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Politics, government and public life for Southern California

Democrats divided on how much to expand MediCal under healthcare reform law

State Assemblywoman Holly Mitchell (D-Los Angeles) says "health and human services has been the stepchild of the budget process forever.”
State Assemblywoman Holly Mitchell (D-Los Angeles) says "health and human services has been the stepchild of the budget process forever.” KPCC

California's plan to expand MediCal as part of federal healthcare reform is now being reconsidered as the state measures the financial burden that will ultimately come.

Nearly 8 million Californians use MediCal, the state’s healthcare program for low income residents. When Congress passed the Affordable Care Act, state officials committed to expanding the program — especially since the federal government agreed to pick up most of the tab.

If California implements the full expansion, it could enroll 1.5 million uninsured adults. But the Gov. Jerry Brown's administration appears to be backing away from full expansion.

At a recent symposium on healthcare reform, California's Secretary of Health and Human Services, Diana Dooley, said there’s a risk in moving too fast.

“I don’t want to be on the hook for promising things we can’t deliver,” Dooley told hundreds of healthcare advocates. “So if we disappoint early because we didn’t go as far as people want, it’s because we have to build this on a solid foundation and be ready to make it real over the long-term.”

Dooley talked about the state's risk of taking on more than it can afford. The federal government will pay 100 percent of the cost increase for MediCal expansion, but only for three years. After that, California will have to pay 10 percent of the increase, which the Kaiser Family Foundation estimates could cost the state more than $6 billion over the next decade.

The federal government has given states the option of offering lesser coverage to the new pool of recipients — and making the pool smaller. The Brown Administration is considering both options.

That possibility frustrates Vanessa Cajina of the Western Center on Law and Poverty.

“We want to provide coverage for people that they can afford and that’s accessible and still having the question open is disconcerting at this point,” Cajina said.

Democratic leaders agree. Senator Ed Hernandez (D-San Gabriel Valley), a former optometrist who chairs the Senate Health Committee, told advocates at the symposium: “I have every intention to make sure that every single person has the fullest amount of benefits available and draw down as many federal dollars as we possibly can.”

Hernandez will carry a handful of bills to make that happen. He also thinks California should also raise the rates the state pays providers for treating Medi-Cal patients. California ranks 47th in the nation for the lowest rates — so low that many physicians refuse to participate.

Democrats also want to reinstate some optional benefits cut in recent years, such as dental coverage for adults. Assemblyman Richard Pan (D-Sacramento) noted that patients can now get covered for a tooth extraction, but not for dentures.

Assemblywoman Holly Mitchell (D-LA) said that’s just not right.

“You know health and human services has been the stepchild of the budget process forever,” Mitchell said. 

She wants Democrats — who gained a two-thirds majority in both houses in the November election — to use their power to take a look back and ask some questions.

“What are actions that we took that we know are wrong-that are harming Californians that we can reverse?" Mitchell said. "Not raise the lid off the box and make everybody nervous, but some areas in which we can invest again in California.”

The Governor will propose a plan for MediCal expansion as part of his January budget.  That’s when he’s also expected to call lawmakers into a special session on healthcare reform.

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