The California example….

Writing for The New Republic’s The Treatment, I report on the grim July for health care in California, which contrasts sharply with the federal optimism around health reform.

On July 1, nearly 3 million Californians–mostly low-income parents, seniors, and people with disabilities–lost
ten key benefits
in their Medi-Cal coverage. The biggest concern is dental coverage, which over 900,000 of these patients use in a given year. Other benefits these patients lost include podiatry, optometry, psychology, and speech therapy.

All of these cuts are foolish: Dental coverage allows for better nutrition and prevents emergency room visits. Podiatry is an early warning signal for diabetes, etc. But these decisions don’t even meet the “penny-wise” cliché. In addition to being cuts to preventative care, the state is losing $1.60 in federal matching funds for every dollar we cut, impacting our health system, and our economy.

And while those cuts focus on all adults on California’s safety-net programs, the children have not been spared. Far from it. Governor Arnold Schwarzenegger has proposed fully eliminating Healthy Families, California’s version of the state Child Health Insurance Program that covers nearly one million children.

Last Friday, July 17th, the board that runs Healthy Families closed enrollment, both to new applicants and even to those who are shifted from other state programs. Children on Medi-Cal coverage turning one or six-years-old in certain income categories will get a birthday gift of losing their health insurance. It is estimated that over 350,000 low-income children will be frozen out of health coverage and placed on a waiting list in the next year.

The news today is even worse: the cuts that legislative leaders just agreed to as an alternative to full elimination would force the program not just to impose a wait list, but also to actively dis-enroll hundreds of thousands more children from coverage. The consequences will be kids not getting glasses to see the blackboard, missing school for toothaches, and otherwise delaying care. One ailment or accident on the playground would put families at risk of financial ruin, and needed care will be delayed or avoided altogether. Children’s and other community groups don’t mince words when they say that cuts at this scale mean kids will die.

The Legislature will vote later this week on the Healthy Families cut and many other shameful cuts to health care–as well as education, human services for our most vulnerable, and the other functions of state budget. The Governor and legislative leaders should reconsider these tragic choices.

…I also think California’s seventh-worst uninsured rate in the nation contributes to the environment that allows such cuts to be even considered. After all, with several hundreds of thousands of uninsured children already, what’s hundreds of thousands more?

And that’s a notion that needs to fundamentally change with health reform.

In the context of a near-universal system, federal health reform would set a floor to prevent such cuts. Now, the number of children covered is arbitrary, and while policymakers may feel its nice to cover as many children as possible, it’s not an imperative. Also during a budget crisis, federal health refrom provide the federal resources to meet these commitments that states may find it impossible, especially in bad budget times.

Its imperative that we work at both levels, at the state level to defend what we can and prevent the worst, while organizing for the best, with the potential of comprehensive health reform that might save us from ourselves.

Health Access California promotes quality, affordable health care for all Californians.

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