Health Care/Aging & Long Term Care

By Patty Berg

Our goal must be universal access to high-quality, affordable health care for all. We must evaluate new models of health care delivery for our state and rural counties. As well, California must adequately plan for the aging of its population. Heading off this potential `demographic train wreck' is at the very top of my agenda." - Patty Berg

MAJOR ISSUES:

Uninsured/Underinsured: Nationally 45 million people have no health insurance, and at least 39 million are underinsured. In California, over 7 million people have no health insurance and 1.8 million of those are children. The majority of those persons who are uninsured work full time in jobs that either do not provide health insurance or do not pay well enough to afford private insurance. They most often work in wholesale, retail, construction and agriculture.

Health Care Costs/Access to Health Care: The cost of health insurance is the main reason people do not buy it even if their employer offers it. The cost of health care and health care insurance continues to escalate. Costs are expected to jump once again by 16 percent this year.

Sixty-five million Americans have no drug coverage, and the cost of prescription drugs increased by 18.8 percent from 1999-2000.

Medi-Cal is the state-federal health care program for more than 5 million low-income Californians administered by the Department of Health Services (DHS). A major problem with Medi-Cal is that rates paid to physicians are relatively low compared to the rates paid by the federal Medicare Program. Why? Because DHS has failed to conduct annual rate reviews or make periodic adjustments to Medi-Cal rates to ensure reasonable access to health care services for low-income people. There should be a rational basis for setting and adjusting Medi-Cal rates on an annual basis. Inadequate reimbursements to physicians mean fewer physicians participate in the program, which negatively impacts access to care for Medi-Cal patients.

HMO's Failure to Provide Services in Rural California: HMOs are mainly concerned with numbers to derive profit. In rural areas there are not enough residents to make it profitable. Rural people tend to have more health problems, are often older, and sometimes poorer. As of the first of the year, 16 rural counties in California have lost some or all of their HMOs. Blue Shield, Health Net and PacifiCare have stopped serving patients in much of the 1st AD, leaving over 12,000 residents without HMO coverage in Humboldt, Trinity, Lake and Mendocino counties. The recent bankruptcy of Health Plan of the Redwoods in Sonoma County has left thousands of residents without their HMO coverage. Eighty percent of Californians living in rural areas do not have access to even one HMO. Of course, what happens is that people are faced with switching insurers, paying higher premiums and out-of-pocket costs, or traveling outside the area for care. In the arena of managed care, physician-patient relationships are threatened for fear of retaliation from HMO administrators, concerned with profits.

Medical Practitioner Shortage in Rural California: Record numbers of individual physicians are quitting practice, retiring early, leaving the state or changing to non-clinical jobs,according to Jack Lewin, Chief of the California Medical Association. A survey conducted by the CMA this year, found 30-50 percent of California's private physicians will leave practice in the next five years mainly due to: inadequate reimbursement levels; a government regulatory environment that negatively impacts the quality and availability of patient care and managed care. These findings proved true in the 1st AD. Rural areas in California have a shortage or lack certain physician specialties; we have difficulty recruiting and retaining physicians, dentists and pharmacists in our communities and we continue to experience a nursing shortage of major proportion. We also suffer from a major shortage of mental health professionals.

Hospital Issues: California's rural hospitals serve a population of more than 2.6 million rural residents, covering a geographic service area that includes approximately 75 percent of the state. They serve an average of 39-percent Medicare and 19-percent Medi-Cal inpatients and 30-percent Medicare and 21-percent Medi-Cal outpatients.

Hospitals in the district are faced with financial problems caused by empty beds, under use of costly equipment, and reimbursements that are too low (30 cents on the dollar for Medi-Cal patients). Hospitals are also struggling to keep open emergency rooms (which those without health insurance often use as their primary care provider) and, are facing the daunting financial obligations to retrofit hospital buildings. In the last year, California has closed 20 emergency rooms, further jeopardizing access to care for the uninsured. The cost of providing care in a hospital emergency room is several times that of a doctor's office.

Reimbursement Parity for Rural Hospitals and Health Services: There exists a remarkable disparity in the rate of reimbursement for identical procedures conducted in small rural hospitals vs. large urban hospitals. This disparity continues to threaten the very survival and sustainability of rural health services.

Current law puts rural health facilities at a disadvantage in competing for scarce resources for emergency care and other life-saving services. For example, the state currently makes some funding for emergency care available only through trauma centers. Because most rural counties do not have trauma centers they are precluded from access to these funding sources. Access to emergency care in rural counties is of equal or greater concern compared to that of metropolitan areas.

There is also the issue of rural health care facilities falling through the cracks with regard to rural designation. A hospital that serves a rural population but is within, what is considered to be, close proximity to an urban area, may not receive rural status and therefore, is unable to access funds as a rural healthcare facility.

