A half-century ago, a governor named Brown persuaded the California Legislature to embark on what those involved thought would be a modest new program of health care for poor Californians.
Medi-Cal, as it was dubbed, was California’s version of the national Medicaid program that had been attached to the new Medicare system of health care for the elderly.
At the time, California’s poor obtained medical care, if they did, from either charity or county-owned hospitals, and Medi-Cal was seen as a way of easing the burden on the counties’ taxpayers.
But as one of the participants in the Medi-Cal legislation, retired Assemblyman Gordon Duffy, recalled in an interview a few years ago, “No one in the world thought it through.”
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It would not be the first time the Legislature adopted a sweeping new policy without fully considering its consequences, nor the last, unfortunately.
Then-Gov. Pat Brown, Duffy recalled, assured the Legislature that despite its complexity, state administrators could make Medi-Cal work. “They (the Brown administration) really pushed so hard on the positive effects. ... Everyone said it was a wonderful thing.”
It has been, however, a political headache for every governor since.
Pat Brown’s son, Jerry, is now serving his second stint as governor and last week revealed that Medi-Cal has mushroomed into a $90.6 billion-a-year program that will soon provide care to 11.5 million Californians or 30 percent of the state’s population. That’s 50 percent higher than the national average.
Just since Brown released his proposed 2014-15 budget in January, Medi-Cal enrollment projections have jumped by 1.4 million people.
More than a million more Californians are coming into the program through the federal health care law, which expanded eligibility income limits upward with promises that the federal government would pay for virtually all costs.
However, the intense enrollment process has also encouraged many others who were already eligible, but had not signed up, to come forth, and the state must pay a substantial share of their costs. There’s a backlog of 900,000 applications for Medi-Cal that has overwhelmed the county-based eligibility system.
The $90.6 billion projected cost is mostly borne by the feds, but the state’s share has mushroomed to $17.4 billion, making it one of the largest single budget segments.
Brown says the Medi-Cal expansion is one of the “good news” aspects of his revised budget.
However, it also commits the state to billions of dollars of annual costs and thus contributes to longer-term fiscal instability. And there are legitimate doubts about the capacity – or even willingness – of medical providers to absorb this big increase since the state’s provider payments are among the nation’s lowest.