More than half of the San Joaquin Valley’s population could be bracing for “devastating” cuts to their health insurance coverage as House Republicans decide how to slash some $880 billion from Medicaid.
Among Californians, Valley residents have perhaps the most to lose due to the eight-county region’s high enrollment in Medi-Cal, the state’s version of the federal Medicaid program for low-income residents. About 51% of people living from San Joaquin County down to Kern County use the program to access medical care, the highest percentage for any region across the state.
“It gives me a lot of stress and anxiety (thinking about Medicaid cuts),” said lifelong Patterson resident Elizabette Guéçamburu, who is disabled and relies on Medicaid/Medi-Cal for vital in-home care and other services. “It would be devastating to healthcare access in the Valley, for sure.”
Statewide, 14.8 million residents rely on Medicaid/Medi-Cal for healthcare, according to the California Department of Health Care Services, which administers the program. Of the San Joaquin Valley’s 4.4 million residents, more than 2.2 million are enrolled.
While Medi-Cal covers low-income Californians, that encompasses a significant percentage of children, elderly and disabled people as well. In the state it pays for healthcare of 3 out of 7 children, 3 out of 5 nursing home patients and 3 out of 7 working-age adults with disabilities – like Guéçamburu – according to data from the nonprofit Kaiser Family Foundation.
The 43-year-old said the program allows her to live independently – something she would have major difficulties with without in-home help for everyday essential activities like taking a shower, getting dressed and preparing meals. The writer and disability rights advocate has used a power wheelchair since she was 7 years old due to a rare neuromuscular genetic disorder.
Without the in-home services Medicaid/Medi-Cal provide, Guéçamburu said she fears for her health and quality of life.
“We are at risk of institutionalization, hospitalization, and in many cases death,” she said. “I’ve had friends who I have lost because they did not have enough care provided to them. They ended up having complications and infections and things that happened to them that could have easily been prevented by just more care provided to them in their home. And it’s devastating.”
Deep cuts could slash services, close providers in the San Joaquin Valley
In February, the Republican-led House passed $880 billion in budget cuts over the next decade from the Committee on Energy and Commerce, which oversees Medicaid. No House Democrats voted for the bill. Despite never mentioning Medicaid in the proposal, an analysis by the nonpartisan Congressional Budget Office found it would be impossible to carve out that much funding without taking it from Medicaid.
The cuts are part of Republican lawmakers’ quest to find $1.5 trillion in savings to extend the expiring 2017 tax cuts passed under the first Trump administration. Those cuts slashed the corporate tax rate and gave the biggest benefits to households making more than $450,000, or the top 5% of earners.
The decision has caused alarm across the county and state from health care advocates and workers.
“These federal budget decisions, they’re going to impact people with low and middle incomes in California and across the country,” said Adriana Ramos-Yamamoto, senior policy analyst at the nonpartisan research group the California Budget & Policy Center. “And state leaders must push back against policies that put corporate profits and tax cuts for the wealthy ahead of the needs of California families.”
While no formal proposals on how to extract the $880 billion from Medicaid have been presented yet, Ramos-Yamamoto said several possibilities have emerged. Those concepts include implementing work requirements to receive benefits, placing per capita or other caps on the amount of Medicaid funding states can receive and eliminating so-called “optional” expansions that pay for in-home care, hospice, dental, vision care and other services.
Any of those options could result in reduction of services and providers available to Medicaid/Medi-Cal enrollees across the country. In the Central Valley, because more than half the population uses the program, any effects could be felt acutely – and not just by those receiving Medi-Cal.
“Any cuts for the program would have the biggest impact on some of our most vulnerable populations – seniors, children, people with disabilities, also veterans,” said Kiran Savage-Sangwan, the executive director of the health equity advocacy group the California Pan-Ethnic Health Network. “But at the end of the day, all of us will be impacted.”
Savage-Sangwan said that because Medicaid is a major source of revenue for all Valley hospitals, cuts could lead to fewer doctors, fewer services, and even fewer hospitals for all patients in the Valley.
“So when that hospital closes or reduces services, everyone in that region is impacted, right?” she said. “Everyone has to drive a long distance to get emergency care, for example, or labor and delivery or health care for their children, even if they’re not enrolled in Medi-Cal because the providers will not be able to continue to operate.”
Region has already had hospital closures, Medi-Cal enrollment struggles
Hospital closures have already been an issue in the San Joaquin Valley. Earlier this month the Madera Community Hospital reopened after a two-year closure rising from severe financial difficulties. Its closure left Madera County and its 163,000 residents without an adult-care hospital facility. Even with its reopening, the hospital does not provide maternity, labor or delivery services. More than half the county population, 51%, is enrolled in Medi-Cal.
Other potential cost-saving options being deliberated by Congress include adding work requirements for eligibility. But any savings would come largely from people dropping out of the program due to procedural hurdles, even if they are still eligible, said Ramos-Yamamoto. California Budget & Policy Center estimates some 8 million residents could lose coverage in the state with work requirements.
Currently, 61% of adult Medi-Cal recipients work jobs, according to a Kaiser Family Foundation report. That includes Guéçamburu who works part time as a bookkeeper for an area agribusiness.
“What really scares me for our area specifically is how much of the rural health care relies upon Medicaid funding,” she said. “It’s so hard that a cut like this to our area could close clinics, hospitals….This is an everybody problem.”
California has already seen the effects of administrative challenges on the program after automatic reenrollment to Medi-Cal ended after the COVID-19 pandemic. San Joaquin, Stanislaus and Merced counties lost 45,000 enrollees year-over-year when the counties started processing applications again. Of those who lost coverage, the California Budget & Policy Center found 9 out of 10 cases were due to problems with procedural paperwork.
“In all these examples (of possible Medicaid cuts), we could see millions of people losing Medi-Cal coverage altogether, or seeing the list of Medicaid benefits reduced,” Ramos-Yamamoto said.
Marijke Rowland is the senior health equity reporter for The Intersection, a project of the Central Valley Journalism Collaborative.
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