC well being system is offering extremely worthwhile state-of-the-art therapies to a choose (and, usually, privileged and white) group of Californians, whereas barring the door to some 14 million low-income Californians.
We suggest that the UCs begin by setting necessary minimums for the variety of Medi-Cal sufferers seen in main care clinics, specialty clinics and elective inpatient providers, and publicly report precise numbers yearly. Earlier than totally taking up their justifiable share of Medi-Cal sufferers, they may begin small, say 5% or 10% for every of those three classes and see what fiscal impact that has. If, after making their care processes extra environment friendly, the UC services nonetheless can’t afford to take care of sufferers at present reimbursement ranges, they may foyer the state and harness public sentiment to turn into a number one advocate for higher compensation charges.
Silently excluding the least highly effective folks in our society is just not an appropriate answer. Why are the governor and state legislators letting UC medical facilities ignore this ethical and social duty?
Michael Wilkes is a professor of drugs and world well being at UC Davis and senior well being correspondent for KCRW-FM. David Schriger is a professor emeritus and vice chair of the division of emergency medication at UCLA.