If proposed cuts to California's Medicaid plan become reality, they will affect people with the most to lose -- the poor and the young.
Gov. Arnold Schwarzenegger has asked for cuts of $1.1 billion in the Medi-Cal insurance program, which covers about 6.6 million low-income people in California. In Merced County, about one-third of the population is either on Medi-Cal or qualifies for it.
"This is going to affect the people who are not the best at protecting their rights," said Christine Noguera, the deputy chief executive officer at Golden Valley Health Clinics in Merced. Golden Valley is a federally qualified health center that takes care of the poor and indigent patients in the county.
Reimbursement rates for doctors would be cut about 10 percent, if the cuts are approved. An average reimbursement rate for an office call for the physicians who currently take Medi-Cal is about $15 per visit. The billed rate for that call is about $60.
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"Most physicians in our area already don't take Medi-Cal, this will just make more of the ones that do, stop taking it," said Christine Muchow, executive director of the Merced-Mariposa Medical Society, a physician membership organization.
Because of the low reimbursement rates, only a few local doctors currently take Medi-Cal patients, and that results in a lot of patients either not getting specialty care or having to go out of town for their health care."People are not getting timely care," said Noguera, who added that some Medi-Cal patients in Merced end up seeing specialists in the Bay Area months after their original office visit.
Medical care for orthopedic and ear, nose and throat problems is the hardest to get for Medi-Cal patients, Noguera said. "The doors for access to Medi-Cal patients are continually closing," she said.
It's not just medical care that is going to be cut. Noguera said that optometry services for all Medi-Cal patients would be cut completely. "Children will not have access, and that's a major impact on children's ability to learn, if they can't see," she said.
The amount of money that will be saved by cutting out both optometry and chiropractic coverage will be small, Noguero said, but the impacts on patients will be huge.
"We want people to have eye care, especially diabetic patients and children," she said.
Although the planned cuts won't directly affect hospitals, the lack of access for patients will indirectly affect Mercy Medical Center Merced.
Ezequiel Tasabia, director of managed care for Catholic Healthcare West, Mercy's parent company, said that more Medi-Cal patients will end up using the emergency room as their primary care doctor, which puts a burden on an already overstressed system.
"If they cut doctors' reimbursements by 10 percent, most people are anticipating that a number of physicians will simply stop taking Medi-Cal patients," Tasabia said.
And those patients will still need care. "The emergency room has to see those patients by law. It will have a huge impact," Tasabia said.
Instead of cutting care to the people who need it the most, Noguera said that the government needs to realize that health care is a basic need that keeps the entire state healthy, not just the individual."This will affect everyone, not just Medi-Cal patients, because we are all part of the greater community," Noguera said.
A real solution to the problem may be far in the future, but Muchow said that cutting rates to doctors won't fix anything.
"These cuts will only make it worse. The whole medical system is broken and needs to be fixed," she said.