People will die, and other budget cut consequences..

Over the years we have written about many proposed health care cuts and the impacts, both human and economic.

Today, after a thorough hearing about the health cuts, we write to describe proposed cuts that will result directly and quickly in patient deaths as well as homelessness and institutionalization.

People will die

Ten doctor, clinic and outpatient visits per year.

* People on kidney dialysis will be cut off after ten treatments when they need twelve to fifteen per month. So they will begin to die within 30 days of the implementation of the proposed budget cut.
* People with cancer will be cut off after ten treatments. Standard treatments for breast cancer include external beam radiation is given five days a week, usually for six weeks and chemotherapy is done every two to three weeks for three to six months. In the words of the Cancer Society, “Ten doctor’s visits would not allow a woman to complete any one of these courses of treatment. Furthermore, these numbers do not take into account the visits required to diagnose the cancer, any visits that are required to determine the course of treatment, and visits that may be needed to address potential adverse reactions, like toxicity from the chemotherapy.”
* Persons with HIV/AIDS will get ten visits per year, even if medication interactions or opportunistic infections require more.
* Allergy injections will be cut off at ten, even if asthma attacks put the lives of patients at risk.
* Organ transplants: no one who needs an organ transplant or who has had an organ transplant of any sort will get more than ten visits. This is worse than Arizona which only stopped coverage for certain kinds of organ transplants: this will affect ALL organ transplants.

The Administration says that 90% of beneficiaries will not be affected. These cuts affect the 10% sickest and poorest Californians on Medi-Cal. Will 10% of the 7.7 million plus Medi-Cal beneficiaries die? Perhaps not. Will tens of thousands die? Certainly.

This cut reduces the number of outpatient visits from 3.3 million to 2 million, a reduction of 40%. For the 700,000 Californians who will be affected by this cut, it is literally a choice between life and death.

Six prescriptions per month, not one more.

Today a woman testified who had been university faculty who has both bladder cancer and a neurological ailment: she now takes seven medicines a day when she is healthy and more when she gets sick.

Today California has a “soft” cap of six prescriptions: it means that someone who needs more can go through an authorization process to get them. This discourages frivolous use of medications but allows those who really need drugs to get them. This is what the Administration proposes to end.

How many Californians will die as a result? We don’t know. But many of them will be the same people affected by the cap on doctor visits: people on dialysis, those with cancer, HIV/AIDS, lupus and other extremely serious conditions.

Wound care

Most people will never need wound care. Most people will never have a bed sore so deep that you can see the bone. But for those Californians who are living at home and who rely on Medi-Cal, if they get a bed sore, their wound care will be so limited that they will never recover from it. Lack of adequate wound care kills people. Florence Nightingale knew as much. This budget proposal does not.

People will be homeless

$200 to go to the hospital, $50 to go to the emergency room—for people living on $600-$800 a month

The Governor’s budget includes copays of $100 a day for hospital care, up to $200. For someone living on $600 to $800 a month, this is literally a quarter or a third of their income. They will be faced with the choice of spending next month’s rent or not going to the hospital when it is medically necessary.

For many of us, $50 is not a lot. It is a lot if you are trying to get by on $600 a month. Some people who should go to the hospital will not. They will die. Other people will go to the emergency room: they will spend next month’s rent money or the money to pay the electric bill. If they spend next month’s rent, they will be homeless.

When I began this work 25 years ago, a visit to the emergency room was the most common cause of homelessness among families. This budget proposes to return us to those dark days.

People will be institutionalized

The budget proposes to eliminate the adult day health care that 34,000 Californians rely on: seniors, persons with disabilities, veterans, people who contributed. Every one of those who is eligible for adult day health care is eligible for nursing home care. Not all will be admitted. In some families, someone will quit their job to stay home to care for the family member but they will not be a nurse or a social worker or trained to care for those with severe limitations—it may be all right for a while (aside from the impoverishment of the family) but these seniors and persons with disabilities will destabilize at some point, beyond the capacity of the family member to cope. Then either the Californians who need care will be institutionalized or they will die.

May Ed Roberts Rest in Peace

For those of us who knew Ed Roberts or knew of him, we know he was not a peace-able soul. He served in the first Brown Administration and broke barriers for the disabled just as Martin Luther King fought for civil rights. Breaking barriers is not work for peaceful souls.

The cuts in this budget will prevent those with comparable disabilities from leaving their homes. The limits on wheelchairs will means that only the most basic wheelchairs (think about the wheelchairs at airports) will be available to those on Medi-Cal.

Cut after cut is aimed at seniors and those with disabilities. Who needs incontinence supplies or catheters? Who is bed bound and needs wound care? Who needs an adjustable wheelchair? Who needs multiple prescriptions or frequent doctor visits? Persons with disabilities and seniors.

Health Access California promotes quality, affordable health care for all Californians.
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