Just last week, I received a call that I’d been dreading. The banker at the end of the speakerphone announced to all of us, the architect, engineer, contractors and owner sitting around a conference room table, that our project – a new 15,000 square-foot community health clinic to serve Central Valley MediCal patients – was being put on hold.
The reason? “With the uncertainty of what’s happening in Washington, especially for Medicaid, the loan committee can’t approve the project at this time.” The doctor in the meeting summarized it nicely, “This is a politically induced coma.”
I can’t blame the banker though. Congress has been clear on its intent to obliterate funding for Medicaid, which is the primary source of revenue for community health clinics. The most recent soup-sandwich of Affordable Care Act replacement legislation included directives to immediately halt the enrollment of new Medicaid participants, eliminate coverage for 20 million Americans (including 300,000 here in the Valley) and cut already too-low Medicaid reimbursement rates by 25%.
The assault on Medicaid didn’t end with Congress. President Trump’s attack was less obvious, but may even be more terminal to our community’s health. His budget proposal would eliminate the Medicaid payroll tax surcharge and investment income taxes paid by the top 1% (those who earn more than $772,00 a year). These were crafted into the ACA to pay for Medicaid expansion.
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And that’s too bad. The expansion of Medicaid and extraordinary growth of community health clinics to serve the newly insured has been transformative to the Central Valley. Since 2013, throughout the eight-county San Joaquin Valley, over 500,000 low- and moderate-income hardworking adults have gotten health insurance through the Medicaid expansion.
It’s a shame our new health clinic was put on ice. In addition to health care, our residents would have found well-paying, career track jobs at the clinic. Since 2013, over 100 community health clinics have opened throughout the Central Valley creating over 25,000 new full-time jobs. Our clinic was slated to create 125 local construction jobs and 45 new full-time jobs averaging over $40,000 per year, with full health, dental, vacation, and retirement benefits.
The new clinics and health care jobs are also making a real difference in reducing our Valley’s chronic shortage of doctors and other health care professionals. Fifty-five percent of Central Valley census tracts are considered “health care professional shortage areas.” Because of the ACA, health providers and networks are now able to hire new clinical staff, open new health centers and clinics, buy new equipment, and improve existing facilities.
One local health network executive referred to the impact of Medicaid expansion as a complete reversal of financial fortunes. “Prior to the ACA, we were barely getting by and at risk of laying off staff and closing clinics. The ACA has put us in a growth position and has allowed us to build capital reserves, give staff raises, and add staff to keep up with our growing volume of patient visits.”
Community health clinics have historically experienced bipartisan support because they’ve been cost effective in delivering health care. But the fact is, any rollback of Medicaid will negatively affect our Valley’s clinics and will lead to layoffs, fewer services and result in a less healthy community. The thousands to be kicked out of Medicaid aren’t going anywhere, just back to the emergency room.
Instead of scaling back Medicaid, our Congressional representatives should look at ways to enhance the program, such as putting Medicaid reimbursements on par with Medicare compensation. This would immediately lead to more physicians accepting Medicaid patients. More physicians accepting Medicaid patients would, in turn, induce more people to enroll in ACA health plans, further reducing the number of uninsured.
Dollars spent on Medicaid are dollars not spent on nonreimbursed care or on conditions that could have been prevented or treated less expensively if diagnosed earlier. Medicaid dollars pay for themselves. It’s good business.
Beyond the numbers and dollars, there’s another aspect our representatives should consider. Something told to me by an older staffer during a visit to another clinic my firm had helped develop.
“You know what’s been the best thing about all this, and for all these people?” the staffer said, pointing to the waiting room. “It’s self-respect. Being able take care of yourself and not having to worry or beg for health care gives everyone a little self-respect.”
Self-respect. Who doesn’t deserve that? Or continued access to health care? We all do.
TJ Cox is president of Central Valley NMTC Fund, LLC, a certified community development entity with offices in Fresno and Modesto. Its mission is to foster community and economic development in distressed neighborhoods throughout the Central Valley.