Opinion: Medi-Cal’s success has turned it into a white-hot political issue

Farmworkers harvest vegetables near Salinas File photo by Chris Stone Times of San Diego One new morning I interviewed a farmworker over breakfast at a McDonald s in the south Salinas Valley Then I drove out of town to talk specific of his colleagues in a cauliflower field A dozen farmworkers were toiling there Over a couple hours we chatted about their diverse circumstances Several were married with children in California schools and colleges and a few were single living far from family The workers had migrated here from various states and countries and they had made their homes in different communities across California But they had one thing in common Every one of them disclosed feeling much healthier than they had in years For that they could thank one of the smartest general policies enacted just now in California the expansion of Medi-Cal the Golden State s version of Medicaid the federal vitality undertaking for the poor It now covers all Californians regardless of immigration status But that guidelines is now under threat precisely because of its success Nearly million Californians are covered under Medi-Cal in the present day million of them children California extended Medi-Cal for undocumented immigrants over the last decade starting with low-income children in adding young adults up to age in and adults or over in and then completing the circle of coverage with adults ages - in January Enrollment by the undocumented in Medi-Cal and the utilization of the wellness care system has exceeded projections State officers seemed to think that the decline in the number of undocumented Californians which has shrunk from million to million over the past two decades would limit costs But undocumented Californians are not young new arrivals of the old stereotype preponderance have been here for at least years and had considerable pent-up demand for strength care after lives of hard work The state had budgeted more than billion annually for this expansion but costs this past year added up to billion more than planned In the early months of this year state personnel borrowed additional billions for cash flow for Medi-Cal and to cover these additional costs turning the expansion into a white-hot political issue The higher costs are only partially about immigrant enrollment Prescription drug prices and strength care bills are rising faster than inflation Medi-Cal also has seen costs surge after an expansion of enrollments during the pandemic and by the state s decision to stop counting assets such as homes or savings accounts when considering seniors eligibility Also the passage of Proposition last November reduced the tax on managed care organizations money that helps advocacy Medi-Cal But Republicans in California and Trumpists in Washington possessed with anti-immigrant hatred have blamed the growing costs primarily on the undocumented and demanded a rollback of the expansion Congressional Republicans are citing the California expansion to justify hundreds of billions in cuts to Medicaid over the next years Fearing the impact certain liberal commentators and Democratic politicians have buckled In California even progressive politicians have suggested that the state can no longer afford the full expansion Among these are Gov Gavin Newsom a champion of the expansion who just revised his budget to freeze project enrollment for immigrant adults and charge -per-month premiums to those already enrolled This is bad politics caving to destructive anti-immigrant prejudice only encourages more prejudice It s even worse physical condition initiative as I saw firsthand in the cauliflower field The farmworkers outside Greenfield who ranged in age from to recounted me that getting coverage had changed their lives by allowing them to get care to reduce the pains of years of twisting pulling and bending over in the fields Newly covered four had gotten surgeries and lined up rehab for knees ankles or feet Two had had back treatments needed after years of picking lettuce and other leafy greens One had a wrist procedure and two both of whom also worked at nearby vineyard had had shoulder operations These procedures had corrected injuries that had dogged them for a decade or more More than half mentioned they had new doctors or new prescriptions for high blood pressure In a saner country these kinds of results would be seen as a roaring success In a kinder country the additional costs would be seen as payback for all the deferred costs of pain In a calmer country in the present day s rising costs might be seen as a blip All but one of the farmworkers surgeries had happened in the past two years But none of the farmworkers expected to have more procedures The matter with going to the specialist or getting surgery is that it costs you work hours and thus pay No one was eager to do it again When I mentioned the disagreement over rising costs the workers suggested those numbers should go down once the newly covered deal with their serious long-untreated problems Such temporary surges in vitality care utilization aren t new And they shouldn t surprise California leaders much less cause them to roll back prosperous programs There was a similar surge in poor Americans using healthcare care in the first scarce years after the Affordable Care Act aka Obamacare went into effect in The surge in utilization was greatest in states that chose to expand their Medicaid programs Studies show that the surge produced higher costs but made people healthier In the cauliflower field workers expressed appreciation for their better healthcare and for better working conditions Over the last generation California has made farmworker pay hourly raised the minimum wage and guaranteed sick leave benefits Such policies took years of planning and political struggle Cutting back the expansion won t save all that much money in a -billion-plus state budget maybe billion over the next four years according to the governor s budget proposal On an annual basis such savings would amount to less than of the billion-plus in total Medi-Cal spending in the current fiscal year Meanwhile excluding people from fitness care coverage means that they get less preventive care and can get stuck with higher biological bills debt or conditions that hurt workers and thus their families and communities Thanks to Medi-Cal expansion the undocumented people who grow this state s food build homes and shopping centers and do any number of other jobs while raising the next generation of Californians are conclusively feeling better These Californians who are our neighbors haven t quit on us Let s not quit on them now Joe Mathews writes the Connecting California column for Z calo Populace Square an ASU Media Enterprise publication