By skyforbes 
Over the past two years, there have been countless tragic stories about the separate and unequal nature of Medi-Cal (California’s Medicaid system). These reports have highlighted numerous disadvantages, overall difficulties, financial hardships, and outrageous delays that far too many Californians and especially those from communites of color face.
From excessively high amounts of amputations at MLK Hospital due to uncontrolled diabetes, to unreasonably long wait times to see specialists with some patients dying, to layers of private insurance company profit through skimping on services, the stories have demonstrated how Medi-Cal is an apartheid system.
California’s Medi-Cal reimbursement ranks 48th out of 50 states as per the Medicaid Fee Index and pays California physicians and hospitals half of what Medicare pays. Because payments are so low, very few doctors and hospitals serve the nearly 13 million enrolled Californians. In fact, some disadvantaged communities have ten times fewer doctors than more affluent cities. And a 2015 survey found a ratio of only 39 full-time primary care doctors per 100,000 Medi-Cal patients.
As a former oncologist, I have witnessed and participated on both sides of this unequal system. When I practiced at Cedars Sinai in Beverly Hills, I treated few, if any Medi-Cal patients. But, when I practiced at Dignity California Hospital in downtown Los Angeles, I treated mostly uninsured and Medi-Cal patients. In fact, a 2021 Lown Institute report found MLK Hospital received 75% of its total patient revenue from Medi-Cal versus 10% for Cedars Sinai. And 94% of patients treated at MLK were of color, but only 36% at Cedars Sinai.
When I started caring for more uninsured and Medi-Cal patients, I noted a disproportionate number of cancer patients who presented with advanced disease. It was clear that this was largely due to an overall lack of access to timely healthcare and overall delays in getting the necessary workup that I rarely witnessed with my former private insurance patients. A recent 2021 Health Policy Survey by the California Health Care Foundation (CHCF) found that 59% of all Californians below the 200% poverty line had to wait longer than was reasonable for a medical appointment.
And while patients struggle to find doctors willing to see them due to minuscule payments, several of California’s Medi-cal insurers continue to reap huge financial windfalls while state regulators have found their patient care to be less than optimal. Given that these insurers get to keep whatever they do not spend on patients, it is preversely in their best interest to delay, deny, and minimize care.
From 2014 to 2016, California’s Medi-cal insurers made over $5.4 Billion in profits with HealthNet (a unit of Centene) reporting over $1.1 Billion and Anthem $549 Million in profits all off the backs of California tax-payers. Of note is that these two plans also had some of the worst quality rankings.
As the current healthcare system is unfair to the millions of Californians enrolled in Medi-Cal, tens of millions of other Californians are also struggling with their healthcare needs.
Of the estimated 2.7 million uninsured California residents, approximately 1.5 million are not eligible for financial subsidies or Medi-Cal. To date, over 75,000 Californians have died due to COVID-19, and a Lancet Commission study reported that one-third of all COVID-19 deaths in the U.S. were linked to a lack of health insurance.
Yet despite contributing more of their paycheck towards their ESP, a 2020 Commonwealth Fund study showed that 42% of all Americans and 26% of those covered by an ESP were underinsured, meaning coverage was not adequate to protect them from financial ruin due to out-of-pocket expenses.
The 2021 CHCF survey also found that a direct consequence of high healthcare costs, co-pays, and deductibles was 51% of all Californians postponed or skipped care due to cost. And of those who delayed care, 41% said it only made their condition worse.
This same study noted the top five of six causes of financial worries were unexpected medical bills, out-of-pocket costs, treatment for COVID-19, monthly health insurance premiums, and prescription drug costs.
It is no wonder that 82% of Californians in this study said that it was extremely and/or very important for Sacramento to focus on making healthcare more affordable and that this should one of the Governor and Legislature’s top two priorities.
Sadly, the only significant healthcare legislation that Sacramento has passed in 2021 is AB 133 which would expand Medi-Cal to Undocumented Californians over the age of 50. It is estimated this bill will add 235,000 more Californians to the Medi-Cal system. While this may make Sacramento feel like it is doing something, without any increased reimbursement to an already overburdened system, the Governor and legislature are simply sweeping the healthcare mess under the rug, and if anything further decreasing access to care. If they truly believe this is really a great solution like so many of them tout to their constituents, perhaps they should trade in their own private insurance and enroll in Medi-Cal as well.
This inadequate access is the basis for a major civil rights lawsuit against the state of California claiming Medi-Cal as separate and unequal. Despite a two-year fight by the State, an Alameda County Superior Court ruled in favor of allowing the lawsuit to proceed.
Sacramento can do far better. AB 1400 introduced by Assemblymember Ash Kalra would establish a comprehensive state run single-payer coverage system. It would streamline payments, greatly reduce per-capita healthcare spending, obtain bulk discounts in medical good, prescription drugs, and services and use these savings to provide enhanced benefits and coverage with no co-pays or deductibles. It would eliminate Medi-Cal and provide everyone with the same equal access to high quality care. Opponents will falsely claim that we cannot afford it, but a 2016 UCLA Center for Health Policy Study showed that public funds already account for 70% of all state healthcare spending. And multiple independent analyses including a 2018 study from the conservative Mercatus Institute have all found single payer systems to save billions of dollars compared to the status quo while insuring everyone. The real question for Sacramento is can we really afford not to?!