The Affordable Care Act is a historic opportunity to increase the number of individuals and families with health insurance as well as access to critical services that can prevent serious illnesses in the first place.
The governor and Legislature should be commended for positioning California to take advantage of federal funding that will help launch health care reform in January 2014. Yet local funding for the very services that health care reform promises to provide is under threat by state budget proposals that would redirect $300 million currently spent on local health care to Sacramento. That number could rise to more than $2 billion over three years.
California’s counties are concerned this shift will cut into health care programs and services, threaten the local health care safety net and reduce counties’ ability to invest in preventive care that will improve residents’ lives and reduce health care costs overall.
It’s assumed that the state’s counties, which currently provide health care for those who either cannot afford or cannot obtain health insurance, will save money as more individuals and families move into coverage programs. But no one knows with any degree of certainty what will happen. One thing is certain, however: Any savings to counties won’t happen immediately.
That’s why it’s critical to stop a raid on local health care funding. We need to see the actual results of the Affordable Care Act before we start shifting money around. A shift that would cause counties to cut into existing programs and services at precisely the time more people will want to get access to care. This could undermine the very success of the Affordable Care Act in California.
Using a formula proposed by Gov. Jerry Brown, San Mateo County could lose $32 million in three years. This would occur at the very same time that we are trying to make enough services available to meet our waiting list for primary care (currently at 1,500 people) and trying to increase appointments for people who will be newly insured.
If this funding is not protected, important programs in San Mateo County could be in jeopardy such as insurance for children — San Mateo County is one of only two counties with universal insurance coverage for children due to county funding of the Healthy Kids programs. Other vital services that are threatened are the Keller Center, which provides expert care and evidence collection for children and adults who have been physically or sexually abused and neighborhood-based health clinics which serve some of our community’s most vulnerable.
That’s why we urge lawmakers in Sacramento to support the following actions as they consider the state budget in the coming weeks:
• Leave county health funding alone for at least three years so that we all can see how many people actually enroll and how many people remain uninsured. The federal government is paying 100 percent of the cost during this time. Why should the state take away money from the counties? It makes no sense to force us to offer fewer appointments and fewer services at precisely the time more newly insured people will be seeking care. If people enroll and then find they cannot get an appointment, you can be sure they will not re-enroll the following year.
• Share any savings between the counties and the state. San Mateo County puts in tens of millions of county dollars into health care each year. Why should the state take this money and benefit from any savings? If county health systems have savings once the Affordable Care Act is fully implemented, counties and the state should share evenly in the savings, with the county able to redirect these dollars to cost-saving preventive measures.
• Ensure that public hospitals and clinics, like San Mateo Medical Center, can continue to serve the public and new Medi-Cal enrollees with adequate funding. If public hospital and clinics are relegated to only serving uninsured residents, county public hospitals and clinics will not survive financially.
Brown’s proposal to take an estimated $32 million in San Mateo County funding in the next three years is neither necessary nor appropriate. With 100 percent federal reimbursement for three years for new Medi-Cal recipients, California lawmakers should take the time to see how things unfold before taking county health funding for their own purposes.
Carole Groom is a member of the San Mateo County Board of Supervisors. She represents District Two.