Medi-Cal, California’s health care program for low-income people, has become big business.
Thanks to the Affordable Care Act, which broadened eligibility for the program, Medi-Cal’s rolls have swollen to about 11 million people, or more than 1 in every 4 state residents.
Persistent reports suggest that the state lacks enough doctors to care for all those people. Or at least enough doctors who are willing to provide care at the rates the state has been willing to pay, which are among the lowest in the nation.
With the stakes so high, it’s not surprising that the issue has moved front and center in the Legislature. Like so many other big issues, it might soon be headed to the ballot.
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A coalition of doctors, hospitals, labor unions and insurers is preparing to spend $10 million on an advertising campaign this spring to pressure the Legislature and Gov. Jerry Brown to increase reimbursement rates. Prepare to be inundated with television, radio, newspaper and online advertising on the topic.
The coalition hopes to get a $500 million pot of federal money that has surfaced since the governor released his initial budget proposal in January.
Too many Medi-Cal enrollees lack convenient access to a doctor or clinic. But increasing payments to health providers is not the end-all answer.
The state needs to make the supply of doctors go further by liberalizing some laws limiting services that other medical professionals, such as nurse practitioners, can provide. Better use of technology also could help doctors reach patients in rural communities.
Meanwhile, some of the same interest groups also are pushing a proposal to increase the tobacco tax by $2 per pack. The tax increase would raise an estimated $1.3 billion a year. The measure likely would earmark some of that money to help pay for Medi-Cal costs associated with tobacco use.
A tobacco tax hike would need the approval of a two-thirds majority in the Legislature, making it unlikely. So the proposal could end up on the ballot next year as an initiative.
We’ve never liked ballot-box budgeting. We have a Legislature to work through complex issues like health care. Initiatives lead to unintended consequences.
The governor released his revised budget Thursday. Lawmakers now should make health-care access a front-burner issue. Better to resolve it now than in a messy ballot fight next year.