#CABudget Preview: Will We Seize Further ACA Opportunities?

Next week, Governor Jerry Brown will release his “May Revise” proposal for the 2014-15 state budget, which has major implications for California’s health care system. The January health and human services budget had few augmentations or restorations, leaving in place the huge cuts made in the worst recession in 75 years, such as a ongoing 10% Medi-Cal rate reduction into the future, on some of the lowest Medicaid provider rates in the country.

California has made great strides under the Affordable Care Act to expand coverage, and the question under this budget is whether we continue that progress, making key targeted investments to make major improvements in our health system.

The questions we will be looking to answer in the budget: How successful was Medi-Cal enrollment efforts? Are we ensuring these new (and old) enrollees have access to care? Are we taking advantage of federal matching funds that are available? How many dollars are we taking from the county safety-net? How are we serving the remaining uninsured? This budget to be negotiated over the next several weeks needs to be the answers to key questions about California’s health system.

We expect budget increases due to Medi-Cal expansion and strong enrollment. We could see Medi-Cal enrollment at over 10 million Californians (not including potentially 900,000 more in an enrollment back-log). In addition to new enrollment numbers, the May Revise may be the first hard numbers at the dollars being “reallocated” from public hospitals and county safety-nets under last year’s budget agreement.

The increased Medi-Cal enrollment provides new opportunities: Relatively small investments can actually improve access for those in Medi-Cal, and extend it to those still excluded from coverage–leveraging existing funds in a more efficient and effective way.

Governor Brown’s January budget left in place health cuts made in the depths of the recession, including a 10% reduction to some of the lowest Medicaid provider reimbursement rates in the nation, making it harder for patients to access doctors and specialists they need. Health providers and patients urge California to cancel the cut, take advantage of enhanced federal matching funds available.  With many more Californians covered under Medi-Cal now, we should cancel the recession-era cut to Medi-Cal providers to ensure millions of Californian have better access to the doctors and specialists they need.

While California led in enrolling so many in the Affordable Care Act options, the process also highlighted how some in our communities are excluded. The reallocation of dollars from county safety-net providers and public hospitals means we need to address the issue of how to cover and care for the remaining uninsured this year. For a small investment, we can fulfill the promise of health reform by extending coverage to California’s remaining uninsured, including the undocumented (as proposed by SB1005 by Senator Lara).

Overall, we should remember that the surplus was created in part out of $15 billion in cuts to health and human services–cuts that continue today and into the future. It would be financially irresponsible not to revisit and restore more of the cuts made in the depth of the recession, including those that can bring in more federal matching funds to a health system and economy that needs it. The level of services for California should not be set at the level of resources available during the worse recession since the Great Depression; there needs to be some balance between frugality and needed investments for the future. The Governor invokes the story of Joseph, who balances years of feast and famine–but for too many Californians are still facing famine, as a record number of Californians are still in poverty and need help.

 

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