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Same Governor, Different Goals

By Cynthia Craft
Health Access California

As July 1st hits, a budget fix for California is apparently nowhere in sight. So how is this year different from years past?

Besides the alarming $24 billion hole in California's budget, we seem to have a different Governor. As recently as 2007-08, Gov. Schwarzenegger was actively advocating for health reform. Now he proposes to endanger the intergrity of the very programs on which health reform would be built.

The "Year of Reform" governor sought to expand and improve Medi-Cal. Today, our public health programs seem to be a prime place he goes to find "savings" in the state budget. While, on one hand, he's demanding big-picture solutions from legislative leaders, with the other hand he's passing around a new package of proposals that could, in effect, make Medi-Cal coverage less accessible.

Under the guise of modernizing the system and "bringing California into the 21st Century," Schwarzenegger would eliminate 27,000 county workers who currently help Medi-Cal recipients with complex enrollment procedures. He calls person-to-person interaction an "antiquated process...relying on slow and time-consuming face-to-face and mail-in processes that are only available between 9-5 and lack uniformity across counties."

Moving the process online, he says, will be "taking advantage of the latest technologies to allow people to apply and enroll in state programs faster and with fewer hassles -- all while reducing costs." It almost sounds too good to be true.

Advocacy groups like the Western Center on Law & Poverty find this alarming.

People need the help of those county workers -- their face-to-face interaction, and step-by-step assistance -- to successfully enroll in Medi-Cal or determine their eligibility. Medi-Cal is an exceedingly complex program.

Advocacy groups also know that a process to apply for Medi-Cal online is already underway, and believe this should be but one of several options for people to sign up for Medi-Cal. The online project is being carefully monitored by stakeholders who want to make sure it's fair, accessible and works well as it proceeds.

Yet the Governor's proposal is something else--a wholesale privatization, turning enrollment into a for-profit private vendor like Maximus. Such privatization makes government programs less transparent and accountable -- and can lead to time lags in enrolling patients (thus saving the state money). Other states have tried privatizing the management of health care eligibility and enrollment with little success.

Even Texas cut the cord on its privatization effort, finding itself without the promised savings and short on workers who previously administered the program. The Fort-Worth Star Telegram reported that, in the end, offices were understaffed, calls went unanswered and Texas was left with "fallout from a major experiment in state government that nearly everyone called a disaster."

To be clear, Schwarzenegger's proposal isn't intended to simplify and eliminate the various enrollment barriers, like the asset test or regular redeterminations. It's meant to undo the network of people that help low-income families navigate this complex and confusing system.

This could result in fewer people enrolling in Medi-Cal, especially since the least likely population to have online access at home include low-income seniors and people with disabilities. Those are the people who Medi-Cal is responsible for serving -- and California already spends less on their care than other states.

So what may seem logical -- taking advantage of online capabilities -- may turn into a barrier, a barrier that results in fewer people receiving Medi-Cal health insurance. But that may be the point.

Health Access California is a statewide health care consumer advocacy coalition of over 200 groups. This article has also been published on the Health Access Weblog.

Posted on July 02, 2009

Comments

It is no longer $24 billion - it's closer to $26 billion, and growing every day as the refusal of the majority dems to actually solve the problem drives California's credit rating deeper into the dust - and costs us more money on every general obligation, revenue appreciation, and every other kind of debt we sell.

They don't care about the taxpayers, and I'm believing to believe they don't really care about the poor either. What they care about is the government employee unions that keep them in power - and their own reelection.

Posted by: George Hanshaw at July 2, 2009 11:07 AM

I am not sure if people are aware of just how big a price tag is attached to privatization of state services. It serves to make a few rich while the intended recipient, the tax payer and resident of the state, goes without a needed service.

The tragedy here is that we have allowed the mismanagement of California dollars for the greedy agenda's of a few. Wake up California!

Posted by: A Moreno at July 2, 2009 04:11 PM

"They don't care about the taxpayers, and I'm believing to believe they don't really care about the poor either. What they care about is the government employee unions that keep them in power - and their own re election'

oh yes .. HOW TRUE THIS STATEMENT IS.. THAT IS ALL THEY CARE ABOUT...PERIOD

Posted by: UPTHECREEK at July 2, 2009 10:57 PM

It is no longer $24 billion - it's closer to $26 billion, and growing every day

As of today, now $26.3 Billion, and that's not including the additional cost of financing the state will pay because of the poorer rating on all of our debt instruments like out revenue anticipation notes and even general obligation bonds.

The dems are fighting in a burning building. Any concessions they extract from the guv about keeping more of the government employee union workers programs going (this never WAS about taxpayers) will be lost in the mounting debt that will force still greater cuts - but the dems fight on. Screw the taxpayers, it's only the government employee unions that are important after all....

Posted by: George Hanshaw at July 3, 2009 08:26 AM

An interesting comment from the Meg Whitman for governor campaign:

Twenty-five percent of California's revenues come from income taxes paid by the 144,000 richest taxpayers, so "if one of them leaves, it's a really bad thing." Lots have left. Some never really arrive. Pierre Omidyar, after founding eBay in San Jose, resided in Nevada, which has no income tax.

It's too bad that many of you can't even begin to consider the very real possibility that the class warfare rhetoric that keeps the dems in power may be the very thing that is killing California.

Posted by: George Hanshaw at July 5, 2009 05:32 PM

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