San Francisco Mayor Gavin Newsom visited with leaders of the state government in Sacramento today, and announced he was going to sue them. Their decisions are messing up his Healthy San Francisco program, which could provide access to health services to half the city’s uninsured population by the end of the year — granted it gets the money it needs.
Specifically, Newsom (or rather, his city) is seeking an injunction against the 10% reduction in reimbursement rates to providers who take care of Medi-Cal recipients. The yet-to-be-filed lawsuit is seeking a broad coalition of co-plaintiffs to stop the $544 million cut, which takes effect July 1, from going forward.
Newsom’s legal action is a criticism of both Gov. Arnold Schwarzenegger and lawmakers — both Democrat and Republican — who are seeking to balance the state budget through a cuts-only strategy. The state is facing a $14.5 billion — and growing state budget deficit. In February, the Legislature and Governor agreed to an approximately $1 billion package of midyear cuts, which included the Medi-Cal rate reduction.
The rate reduction is bad news for Medi-Cal recipients statewide, who already have a hard time finding doctors who’ll take them. California ranks 42nd in the nation in provider reimbursement rates; primary care providers are paid between $18 to $24 for seeing patients.
In San Francisco, this rate cut translates to an $8.7 million loss to the city’s public health department — a figure that does not include the network of private practice physicians who also see — or don’t see — Medi-Cal recipients.
“The impact is already being felt,” and some physicians are refusing to take appointments from Medi-Cal patients, Newsom said. That means 123,000 Medi-Cal recipients in San Francisco are going to have a harder time getting health care, and they will suffer. Those who get really, really sick will end up in San Francisco General Hospital’s emergency room, which will shift costs to other patients and in other ways to the local economy. It’s a burden on everyone, it’s unfair and that’s what Newsom will argue in court.
I’m a little disappointed, though, that Newsom didn’t come out more strongly in favor of a solution–one that includes revenues. He knows one of the problems is that we don’t have enough money. The state has chosen to shuffle money hither and yon and enact budgets that slid out of balance the minute they were signed into law.
Given his experience in budgeting with massive deficits ($300 million in SF this year), he knows the need to increase revenues. He admitted that he has raised fees to the hilt and has run out of new fees to increase. Still, he stopped short of supporting higher taxes/fees/revenues, saying tepidly, “I don’t believe in a tax-first strategy. But given the magnitude of the problem, it would be wrong not to have revenues on the table.”
While taxes and revenues are the long-term solution, the Mayor’s announcement is an important immediate tactic, to not take the cuts laying down. In San Francisco, Newsom is actively supporting his Healthy San Francisco program, which he says should be a model for the state. But, he said, “other health care programs will get cut. This money comes from somewhere. Finding a way to get it done will impact other programs in the city. there will be layoffs within the city as a consequence.’
It’s nice that there is a high-profile ally who will shed light on budget cuts–he predicts that these cuts will have a big impact on San Francisco–a county that comparatively spends more on health care than others. If that’s the impact in SF, how much worse will it be in the rest of the state?