I received a call that I’d been dreading recently. 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 Medi-Cal patients in the Valley – 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 diagnosed our situation nicely, “This is a politically induced coma.”
I can’t blame the banker. Congress has been clear on its intent to obliterate funding for Medicaid, which is the primary source of revenue for community health clinics. Thursday’s passing of the soup-sandwich of Affordable Care Act (ACA) replacement legislation included directives to immediately halt the enrollment of new Medicaid participants, jettison coverage for 20 million Americans (including 300,000 here in the Valley) and cut already too-low Medicaid reimbursement rates by 25 percent.
Central to the House’s bill is the elimination of the revenue sources (taxes on the 1 percent) crafted into the ACA to pay for Medicaid expansion. The high-fives on Wall Street could be heard here in California. The truth is, though, the attack on Medicaid will be terminal to our community’s health
And that’s too bad. The expansion of Medicaid and extraordinary growth of community health clinics to serve the newly insured has been transformative. Since 2013, throughout the eight-county San Joaquin Valley, over 500,000 low and moderate income hard-working adults have gotten health insurance through the Medicaid expansion – 300,000 of those for the first time.
The largest drops in uninsured have been most vulnerable among us: young adults, part-time workers and the “working poor” (people holding full-time jobs but who earn salaries just above the poverty level).
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 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.
These new clinics and health-care jobs are making a real difference in reducing our region’s chronic shortage of doctors and other health-care professionals. Fifty-five percent of Valley census tracts are considered “health-care professional shortage areas.” Because of Medicaid expansion, health-care providers were 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.”
Instead of scaling back Medicaid, our congressional representatives should have been looking at ways to enhance the program, such as putting Medicaid reimbursements on par with Medicare compensation, making insurance premiums tax-deductible or letting people buy into Medicaid or Medicare.
The fact is, the rollback of Medicaid will negatively affect our Valley’s clinics and will lead to layoffs, fewer services and a less healthy community. The thousands to be kicked out of Medicaid aren’t going anywhere, just back to the emergency room. Dollars spent on Medicaid are dollars not spent on unreimbursed 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.
But beyond the numbers and dollars, there’s another aspect the Senate 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.