Op-Ed: Why aren’t UC clinics serving patients with Medi-Cal?
One in three Californians is insured by Medical — the state health insurance program for low-income residents. Yet very few of these patients are able to obtain care through the University of California Health Systems.
Only a tiny fraction of primary care patients seen at UC clinics have Medi-Cal coverage. At some sites, it’s as low as 1% — even in areas with high numbers of Medi-Cal enrollees. The reason for this lack of access, UC administrators say, is that state reimbursements for Medi-Cal patients do not cover the cost of their treatment.
It’s even worse for Medi-Cal patients who seek out medical specialists, such as neurologists, orthopedic surgeons, and cardiologists. Most UC specialty clinics will not take Medi-Cal at all.
Here is an example from our experience as UC physicians: A 45-year-old woman is diagnosed with breast cancer at a community clinic near a UC hospital or in the emergency department of a UC hospital. The woman is insured by Medi-Cal. The next step requires a consultation with a surgeon and a cancer specialist.
What are his options? Once she is diagnosed, she cannot be seen at a UC surgery or cancer clinic because they do not accept her insurance. Essentially, a public hospital does not accept their publicly funded health insurance. So she or her primary care provider will need to find appointments with specialists in a place that accepts Medi-Cal. Sometimes these providers have less expertise than would be available at a UC hospital.
Since income levels and race are often correlated, it also means that CUs disproportionately exclude people of color. How can this de facto racist policy be acceptable?
Our six major medical schools at UC have three guiding missions: to improve the health of the public through research, to train the health care providers of tomorrow, and to provide health services to Californians.
While the UC system works admirably on the first two, it shied away from responsibility on the third. Most UC-affiliated health facilities provide little or no care to poor patients whose health insurance is provided by Medi-Cal.
What message does this send to the taxpayers who fund these medical schools, when a large percentage of them cannot seek treatment at UC-affiliated medical centers? What message does it send to the doctors, nurses and pharmacists of tomorrow? We teach them that there is nothing wrong with choosing profitable patients and hope that other members of the community will take care of the others.
In the late 1980s, when we were beginning our academic careers in the UC system, it would have been considered highly unprofessional and inappropriate for a doctor-in-training or faculty member to inquire about the insurance status of a patient. Any doctor who did this would have received harsh advice from supervisors, but now such a question is commonplace and reflects a culture that accepts profit over compassion.
UC’s health leadership has long maintained that it wants to treat Medi-Cal patients but cannot negotiate contracts that would cover the costs. They point to UC’s partnerships with county facilities and free or low-cost clinics to care for these patients. However, these primary care clinics cannot do much without the help of medical specialists.
The fact is that the annual income to some UC Health Campuses are overspending by more than $100 million. Trustees argue that this excess money subsidizes the operations of the medical school and main campus, and if they were to allocate part of this amount to cover any budget shortfalls incurred while treating Medi-Cal patients, the system would be in a vulnerable position.
But private hospitals in California accept Medi-Cal patients with the same reimbursement and make it work financially — even if Medi-Cal compensates the hospital poorly. So why aren’t UCs accepting these patients? Why can’t UC adopt some of the strategies that allow other hospitals to do so, or use some of their excess revenue to cover Medi-Cal enrollees, or ask the state for more money to do it ?
As it stands, the UC health system provides highly cost-effective cutting-edge treatments to a select (and often privileged and white) group of Californians, while closing the door to some 14 million low-income Californians. income.
We propose that UCs begin by setting mandatory minimums for the number of Medi-Cal patients seen in primary care clinics, specialty clinics, and elective inpatient wards, and publicly report actual numbers annually. Before fully supporting their fair share of Medi-Cal patients, they could start small, say 5% or 10% for each of these three categories and see what tax effect that has. If, after making their care processes more efficient, UC facilities still cannot afford to care for patients at current reimbursement levels, they could pressure the state and exploit public sentiment to become l a leading advocate for better pay rates.
Silently excluding the less powerful people from our society is not an acceptable solution. Why are the governor and state legislators letting UC medical centers ignore this moral and social responsibility?
Michael Wilkes is Professor of Medicine and Global Health at UC Davis and Senior Health Correspondent for KCRW-FM. David Schriger is Professor Emeritus and Vice Chairman of the Department of Emergency Medicine at UCLA.