Complaints Rise in California as Nursing Homes Evict Poor Patients
Congress’ Cold Shoulder Sends Shivers Through Community Health Centers
'Devastating' Cuts to Come: How California Would Suffer Under GOP Health Plan
On Precipice of Senate Vote, East Bay Health Clinic Fears for Thousands of Patients
Latino Patients Sue State Over 'Separate and Unequal' Health Care
Nursing Homes Worry Proposed Medicaid Cuts Will Force Cuts, Closures
Feinstein: Health Care of 14 Million Californians At Risk Under GOP Plan
Analysis: Why Senate Health Bill Is Even 'Meaner' for California
Medi-Cal Patients Flocking to ERs More Than Before ACA
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She specializes in covering altered states of mind, from postpartum depression to methamphetamine-induced psychosis to the insanity defense. Her investigative series on insurance companies sidestepping mental health laws won multiple awards, including first place in beat reporting from the national Association of Health Care Journalists. She is the recipient of numerous other prizes and fellowships, including a national Edward R. Murrow award for investigative reporting, a Society of Professional Journalists award for long-form storytelling, and a Carter Center Fellowship for Mental Health Journalism.\r\n\r\nDembosky reported and produced \u003cem>Soundtrack of Silence\u003c/em>, an audio documentary about music and memory that is currently being made into a feature film by Paramount Pictures.\r\n\r\nBefore joining KQED in 2013, Dembosky covered technology and Silicon Valley for \u003cem>The Financial Times of London,\u003c/em> and contributed business and arts stories to \u003cem>Marketplace \u003c/em>and \u003cem>The New York Times.\u003c/em> She got her undergraduate degree in philosophy from Smith College and her master's in journalism from the University of California, Berkeley. She is a classically trained violinist and proud alum of the first symphony orchestra at Burning Man.","avatar":"https://secure.gravatar.com/avatar/ef92999be4ceb9ea60701e7dc276f813?s=600&d=blank&r=g","twitter":"adembosky","facebook":null,"instagram":null,"linkedin":null,"sites":[{"site":"arts","roles":["author"]},{"site":"news","roles":["editor"]},{"site":"futureofyou","roles":["author"]},{"site":"stateofhealth","roles":["editor"]},{"site":"science","roles":["editor"]},{"site":"forum","roles":["editor"]}],"headData":{"title":"April Dembosky | KQED","description":"KQED Health Correspondent","ogImgSrc":"https://secure.gravatar.com/avatar/ef92999be4ceb9ea60701e7dc276f813?s=600&d=blank&r=g","twImgSrc":"https://secure.gravatar.com/avatar/ef92999be4ceb9ea60701e7dc276f813?s=600&d=blank&r=g"},"isLoading":false,"link":"/author/adembosky"},"lklivans":{"type":"authors","id":"8648","meta":{"index":"authors_1591205172","id":"8648","found":true},"name":"Laura Klivans","firstName":"Laura","lastName":"Klivans","slug":"lklivans","email":"lklivans@kqed.org","display_author_email":true,"staff_mastheads":["news","science"],"title":"Reporter and Host","bio":"Laura Klivans is a science reporter and the host of KQED's video series about tiny, amazing animals, \u003cem>Deep Look\u003c/em>. Her work can also be heard on NPR, \u003cem>Here & Now, \u003c/em>and PRI. Before working in audio, she taught, leading groups of students abroad. One of her favorite jobs was teaching on the Thai-Burmese border, working with immigrants and refugees.\r\n\r\nLaura has won three Northern California Area Emmys along with her Deep Look colleagues. She's won the North Gate Award for Excellence in Audio Reporting and the Gobind Behari Lal Award for a radio documentary about adults with imaginary friends. She's a fellowship junkie, completing the USC Center for Health Journalism's California Fellowship, UC Berkeley's Human Rights Fellowship and the Coro Fellowship in Public Affairs. Laura has a master’s in journalism from UC Berkeley and a master’s in education from Harvard.\r\n\r\nShe likes to eat chocolate for breakfast. She's also open to eating it all day long.","avatar":"https://secure.gravatar.com/avatar/af8e757bb8ce7b7fee6160ba66e37327?s=600&d=blank&r=g","twitter":"lauraklivans","facebook":null,"instagram":null,"linkedin":null,"sites":[{"site":"news","roles":["editor"]},{"site":"stateofhealth","roles":["contributor","editor"]},{"site":"science","roles":["editor"]},{"site":"forum","roles":["editor"]}],"headData":{"title":"Laura Klivans | KQED","description":"Reporter and Host","ogImgSrc":"https://secure.gravatar.com/avatar/af8e757bb8ce7b7fee6160ba66e37327?s=600&d=blank&r=g","twImgSrc":"https://secure.gravatar.com/avatar/af8e757bb8ce7b7fee6160ba66e37327?s=600&d=blank&r=g"},"isLoading":false,"link":"/author/lklivans"},"cfeibel":{"type":"authors","id":"11314","meta":{"index":"authors_1591205172","id":"11314","found":true},"name":"Carrie Feibel","firstName":"Carrie","lastName":"Feibel","slug":"cfeibel","email":"cfeibel@KQED.org","display_author_email":false,"staff_mastheads":[],"title":"KQED