Bridge to Health Reform "Undoable" in San Luis Obsipo

By John Gonzales, Center for Health Reporting

California's "Bridge to Reform" program is intended to do exactly that: provide a bridge to the 2014 roll-out of the Affordable Care Act. Right now, 47 of California's 58 counties have already provided health care to more than 335,000 people. San Luis Obispo is a case study in one county that is not participating.

We have reported on the Bridge to Reform, also known as the Low Income Health Program, since its early phases. I was the reporter on our first piece, which looked at Kern County’s efforts to build the bridge. A follow-up examined the challenges of implementing the program in the far corners of Humboldt and Del Norte counties.

In San Luis Obispo, Health Agency Director Jeff Hamm said he made the decision to withdraw from participation reluctantly. For years, the county has slashed its health budget and outsourced its medical safety net.

It reached the point, Hamm said, of not having the start-up funds, or medical infrastructure, needed to implement the Bridge to Reform.

“We understood it would be good for a lot of people. We didn’t have the money,” said Hamm, whose county joins Fresno as a non-participant. “It was a big paradigm shift, a really big shift in terms of infrastructure, requirements for data collection, and processing. ... We’re talking a 150-page contract with the State of California. ... It became undoable for us.”

It’s an interesting perspective, particularly as nine other counties and the Rural Indian Health Board work to meet requirements of that 150-page contract so they can participate. The program offers the much-ballyhooed “free money” from the federal government -- in this case a 50 percent match on money a county spends providing health care.

Anthony Wright, executive director of Health Access California, which advocates for expanded health coverage, found it hard to buy Hamm’s position. “There are obstacles, from resources, to politics, to bureaucratic inertia,” said Wright. “But this is just too good a deal to pass up.”

The idea is for counties to implement the Bridge to Reform ahead of a huge expansion in federally funded Medi-Cal coverage scheduled for 2014. The feds will pick up 90 percent of the cost as part of the Affordable Care Act. It could ultimately provide 1.9 million Californians health benefits they didn’t have before.

Wright admits that his perspective about the Bridget to Reform is shaped by his belief that the larger Medi-Cal expansion will indeed become reality in 2014. The Supreme Court, of course, could chart a new course. Its ruling on health reform is expected in late June.

Court-watchers initially thought the Medicaid expansion would be upheld by the Supreme Court. But after oral arguments in March, no one can read the judicial tea leaves. While we're waiting for the court's decision, it’s tough to decide if a county should, or should not, take the plunge and help build the Bridge to Reform.

But there is something very measureable in the 337,282 Californians already receiving coverage though the program.