Mental Health and Public Health Services Grossly Underfunded: Over 30 years ago, California decided that people with mental illness should live in their communities rather than be locked up in institutions. It was determined they would benefit from community-based treatment. We have failed to follow through with all that was required by this decision. As a result, people with serious mental illnesses live on street corners and sleep in parks. They are in our jails and prisons, jailed for their protection, not the public's. They are disproportionately represented among the poor, the victims of crime, the unemployed and the homeless. Mental health programs are the chronic losers in budget debates, and an estimated 1.5 million Californians are in need of help, but do not receive it. We simply have to dedicate more resources to mental health.

For the sake of everyone's health, we must make adequate investments in California's public health system and guard against shortsighted efforts to balance the budget at the expense of Californians' health and well-being. Some have suggested borrowing against future tobacco settlement funds in order to balance the budget. This would be a mistake. It is in the long-term interest of our people to ensure that these funds are preserved for legitimate public health purposes, such as expanding health coverage for children, tobacco prevention, health education and prevention services, surveillance and control of infectious diseases, environmental health and public health disaster planning.

Strengthening Community Health Centers: Over 740 Community Health Centers in California provide services to almost 3 million individuals. In Assembly District 1 alone, more than one-in-five residents use the services of their local community health center. In rural areas, health centers are often the only source of medical care in the entire community. Community health centers provide quality, affordable health care in culturally and linguistically sensitive settings. They are vital economic and social centers and, in rural areas, is often one of the community's largest employers. The community health center system is an excellent model of a successful, compassionate and cost-effective system of primary and preventive care. These health centers must be supported and strengthened by state agencies at all levels.

PATTY BERG'S HEALTH CARE AGENDA:

• Research and refine "new models" of health care delivery tailored to the health care needs of all Californians, the goal being to ensure all Californians have access to affordable and dependable health services. Explore the community health center model as the potential core structure of an effective and comprehensive primary care system.

• Ensure all qualified children and working families are enrolled in the Healthy Families Program and learn from other states that have been successful in registering children as well as from Santa Clara County's successful outreach model.

• Provide prescription drug coverage to low-income senior citizens using the Illinois SenioRx Program as a model.

• Make available affordable and comprehensive long-term care insurance that guarantees a menu of services, including: home care, assisted living and convalescent care.

• Provide Medi-Cal coverage for residential and board and care facilities.

• Expand access to long-term care and make better use of existing capacity by increasing state Medi-Cal payments to long-term care providers.

• Establish a rational process for annually reviewing and adjusting Medi-Cal rates, using the Medicare rate-setting system as the benchmark.

• Require HMO's who do business in California to provide services in rural areas.

• Create a funding formula to ensure rural parity for health care services, ensuring that federal and state definitions of rural are made consistent.

• Ensure that rural counties have equal access to funding for emergency services and other life-saving services available to metropolitan areas.

• Provide incentives to medical practitioners (such as offsetting school loans) who practice in rural, underserved areas.

• Invest in comprehensive services for the mentally ill, including community-based resources.

• Ensure tobacco settlement revenues are reserved to achieve legitimate public health objectives, like expanding health coverage for children, tobacco prevention, and general health education prevention services.

• Explore ways to mitigate the escalating cost of prescription drugs, consistent with maintaining a viable drug research effort, but with the goal of providing affordable health care to all Californians.

• California Nurses Association
• American Nurses Association
• California Dental Association
• Humboldt/Del Norte Medical Society
• National Association of Social Workers, California
• SEIU 250, Homecare Workers Union

AGING AND LONG TERM CARE

"Citizens over 85 are the fastest growing segment of our population. By 2010, one out of five Californians will be 60 or older. California is not prepared for a shift in demographics of this magnitude. California must adequately plan for the aging of its population. Heading off this potential 'demographic train wreck' is at the very top of my agenda." - Patty Berg

• Legislation guaranteeing the release of federal funds for senior services in the event the State Budget Act is not enacted by June 30.

• Implement California's statewide strategic plan on aging, which will address the health and social challenges of aging in the 21st century. (As referenced in Senate Bill No. 910, approved by the Governor October 10, 1999).

• Provide prescription drug coverage to low-income senior citizens.

• Make available affordable and comprehensive long-term care insurance that guarantees a menu of services, including: home care, assisted living and convalescent care.

• Provide MediCal coverage for residential and board and care facilities.

• Expand community-base services, so that seniors can remain independent. Ensure a quality case management program exists in all 58 counties in California for the purpose of intake, assessment, service planning, service delivery and reassessment.

• Ensure the provision of in-home care that is affordable and accessible and provide statewide training curriculum and registry services for in-home providers.

• Expand affordable housing options for seniors including the establishment of foster care statewide.

• Enact tough laws to put patient care before insurance company profits.

• Dixon Arnett, Former Director California Department of Aging
• Barry Donenfeld, Past President National Association of Area Agencies on Aging
• Dan Laver, Past President National Association of Area Agencies on Aging
• Mary Dennison, California Senior Senator, Humboldt & Del Norte Counties
• Thea Gast, California Senior Senator, Humboldt & Del Norte Counties