Op-Ed: Why Won’t UC Clinics Provide 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 can be cared for by the University of California health care systems.

Only a tiny fraction of primary care patients treated at UC clinics are covered by Medi-Cal. In some locations it’s as low as 1% – even in areas with high Medi-Cal enrollments. The reason for this lack of access, according to UC administrators, is that state reimbursements for Medi-Cal patients do not cover the cost of treatment.

It’s even worse for Medi-Cal patients who seek medical specialists such as neurologists, orthopedists and cardiologists. Most UC specialty clinics do not take Medi-Cal at all.

Here’s 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 room of a UC Hospital. The woman is insured with Medi-Cal. The next step requires a consultation with a surgeon and a cancer specialist.

What options does she have? After receiving her diagnosis, she cannot be seen at a UC surgery or cancer clinic because she won’t accept her insurance. Essentially, a government hospital will not accept their government-funded health insurance. Therefore, she or her GP needs to find appointments with specialists at a location that accepts Medi-Cal. Sometimes these providers have less expertise than would be available in a UC hospital.

Because income level and race are often correlated, it also means that UCs disproportionately exclude people of color. How can this de facto racist policy be acceptable?

Our six amazing UC medical schools have three missions: to improve the health of the public through research, to educate the healthcare providers of tomorrow, and to bring healthcare to Californians.

While the UC system performed admirably on the first two, it shied away from its responsibilities on the third. Most UC-affiliated healthcare facilities pay little to no attention to poor patients whose health insurance is covered by Medi-Cal.

What message does this send to the taxpayers who fund these medical schools when a large percentage of them cannot get care at UC-affiliated medical centers? What message does it send to the doctors, nurses and pharmacists of tomorrow? We teach them that it’s okay to pick profitable patients and hope others in the community will take care of the rest.

In the late 1980’s, when we began our academic careers in the UC system, it would have been considered highly unprofessional and inappropriate for a MD or faculty member to inquire about a patient’s insurance status. Any doctor who did this would have received harsh advice from supervisors, but now such a question is common and reflects a culture that accepts gain over compassion.

UC health leadership has long argued that it wants to treat Medi-Cal patients but cannot negotiate contracts that would cover the costs. They point to UC partnerships with district facilities and free or low-cost clinics to care for these patients. However, these primary care clinics are limited in what they can do without the support of specialist physicians.

The fact is, annual sales at some UC health campuses exceed spending by more than $100 million. Administrators argue that this excess money subsidizes operations of the medical school and main campus, and if they used some of that amount to fill budget gaps created by treating Medi-Cal patients, the system would be in a vulnerable state 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 don’t UCs accept these patients? Why can’t the UCs adopt some of the strategies that allow other hospitals, or use some of their excess revenue to cover Medi-Cal contenders, or ask the state for more money to do so?

As it stands now, the UC healthcare system is providing highly profitable cutting-edge treatments to a select (and often privileged and white) group of Californians while locking the door on approximately 14 million low-income Californians.

We propose that UCs begin by setting mandatory minimum numbers for the number of Medi-Cal patients treated in primary care clinics, specialty clinics, and inpatient elective services, and publicly report actual numbers annually. Before they fully take on their fair share of Medi-Cal patients, they could start small, say 5% or 10% for each of those three categories, and see what the tax implications are. If, after making their care processes more efficient, UC facilities still cannot afford to care for patients at current reimbursement levels, they could lobby the state and use public sentiment to become a leading advocate for better reimbursement rates.

Silently excluding the weakest people in our society is not an acceptable solution. Why do the governor and state legislatures allow the University of California Medical Centers to 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 Chair of the Department of Emergency Medicine at UCLA. Op-Ed: Why Won’t UC Clinics Provide Patients with Medi-Cal?

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