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Same State, Different Worlds

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There are two Californias when it comes to health care. 

In one, patients and communities are well-served by their health care system. Physicians, nurses, pharmacists, and other providers are easily accessible, offer a wide variety of services at multiple locations, and deliver care using the latest technology. 

In the other, care sites are harder to come by and people must travel farther — especially for specialty services. Medical equipment is aging and outdated, and people seeking care all too often hear that Medi-Cal coverage isn’t accepted at that location. 

For the one in three Californians who rely on Medi-Cal — two-thirds of whom are non-white — health care delivery can sometimes feel like a caste system, and they experience our health care system and their own personal care very differently. 

Data prove the point: A recent California Health Care Foundation report showed that more than 22% of Medi-Cal enrollees have no usual source of care, compared with less than 9% of enrollees in employer-sponsored insurance. And 33% of Medi-Cal enrollees are either in fair or poor health, compared with 13% of those with employer-sponsored insurance. 

What does this inequitable system mean for Californians and their families

It means that if you are Black in California, you can be expected to live five years less than other Californians. It means that you have higher rates of new prostate, colorectal, and lung cancer cases. It means you are at greater risk of depression. 

If you are Latinx, it means you are more likely to report being in fair/poor health, to have an income below the federal poverty level, and to be uninsured.  

This cannot stand if we value a just and healthy society.   

Key to this inequity is the fact that Medi-Cal enrollees are shortchanged: systemic state and federal underfunding means that hospitals that care for Medi-Cal patients are reimbursed just 74 cents for every dollar they spend providing care, resulting in fewer resources for California’s most vulnerable communities. 

The remedies are straightforward and require a commitment on the part of California’s leaders to begin to address an issue that can feel overwhelming but could be improved with a series of key adjustments. CHA is working to advance several changes to create greater health equity through the state’s legislative and budget process: 

  • Replacing the policy that froze Medi-Cal hospital APR-DRG rates (a schedule of payments for common procedures) at 2012-13 levels 
  • New, annual payment adjustments that account for the social and environmental challenges patients may be experiencing 
  • Converting designated public hospitals’ Medi-Cal fee-for-service inpatient reimbursement to a value-based structure that includes state General Fund support  

These actions alone will not solve the challenge of health inequity in California — that broader challenge is one of enhancing diversity, addressing bias, incorporating inclusion. More important, it is about understanding the diverse needs of our communities — not just by ZIP code, not just by street, but house by house. It begins by ensuring that the most vulnerable communities in California get the resources they need to preserve health; these proposals are a solid first step and one that California should not hesitate to take.