Thought lead­ers ar­gue ex­tend­ing health cov­er­age will save in costs

The Fresno Bee (Sunday) - - Insight - BY DAN SCHNUR Spe­cial to The Sacra­mento Bee

to read­ers: Each week through Novem­ber 2019, a se­lec­tion of our 101 Cal­i­for­nia In­flu­encers an­swers a ques­tion that is crit­i­cal to Cal­i­for­nia’s fu­ture. Top­ics in­clude ed­u­ca­tion, health­care, en­vi­ron­ment, hous­ing and eco­nomic growth.

Stay in the know: Go to www.fres­ in­flu­encers to sign up for the Cal­i­for­nia In­flu­encers news­let­ter – and tell us what you think.

In other parts of the coun­try, they’re fight­ing about whether to build a bor­der wall or whether to de­port asy­lum seek­ers. But here in Cal­i­for­nia we’re hav­ing an en­tirely dif­fer­ent type of de­bate.

When Gov. Gavin New­som’s bud­get pro­posed ex­pand­ing health cov­er­age to all un­doc­u­mented im­mi­grants up to age 26, his fiercest crit­i­cism came from those who felt his pro­posal was not nearly am­bi­tious enough.

So it shouldn’t be sur­pris­ing that most of our Cal­i­for­nia In­flu­encers sup­port pro­vid­ing health in­sur­ance to larger num­bers of low-in­come im­mi­grants, cit­ing a range of pub­lic health, eco­nomic and hu­man­i­tar­ian con­cerns.

Mark Ghaly, New­som’s sec­re­tary of Health and Hu­man Ser­vices, cited fed­eral re­quire­ments to pro­vide emer­gency ser­vices to all unin­sured pa­tients and sug­gested that it would not make sense to with­hold other types of care to un­doc­u­mented im­mi­grants.

“The ques­tion should be, what should Cal­i­for­nia do given our clearly de­fined min­i­mum obli­ga­tion un­der fed­eral law,” Ghaly asked. “Should we stop there or should we take it a rel­a­tively small step fur­ther by en­sur­ing the full ben­e­fits of a health care sys­tem built on the back­bone of pri­mary and pre­ven­tive care rather than emer­gency and hos­pi­tal care? I vote the lat­ter.”

Robin Swan­son, founder of Swan­son Com­mu­ni­ca­tions, was em­phatic in an­swer­ing Ghaly’s ques­tion.

“Stud­ies have shown that high rates of unin­sured re­sult in con­sid­er­able fi­nan­cial bur­dens for hos­pi­tal sys­tems, which are charged with pro­vid­ing care whether or not a pa­tient who walks in the door is in­sured,” she said. “We can ei­ther ad­dress the is­sue up­front and pro­vide ba­sic preven­ta­tive care, or we can wait un­til health prob­lems be­come a very ex­pen­sive cri­sis.”

Santa Cruz County Su­per­vi­sor Zach Friend agreed.

“There is a real and direct cost, es­pe­cially at the lo­cal level, to not pro­vid­ing ad­e­quate health care and cov­er­age to unNote

doc­u­mented im­mi­grants,” Friend said. “In our county, we see the costs from those that aren’t in­sured – from poorer health out­comes to de­creased worker pro­duc­tiv­ity.”

Le On­dra Clark Har­vey, di­rec­tor of Pol­icy and Leg­isla­tive Af­fairs for the Cal­i­for­nia Coun­cil of Com­mu­nity Behavioral Health Agen­cies, was even more spe­cific.

“Poor health­care in­fra­struc­ture for un­doc­u­mented im­mi­grants can re­sult in a lack of preven­ta­tive care, over­crowded emer­gency rooms, an over­re­liance on county in­di­gent care and safety net sys­tem,” Clark Har­vey said. “And poor health out­comes im­pact more than the in­di­vid­ual and their fam­ily – these out­comes also im­pact the com­mu­nity they re­side in and … the ed­u­ca­tion and crim­i­nal jus­tice sys­tems.”

For­mer AARP Pres­i­dent Jea­nine English added that un­doc­u­mented im­mi­grants are also part of the com­mu­nity

“They are the moth­ers, fa­thers and grand­par­ents of our cit­i­zens,” English said. “Re­gard­less of parent­age, the ba­bies that we de­liver in our hos­pi­tals are cit­i­zens, and it is im­por­tant that they be­come healthy chil­dren who have the best chance of be­com­ing pro­duc­tive and con­tribut­ing mem­bers of our com­mu­nity.”

As­sem­bly Repub­li­can



Le On­dra Clark Har­vey

leader Marie Waldron did not con­test the hu­man­i­tar­ian is­sues raised by her fel­low In­flu­encers, but called for the need to first ad­dress short­com­ings in cur­rent state health pro­grams.

“The ques­tion should be: How do we dis­trib­ute our lim­ited re­sources to make sure they’re do­ing the most good? ...It’s clear that we need to en­sure our safety net health care pro­grams are serv­ing cur­rent en­rollees be­fore we ex­pand the pro­grams any fur­ther,” said Waldron, who pointed to low rates of ser­vices for low­in­come chil­dren. “Low payments to providers and other bar­ri­ers to ac­cess­ing care need to be ad­dressed be­fore we add thou­sands of ad­di­tional peo­ple to Medi-Cal. Un­til then, it just doesn’t make sense to ex­pand a pro­gram that’s not do­ing a good job at its cur­rent size.”

Other In­flu­encers pointed to the im­prac­ti­cal­i­ties of dif­fer­en­ti­at­ing care ac­cord­ing to doc­u­men­ta­tion.

“The re­al­ity is that ma­jor epi­demic ill­nesses like the flu, measles, or tu­ber­cu­lo­sis don’t check res­i­dency sta­tus,” said Bruce Ch­er­nof, pres­i­dent and CEO of The Scan Foun­da­tion. “Chronic dis­eases are far more ex­pen­sive seen in the emer­gency room than man­aged ap­pro­pri­ately in an out­pa­tient set­ting. Our health… is shaped by all those liv­ing in our com­mu­ni­ties.”

Dustin Cor­co­ran, CEO of the Cal­i­for­nia Med­i­cal As­so­ci­a­tion, echoed those sen­ti­ments.

“Physi­cians should not be con­cerned with a pa­tient’s im­mi­gra­tion sta­tus when that pa­tient needs health care,” Cor­co­ran said.

Kassy Perry, pres­i­dent of Perry Com­mu­ni­ca­tions Group, pointed out that the so­lu­tion would need to come from Wash­ing­ton not Sacra­mento.

“The real re­spon­si­bil­ity here rests with Congress, whose in­abil­ity to reach across the aisle… for the good of the na­tion is ap­palling,” she said. “Our chal­lenge is how do we move Congress to pay for the care pro­vided to those liv­ing and work­ing in Cal­i­for­nia with­out le­gal sta­tus.”

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