Budget cuts, more uninsured strain CA’s health care system

Nurses pulling a sickbed in a hospital
Nurses pulling a sickbed in a hospital iStockphoto

The recession has hit California’s health care system with a one-two punch.

It’s pushed thousands of Californians out of work – and out of health insurance. They’ve turned to emergency rooms or community clinics for care.

But the recession has also forced lawmakers to cut state-funded health programs to the bone – the same programs that help keep clinics open.

KPCC’s Julie Small reports it’s a medical “Catch-22.”

Julie Small: More than half of California’s emergency rooms say they’re treating more uninsured patients this year. David Feinberg, the man in charge at UCLA Medical Center, says the Westwood hospital has seen a 25 percent increase in uninsured patients

David Feinberg: They’re coming to us for their primary care in the high-cost emergency room.

Small: Feinberg says in a good year, UCLA Medical Center makes enough of a profit from elective surgery and other care to offer discounted or free care to the uninsured. Last year, the hospital provided $52 million in charity care. But Feinberg says this year, patients with insurance are worried about money, so they’re delaying elective surgery.

Feinberg: So you could take, for example, somebody who’s employed, who has a job, has insurance and needs a hip replacement. But they may put that off because they fear that if they’re away for thee weeks or four weeks, they may come back and not have their job.

Small: Half of California’s hospitals have seen similar drops in elective surgery and admissions this year. That’s narrowed their profit margins, and that’s made it hard to fund charity and discount care just when demand is on the rise.

And while that’s been happening, state lawmakers have slashed $16 billion from health and human services programs for low-income Californians. Jean Ross heads the California Budget Project. The Sacramento-based non-profit tracks the state government’s budget decisions.

Jean Ross: It’s multiple cuts. It’s cutbacks in funding for immunization program, cutbacks in funding for community clinics that have provided the safety net of last resort for families lacking health care coverage for many years.

Small: Two of those cuts hit community clinics and health centers where it hurts. The first was a cut to “optional” Medi-Cal benefits for low-income Californians – things like dental services. Those services provide clinics with their main source of funding. Part Two of the double whammy came when the governor eliminated state funding for community clinics and health centers.

Carmela Castellano-Garcia: Really! That has really shaken community health centers and made it very difficult to provide services at a time when there’s an increasing demand from the community.

Small: Carmela Castellano-Garcia heads the California Primary Care Association. It represents more than 800 of the state’s community clinics and health care centers. Castalleno-Garcia says some clinics say the number of uninsured they treat has jumped 50 percent this year.

But state budget cuts have hampered their ability to respond. One clinic closed its doors after 27 years. Two others shut some satellite facilities, and many more laid off dental staff and scaled back clinic programs and hours.

Castellano-Garcia: When that happens, that means that they become full quicker. And in those instances, people are turned away.

Small: Castalleno-Garcia says those people turned away may be forced to get care at hospital emergency rooms. UCLA Medical Center’s Dave Feinberg says when they get that care, they’ll be sicker.

Feinberg: If you don’t get good primary care for a year, two, three years, we will then see that translate to more admissions. Because now when you come to our emergency room in the next year or two, you’re going to be more ill than what we’ve been seeing. It’s no longer a cold. It’s now, “I’ve been having rectal bleeding” or “I have this lump in my breast and I haven’t attended to it for two to three years.”

Small: David Feinberg says from a fiscal standpoint, delayed care will be expensive. From a human standpoint, it will be tragic.

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