Contributor","bio":"Carrie Feibel is a former health editor at KQED, where she has also reported for radio and online. Her stories have appeared on the national NPR shows \u003cem>Morning Edition\u003c/em>, \u003cem>All Things Considered\u003c/em>, and \u003cem>Here & Now\u003c/em>, and on the national website, Kaiser Health News. Her print career included stints at the \u003cem>Houston Chronicle\u003c/em>, \u003cem>The (Bergen) Record,\u003c/em> and the Associated Press in New York City. A native of St. Louis, Feibel attended Cornell University, and earned a master's in journalism from Columbia University.","avatar":"https://secure.gravatar.com/avatar/c64a7e3c9a910e1bffd4ad32a5264aa9?s=600&d=blank&r=g","twitter":"KQEDHealth","facebook":null,"instagram":null,"linkedin":null,"sites":[{"site":"news","roles":["subscriber"]},{"site":"stateofhealth","roles":["administrator"]}],"headData":{"title":"Carrie Feibel | KQED","description":"KQED Contributor","ogImgSrc":"https://secure.gravatar.com/avatar/c64a7e3c9a910e1bffd4ad32a5264aa9?s=600&d=blank&r=g","twImgSrc":"https://secure.gravatar.com/avatar/c64a7e3c9a910e1bffd4ad32a5264aa9?s=600&d=blank&r=g"},"isLoading":false,"link":"/author/cfeibel"}},"breakingNewsReducer":{},"campaignFinanceReducer":{},"firebase":{"requesting":{},"requested":{},"timestamps":{},"data":{},"ordered":{},"auth":{"isLoaded":false,"isEmpty":true},"authError":null,"profile":{"isLoaded":false,"isEmpty":true},"listeners":{"byId":{},"allIds":[]},"isInitializing":false,"errors":[]},"navBarReducer":{"navBarId":"home","fullView":true,"showPlayer":false},"navMenuReducer":{"menus":[{"key":"menu1","items":[{"name":"News","link":"/","type":"title"},{"name":"Politics","link":"/politics"},{"name":"Science","link":"/science"},{"name":"Education","link":"/educationnews"},{"name":"Housing","link":"/housing"},{"name":"Immigration","link":"/immigration"},{"name":"Criminal Justice","link":"/criminaljustice"},{"name":"Silicon Valley","link":"/siliconvalley"},{"name":"Forum","link":"/forum"},{"name":"The California Report","link":"/californiareport"}]},{"key":"menu2","items":[{"name":"Arts & Culture","link":"/arts","type":"title"},{"name":"Critics’ Picks","link":"/thedolist"},{"name":"Cultural Commentary","link":"/artscommentary"},{"name":"Food & Drink","link":"/food"},{"name":"Bay Area Hip-Hop","link":"/bayareahiphop"},{"name":"Rebel Girls","link":"/rebelgirls"},{"name":"Arts Video","link":"/artsvideos"}]},{"key":"menu3","items":[{"name":"Podcasts","link":"/podcasts","type":"title"},{"name":"Bay Curious","link":"/podcasts/baycurious"},{"name":"Rightnowish","link":"/podcasts/rightnowish"},{"name":"The Bay","link":"/podcasts/thebay"},{"name":"On Our Watch","link":"/podcasts/onourwatch"},{"name":"Mindshift","link":"/podcasts/mindshift"},{"name":"Consider This","link":"/podcasts/considerthis"},{"name":"Political Breakdown","link":"/podcasts/politicalbreakdown"}]},{"key":"menu4","items":[{"name":"Live Radio","link":"/radio","type":"title"},{"name":"TV","link":"/tv","type":"title"},{"name":"Events","link":"/events","type":"title"},{"name":"For Educators","link":"/education","type":"title"},{"name":"Support KQED","link":"/support","type":"title"},{"name":"About","link":"/about","type":"title"},{"name":"Help Center","link":"https://kqed-helpcenter.kqed.org/s","type":"title"}]}]},"pagesReducer":{},"postsReducer":{"stream_live":{"type":"live","id":"stream_live","audioUrl":"https://streams.kqed.org/kqedradio","title":"Live Stream","excerpt":"Live Stream information currently unavailable.","link":"/radio","featImg":"","label":{"name":"KQED Live","link":"/"}},"stream_kqedNewscast":{"type":"posts","id":"stream_kqedNewscast","audioUrl":"https://www.kqed.org/.stream/anon/radio/RDnews/newscast.mp3?_=1","title":"KQED Newscast","featImg":"","label":{"name":"88.5 FM","link":"/"}},"stateofhealth_362214":{"type":"posts","id":"stateofhealth_362214","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"362214","score":null,"sort":[1513692052000]},"guestAuthors":[],"slug":"complaints-rise-in-california-as-nursing-homes-evict-poor-patients","title":"Complaints Rise in California as Nursing Homes Evict Poor Patients","publishDate":1513692052,"format":"audio","headTitle":"California Healthline | State of Health | KQED News","labelTerm":{"term":3036,"site":"stateofhealth"},"content":"\u003cp>Anita Willis says the social worker offered her a painful choice: She could either leave the San Jose, Calif., nursing home where she’d spent a month recovering from a stroke — or come up with $336 a day to stay on.\u003c/p>\n\u003cp>She had until midnight to decide.\u003c/p>\n\u003cp>Willis’ Medicaid managed-care plan had told the home that it was cutting off payment because she no longer qualified for such a high level of care. If Willis, 58, stayed and paid the daily rate, her Social Security disability money would run out in three days. But if she left, she had nowhere to go. She’d recently become homeless after a breakup and said she couldn’t even afford a room-and-board setting.