Hospitals Struggle with Medi-Cal Cuts

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Medi-Cal is California's health insurance for anyone out of work or too poor to pay for medical care. In January, state legislators cut Medi-Cal by ten-percent to help reduce the state's multi-billion dollar deficit. But the cut means hospitals that treat Medi-Cal patients won't be reimbursed for the full cost of care. KPCC's Julie Small says this could affect you if anyone in your family is severely disabled.

Julie Small: The 83 patients at Sharp Coronado Hospital on sunny Coronado Island came from hospitals all over the state. Chief Executive Officer Marcia Hall says they're at her San Diego facility because they needed specialized subacute care.

Marcia Hall: They are here for life. They have failed rehab, typically have a spinal cord injury, a head injury. They can be as young as 17 years old, as old as, you know, however old, but they've had some traumatic injury or illness that makes, in this unit, makes them incapable of breathing on their own.

Small: That 17-year-old is a young woman whose car flipped into a ravine and landed in water. She almost drowned, and that's what caused her injury.

[Sound of alarms]

Small: Alarms in the subacute unit go off every time the nurses change a patient's respirator.

Nurse Gemma Sullivan: We're going to reposition you, OK?

Small: Most of the patients can't move on their own, so the nurses turn them. Nurses Gemma Sullivan and Janice Smith work together to gently lift an 80-year-old woman. She suffered a hemorrhage, and her lungs don't work.

Sullivan & Smith: One, two, three!

Small: Rose Marie Cruz manages the subacute unit at Sharp Coronado. She doesn't call the people in her care "patients." They're "residents".

Rose Marie Cruz: The residents that are here are dependent on us. We turn them every two hours so that they don't have bedsores. They're not able to move themselves.

Small: The nurses give the patients their medications and try to control their pain. It's a 24/7 job.

Cruz: We also give them compassionate care, and they become part of our family. Because when they come to us, they're here to stay with us. Then we celebrate their birthdays, we celebrate holidays. We make their stay here as normal as we can make it.

Small: And when a patient dies, the nurses mourn alongside the families.

Cruz: Our nurses get very attached to our patients. So that when they pass, it's a loss for us, also. 'Cause we've had patients that have been here 20 years.

[Sound of respirator alarm]

Small: The subacute patients at Sharp Coronado wind up on Medi-Cal when their private insurance runs out. Hospitals that accept Medi-Cal patients agree to get paid by the state for the cost of care. CEO Marcia Hall says if the state's cuts to Medi-Cal go through, she might have to turn away new patients.

Hall: I think the bottom line is, if they're not here in one of our beds, they're going to be in an intensive care unit bed, or an acute care bed somewhere else. They will not be at home. They will not be in a rehab facility. And they will not be in another level of long term care bed. They're too sick.

Small: But if these patients move to acute care, those beds won't be available for emergency room patients who need care for heart attacks, or crash injuries, or some other immediate health threat. Mike Murphy is trying to persuade lawmakers in Sacramento to overturn the cuts in Medi-Cal reimbursements. Murphy is the president of Sharp HealthCare, the non-profit that manages the Coronado facility and six other San Diego hospitals.

Mike Murphy: As services are constrained, or services are eliminated, then access to those services becomes more constrained to the individuals seeking them. And that's true whether you're an uninsured patient, or a Medi-Cal patient, or an insured patient. If you're looking for an emergency room and three of them closed in the inner city of Los Angeles, then you're going to be looking further out.

Small: Murphy says Sacramento's cut health care over and over and over again. Maybe, he says, lawmakers look at hospitals and say...

Murphy: "They'll figure out a way to deal with it." But I think if you look back in the last 10 years, we haven't figured out a way to deal with it unless people are really happy with 70 less hospitals, less access to emergency rooms, less access to physicians.

Small: Sharp HealthCare's Mike Murphy says a decade of budget cuts has weakened health care in California. And he says cutting it again only makes it worse.