Friday, Jul. 25, 2008

Budget cut casualties: Cost of state's fiscal fiasco extends beyond dollar figures

By CAROL REITER
creiter@mercedsun-star.com

$1,000 a minute.

That's the hit that San Joaquin Valley safety net health clinics started taking Thursday when Medi-Cal payments stopped because of the state's budget impasse. The cuts will mean a loss of $10 million a week in revenue to California's community clinics and health centers -- the offices that take care of the poor.

On day 24 without a state budget in place, Golden Valley Health Center's Chief Executive Officer Mike Sullivan spoke to a group in Modesto about how cutting Medi-Cal payments hurts the people least able to withstand a hit to their health.

"The legislators are putting their budget problems on the backs of the poor," Sullivan said.

Golden Valley Health Center is a group of clinics in Merced and Stanislaus counties that gives health care to the working poor, uninsured and Medi-Cal patients. About 64 percent of the patients seen at the clinics are on Medi-Cal, Sullivan said, and taking that money away from clinics trying to help the poor is a disaster in the making.

"We serve and care for 75,000 patients -- no state budget means those people will suffer," Sullivan said.

The safety-net clinics in the San Joaquin Valley are virtually the only places that take care of seasonal and migratory workers, with about 40 percent of the patients coming from that group. More than 75 percent of the patients seen at Golden Valley are living in poverty; 74 percent are Latinos.

Because Golden Valley has been around for more than 35 years, Sullivan said it has enough money saved to keep the clinics going for about 60 days without any income from Medi-Cal. After that, services to patients could be dropped and staff may be let go.

"The governor is looking for $15 billion, and he's trying to get it from the people who have no voice," Sullivan said.

The people safety-net clinics take care of are the working poor -- those who work for a living but have no health insurance, said Dr. Sylvia Diego, chief medical director for the Central Valley Health Network, a consortium of safety net clinics.

"We represent the fragile people, the ones who have no idea what is going on," Diego said. "If these clinics close, who will take care of these patients?"

Because Medi-Cal payments to physicians are so low, most local doctors don't see any Medi-Cal patients, leaving the safety-net clinics to pick up the slack.

Dr. Thom Mahoney, director of clinical affairs for the California Primary Care Association, said that this isn't the first time that budget problems have hit the poorest of the poor.

"This is the 20th year in a row that the state hasn't had a budget on time -- it needs to stop," Mahoney said.

Clinics at Mercy Medical Center Merced are also affected by the state budget problems. Alicia Bohlke, director of the rural health clinics at the hospital, said that although the clinics are in a little better shape than some because they're associated with a large corporation, any type of payment freeze will affect their ability to give care.

"64 percent of our clinic visits are Medi-Cal patients," Bohlke said, out of about 63,000 patient visits a year.

Patients affected by the cuts will need extra help making their way through the maze of staying qualified, and clinic directors are afraid that a lot of people will fall by the wayside.

"Health care can be confusing anyway," Bohlke said. "When something like this happens, it makes it so much more difficult for our patients."

Sullivan said that California, and its legislators, have a responsibility to take care of the people who work to keep the agricultural economy of the Central Valley going.

"This is the Appalachia of California," Sullivan said. "It's simply political responsibility. Our legislators need to act more responsibly."

Reporter Carol Reiter can be reached at (209) 385-2486 or creiter@mercedsun-star.com