The Affordable Care Act may be staying in place for now, but the long-term future of health care is still far from certain. And that uncertainty is already taking its toll on some health care programs--with ripple effects felt throughout the Valley.
If you peruse the Airbnb listings outside Bakersfield, you may stumble upon Broken Shadow Hermitage—a 3-bedroom getaway in the Tehachapi Mountains. The owner, Rick Hobbs, says it’s a great place to meditate and commune with nature.
“You can hear a pin drop, it’s just so quiet,” he says. “And there’s no light pollution. So you turn the lights off and it’s just dark and quiet and it’s just so regenerating.”
Hobbs put his house up for rent a few months ago when he got a new job in Lake Isabella—over an hour away.
“There was a spot made available, I was asked if I wanted to do it, I was excited to do it, and we started moving in that direction,” he says. “So I had to get ready. I had to figure out how I’m going to pay for my house, because I don’t want to sell it.”
But turning it into a rental property may have been pre-emptive. Just a few days in, he got a call from his boss that no one wants to get.
“He says, basically, ‘I got some bad news. The state of California has frozen the funding for those jobs that were created because they’re afraid of what’s going to happen to the Affordable Care Act. So we’re going to put it all on hold,’” he says.
Hobbs is a licensed marriage and family therapist, or LMFT—a behavioral health specialist who primarily practices talk therapy and counseling. His new job would have been at a federally qualified health center, which serves California’s neediest patients—those with Medi-Cal or no health insurance. But because of some complicated rules, LMFTs like Hobbs are not allowed to work in those health centers, unless they’re funded through grants or separate contracts.
A new state law, AB 1863, would have changed that, and would have allowed Hobbs to practice at a federally qualified health center in Wofford Heights. But on January 10, just nine days after the law went into effect, Governor Brown deferred its implementation to July of 2018 at the earliest—likely because of uncertainty surrounding future Medicaid reimbursements from the feds.
Heather Berry, an LMFT at a private clinic in Lake Isabella, had been looking forward to Hobbs’s arrival. She says last year’s Erskine Fire left the region deeply in need of mental health care.
“Three hundred homes burning to the ground in 48 hours,” she says. “People running for their lives. I’m seeing vets who say that the experience of living through this fire was worse than anything they had in their military careers.”
Lake Isabella was one of many communities poised to benefit from AB 1863. A total of 12 LMFTs were ready to start new jobs with Clinica Sierra Vista, a network of federally qualified health centers serving Fresno, Kern and Inyo counties. Chris Reilly is Rick Hobbs’s boss and Clinica’s director of behavioral health services.
“They’d be serving outlying mountain communities like Frazier Park, inner city parts of Bakersfield, the southwest side of Fresno,” Reilly says. “There really isn’t a center that we run that wouldn’t be better for patients if it had a behavioral health provider in it.”
Right now, Rick Hobbs is already working for Clinica, but through a county contract. Counties do serve Medi-Cal patients, but only the most severe—which leaves a gap in services for Medi-Cal patients suffering mild to moderate issues like anxiety and depression. In those cases, Reilly says, treating those issues commonly falls to primary care doctors—which can be problematic.
“Your primary care providers are much more likely to go, ‘this is out of my scope, I can’t do it,’” he says. “The patient is much more likely to decompensate or to go neglected entirely, until some catastrophic emergency thing brings them into what is the county’s super expensive $6,000-$25,000 per patient system.”
The law was deferred for budgetary reasons, but Reilly argues LMFTs are a more than worthwhile investment. They reduce the burden on primary care doctors, and they provide a place for counties to discharge their more stable patients. Plus, combining basic mental health care with a doctor’s appointment can prevent more severe mental health problems.
“Having therapists in health centers saves money right out of the gate,” Reilly says. “The day you open it saves money.”
The need for these therapists extends beyond Kern County. Dawan Utecht, director of Fresno County’s behavioral health department, says AB 1863’s deferral puts the whole valley at a disadvantage.
“Because we have a higher percentage of poverty than other parts of the state, without a doubt we’re more impacted,” she says.
Governor Brown should release his revised budget in May, but Reilly and other advocates think it’s unlikely he’ll revisit AB 1863.