In Fresno County, implementation of the federal healthcare law has had some unintended consequences.
For one, the law expanded the insurance program for the poor, known here as Medi-Cal. That’s a huge benefit to uninsured people who could not previously afford health coverage. But it’s turned out to be a problem for the county. It’s now receiving less state funding for its medical safety-net program, based on the assumption that less people will need it. The county contracts out this care to Community Regional Medical Center.
The situation has put the county in a financial pickle, says county Supervisor Henry Perea.
“There’s just not enough money to continue the contract with Community hospital and provide care for the remaining populations that we’re responsible for,” Perea says.
According to a November court filing, the county health department currently receives $42 million from state and county funding, called health realignment. Starting this month, the county will only receive $28 million, and about three-quarters of that will be used for other mandated programs. The county says it would be left with a multi-million dollar shortfall if it continues to fund the indigent care contract.
As a result, the county has quietly asked a judge to release it from a 30-year-old, court-ordered requirement to provide safety-net services to the undocumented.
Supervisor Perea says he doesn’t support this tactic.
"There's just no way that we can expect folks to pick our crops, build our homes... and then turn our back on them when they get sick" - Henry Perea
“Is there enough money left to provide care for the undocumented?” Perea says. “The math will tell you no. But from a moral standpoint, there’s just no way that we can expect folks to pick our crops, build our homes… and then turn our back on them when they get sick.”
The county claims that under state law it’s only required to provide care to legal residents, and that more recent court decisions in other counties conflict with the 1984 case involving Fresno. Fresno is among just a handful of California counties that provide access to healthcare for the undocumented.
The county’s attempt to care for the undocumented has angered consumer advocates, who see it as a step toward scrapping the county’s entire Medically Indigent Services Program – or MISP - which they say is required by state law.
“They have no basis to just do away with the MISP program, says Chris Schneider, the executive director of Central California Legal Services. “The changes that were brought about under the Affordable Care Act did not remove the county’s obligations under that section of the Welfare and Institutions code.”
In a November court filing, the county stated its case for ending coverage for the undocumented. The county said it can no longer afford this care. It said the undocumented can still receive emergency, pre-natal and pregnancy services through Medi-Cal, and can get primary care at community health centers.
But health advocates say that still leaves gaps in coverage. Schneider says the loss of the program could be devastating for both the poor and the undocumented.
“We know that it’s estimated that there will be about 100,000 uninsured Fresno residents even after the full roll-out of the Affordable Care Act next year, and only about 20% of those are believed to be undocumented,” he says.
"Diseases, health issues, don't discriminate based on immigration status, and our health care system shouldn't either" - Anthony Wright
The situation shines a light on the recurring question of who should fund and provide care for the undocumented. They are generally excluded from the federal health care law. In California, some counties provide safety-net care to the undocumented, others don’t.
Anthony Wright, executive director of Health Access, says that especially in a county like Fresno, it’s critical to provide care to the undocumented.
“Diseases, health issues, don’t discriminate based on immigration status, and our health care system shouldn’t either,” Wright says.
The issue could find a resolution in Sacramento. State Senator Ricardo Lara, a Democrat from the Los Angeles area, announced last week that he would introduce legislation to expand health care to all Californians, regardless of their immigration status.
In the meantime, county officials and advocates will debate the issue in Fresno County Superior Court next month.
