Report Finds Medi-Cal Expansion Strains San Diego's Safety Net

San Diego's healthcare provision is straining due to expansion of the Medi-Cal program. A report by the California Health Care Foundation has found that the number people in San Diego with Medi-Cal coverage had doubled to nearly 700,000. Ha Tu, report co-author, said the greatest area of challenge lay in access to San Diego's specialty care and behavioral health care, with many specialties declining to treat Medi-Cal patients because of low reimbursement rates. The report also looked at health care systems in the county and found that while some have gained market share others have lost out.

I'm Maureen Cavanaugh. It's Thursday, July 14. Our top story on Midday Edition. More people having access to healthcare through Medi-Cal is one of the success stories of the affordable care act. That it's not without challenges. Any report from the California Health Care Foundation finds that in San Diego, the number of people seeking health care services through Medi-Cal is putting a strain on the healthcare safety net. I spoke with health reporter, Kenny Goldberg. Kenny, think you for joining us. Thank you. What exactly is the healthcare safety net made up of here in San Diego? The healthcare safety net is first the Medi-Cal program which provides low income people with health insurance. And they get the care primarily from community clinics. There is a network of different clinics all over the county that provide primary care, some mental health care and a limited amount of specialty care. How successful has the Medi-Cal expansion been here in San Diego in terms of signing up people to the expanded program? It's been very successful since Obama care went into effect. The number of people on Medi-Cal and San Diego County has doubled. There are more than 700,000 people in the county that have the decal coverage. What does this report say about how the clinics are handling the expansion? They are handling it pretty well. They have expanded to handle the increased load. And community clinics provide care regardless of someone's ability to pay. When people have Medi-Cal, it offers a little bit of reimbursement to the clinics which helps their bottom line. And as I mentioned earlier, they have expanded to handle the increased capacity. However, having Medi-Cal insurance does not necessarily guarantee that you're going to get coverage for everything you need. That is one of the problems. This report said that primary care was doing well, right? That's right. Primary care is doing well. Again, that is because of community clinics. But some specialties apparently will not see any new Medi-Cal patients. Telis about that. This has been a problem I've reported on for many years. In the rate that the state pays doctors to treat Medicare patients is so low that doctors say it does not cover their cost, let alone make a profit. We're seeing an increasing number of doctors, especially specialists who are just not willing to treat Medi-Cal patients, new Medi-Cal patients, that is, for the rate the state paid. As a result you have orthopedic surgeons, for example, none of whom in San Diego County, as I understand it, will treat a Medi-Cal patient unless it is an emergency and they are on call. Does this new population of Medi-Cal enrollees also present special challenges when it comes to their health? Definitely. Many of these people are newly insured. They have not had health insurance in the recent past or even ever. Some of them are older patients. They have had a lot of health needs that they have neglected for years. Some of them are presented themselves to the community clinic with a variety of different chronic illnesses. Some more serious than others. Have a variety of unmet medical needs that they have neglected for some time. Are the clinics that usually see people who are on Medi-Cal or can only pay so much for their healthcare -- are they now working with hospitals more closely? Yes. Some of them are, to try to get more comprehensive care to Medi-Cal patients and some of their other clients. However, there's only so much charity care that hospitals can deliver. We still get down to the problem of Medi-Cal reimbursement. Somebody has to pay the surgeon. Someone needs to pay the anesthesiologist. If Medi-Cal reimbursements are so low, there has to be a source of money to make up the difference. Some of these things are happening. Some collaborative projects -- but it's still not as good as someone with private insurance. Also, the report examined the state of San Diego's hospitals. How are they coping with the change? I read some small hospitals are struggling. Yes, they are. That's not just because of the Medi-Cal expansion of course, that has been in the works. For example, hospitals like Tri-City are still having trouble meeting their bottom line. What is looming for many hospitals is 2030 -- that is the date by which all hospitals in California must be earthquake proof. They have moved that deadline back many times but I don't know if they will move it back again. Hospitals like Tri-City, who have tried to get local residents to approve a bond on successfully -- unsuccessfully, these hospitals need to find a source of money to upgrade or they will not be able to stay in business. I've been speaking with health reporter, Kenny Goldberg. Kenny, thank you. Thank you.