California’s health care reckoning could soon become Becerra’s problem

Por Rachel Bluth — POLITICO – TOP Stories

MADERA, California — Xavier Becerra kept coming back to one figure as he toured a Central Valley dental clinic.

“If $200,000 was all it took to get you guys going, I can figure out where to get that,” he told Paulo Soares, CEO of Camarena Health, who cobbled together the money from donors to open a new lab as part of the clinic’s mission to provide free or low-cost care to the region’s poor, largely immigrant population. If other clinics could do the same, he said, “we’ve got to figure out how to make it work.”

The lab was a rare bright spot in what are otherwise unsettled days for California’s expansive and costly health care system — a modest investment Becerra suggested could be replicated elsewhere if, as is widely expected, he is elected governor in November. But the challenges awaiting the state’s next leader are far bigger.

Recent cost-saving cuts by Gov. Gavin Newsom (D) have left undocumented immigrants unable to enroll in Medi-Cal and those already in the program facing the loss of dental coverage, while moves by Newsom and federal officials are expected to cause over a million people to lose their health insurance. And clinics are slated to lose $1 billion in state funding earmarked for care of patients with “unsatisfactory immigration status” — a retreat Newsom approved, but delayed until his successor is in office.

The tour of Camarena last month by a candidate who served as former President Joe Biden’s secretary of Health and Human Services and professes to support an expansive, state-funded safety net, has helped stoke the hopes of health care advocates that he’ll deliver on a daunting wish list they plan to deliver to him on Day 1: a reversal of the Newsom-era cuts and the political appetite to raise taxes that Newsom avoided in order to better fund health care.

“We are hopeful that if we have an incoming governor Becerra, he may take a different approach than we’ve seen from Gov. Newsom in the last two years,” said Josh Stehlik, policy director for the California Immigrant Policy Center.

But reversing Newsom’s cuts would cost the state billions, and the next governor will inherit the severe fiscal pressures that led Newsom to scale back his health care agenda. A proposed one-time wealth tax on California billionaires could provide an infusion of funding, but it’s unclear whether voters will approve it. Both Newsom and Becerra oppose the measure.

Newsom signed a $300 billion budget in June that delays and defers major decisions on health care to the winner in November.

State Sen. María Elena Durazo called it bluntly: “This is a budget that bought time.”

At the clinic

Camarena and the farmworking community it serves in Madera County are, in many ways, a microcosm of the challenges facing the state. The clinic sees roughly 1,000 prenatal patients each month, all of whom have to travel outside the county to give birth because Madera’s lone hospital has no labor department. The hospital, Madera Community, shut down in 2023, becoming a symbol of a funding crisis playing out at hospitals around the state. It took two years and infusions of more than $57 million in public funds to reopen it.

Newsom’s final budget, which he negotiated with legislative leaders in June, set aside almost $400 million in one-time funding for hospitals statewide, but local governments, health insurance providers and others have been pushing for a long-term solution. The need is expected to grow more acute in the coming year as clinics and hospitals are forced to absorb the surge of newly uninsured patients from state and federal cuts.

Becerra said bolstering clinics like Camarena will be a cornerstone of the fix he envisions deploying as governor.

“If I am fortunate to become governor, I’m going to use these guys,” he said. “This is the way I offer access at an affordable rate everywhere in the state. The most important thing I could do — and it is strategy, it is a policy — is don’t let these guys close their doors.”

That means getting patients in the door “as paying customers who have insurance, not as customers who need charity care,” he said.

Becerra was noncommittal about specifics, but struck a tone that should be encouraging to health care advocates. “I’m not in yet, so I can’t see what’s in the basement and what’s in the storage closet and what types of levers I can pull,” he said. “I don’t want to scale back services. It’s pennywise to just cut and say, ‘I don’t have the money.’”

Great expectations

In his final two years in office, as the cost of providing free medical care for over 1 million undocumented people blew holes in the state budget, Newsom began cutting back on the state’s generous health care safety net that he had proudly championed and expanded. Health advocates eventually gave up on pushing him to make services more widely available and began trying to minimize their losses. But Newsom rebuffed their pleas to reopen the Medi-Cal program to undocumented immigrants after imposing a freeze on new sign-ups. He then went further in his austerity measures, adding work requirements for those living in the country illegally, which are slated to take effect next year, and a proposal to raise their upcoming Medi-Cal premiums.

“Just getting Newsom to the place where he didn’t make it worse felt like a big win,” said Rachel Linn Gish, interim deputy director of Health Access California. “Now he’s a lame-duck governor, and we feel a lot of hope. I think that a Becerra governorship could at least bring a new, fresh perspective to this issue.”

Legislators have already told Becerrathey’re going to push him to reverse the cuts to coverage for undocumented immigrants.

With his comments at the clinic, Becerra indicated he wants to do just that. He’s also signaled an openness to a levyon companies whose workers rely heavily on Medi-Cal — a proposal favored by progressives and legislative leaders as a way to generate new revenue for the program. Newsom mostly steered clear of new taxes in his final budget, though this year he signed a budget requiring his successor to bring forward options next spring for a so-called fair-share tax. Becerra campaigned on the concept and told POLITICO that if elected, he’d turn it into “a real, enforceable policy.”

Behind the scenes, the maneuvering for Becerra’s first budget is already underway. A coalition of doctors, hospitals, insurers and clinics that wrote Proposition 35 — a voter-approved tax on health insurers Newsom has used primarily to help balance the budget rather than its intended purpose of boosting payments to certain specialists — is regrouping to press its case with the next administration, said Jodi Hicks, CEO of Planned Parenthood Affiliates of California.

“There is a plan for the health care folks to come together again with some real opportunities and plans for how we can accomplish what we know we need to,” Hicks said, “which is always the original mission: to ensure that we’re improving access to care for vulnerable communities.”

Gish said expectations for Becerra are already high.

“I do think there is some hope in the health consumer world that he will take some big swings, like an early Newsom,” she said.

Fonte: POLITICO – TOP Stories