\u003c/p>\n\u003cp>In tears, she said, she agreed to leave. Thus began a months-long odyssey from budget motels to acquaintances’ couches to hospital ERs — at least five emergency visits in all, she said. Sometimes, her 25-year-old daughter drove down from Sacramento, and Willis slept in her daughter’s car.\u003c/p>\n\u003cp>“They kicked me out in the cold,” said Willis, a former Head Start teacher.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Complaints about allegedly improper evictions and discharges from nursing homes are on the rise in California, Illinois and other states, according to government data. These concerns are echoed in lawsuits and by ombudsmen and consumer advocates.\u003c/p>\n\u003cp>In California alone, such complaints have jumped 70 percent in five years, reaching 1,504 last year, said Joseph Rodrigues, the state-employed Long-Term Care Ombudsman, who for 15 years has overseen local ombudsman programs, which are responsible for resolving consumer complaints.\u003c/p>\n\u003cp>Around the country, ombudsmen say many patients like Willis end up with no permanent housing or regular medical care after being discharged. Even when the discharges are deemed legal, these ombudsmen say, they often are unethical.\u003c/p>\n\u003cp>“It’s a growing problem,” said Leza Coleman, executive director of the California Long-Term Care Ombudsman Association. Coleman says the practice stems from skilled nursing facilities’ desire for better compensation for their services and from the shortage of other affordable long-term care options that might absorb less severe cases.\u003c/p>\n\u003cp>In Willis’ case, she ultimately lost her appeal to return to the nursing home, Courtyard Care Center. A state hearing judge determined that she had left the home voluntarily because she refused the opportunity to pay to remain there.\u003c/p>\n\u003cp>Top administrators at Sava Senior Care, which owns Courtyard, did not return repeated calls for comment.\u003c/p>\n\u003cp>Among other recent cases of allegedly improper discharges:\u003c/p>\n\u003cul>\n\u003cli>In October, California’s attorney general moved to prevent a Bakersfield nursing home administrator from working with elderly and disabled people, while he awaits trial on charges of elder abuse and wrongful discharge. State prosecutors said one patient was falsely informed that she owed the home money, then sent to an independent living center even though she could not “walk or toilet on her own.” The administrator did not return messages left at the nursing home.\u003c/li>\n\u003cli>A \u003ca href=\"http://www.marylandattorneygeneral.gov/News%20Documents/State_v_NMS_Complaint.pdf\" target=\"_blank\" rel=\"noopener\">pending lawsuit\u003c/a> by Maryland’s attorney general alleges a nursing home chain, Neiswanger Management Services (NMS), illegally evicted residents, sending them to homeless shelters or other inadequate facilities to free up bed space for higher-paying patients. NMS countersued state regulators, alleging they are trying to drive the chain out of business.\u003c/li>\n\u003cli>Last month, a 73-year-old woman with diabetes and heart failure \u003ca href=\"http://canhr.org/newsroom/newdev_archive/2017/PDFs/Complaint-JohnsonMoore-Dumping.pdf\" target=\"_blank\" rel=\"noopener\">sued a Fresno, Calif., nursing home\u003c/a> for allegedly \u003ca href=\"http://www.fresnobee.com/news/local/article182618836.html\" target=\"_blank\" rel=\"noopener\">leaving her with an open wound on a sidewalk\u003c/a> in front of a relative’s home. The suit said conditions in the residence were unsafe and a family member refused to allow her inside. The state cited the home in July and issued a $20,000 fine.\u003c/li>\n\u003c/ul>\n\u003cp>Of course, not all complaints or lawsuits are well-founded. Federal law allows a nursing home to discharge or evict a patient when it cannot meet the resident’s needs or the person no longer requires services; if the resident endangers the health and safety of other individuals; or if the patient has failed, after reasonable and appropriate notice, to pay.\u003c/p>\n\u003cp>The law also generally requires a home to provide 30 days’ notice before discharging a patient involuntarily and requires all discharges be safe and orderly.\u003c/p>\n\u003cp>Deborah Pacyna, spokeswoman for the California Association of Health Facilities, a trade organization that represents nursing homes, questions why nursing homes should be responsible for providing a safety net for the indigent and homeless.\u003c/p>\n\u003cp>“Nursing home residents reflect society,” she said in a written statement. “Some nursing home residents live in homeless shelters or hotels. They may request that they go back ‘home,’ or to their local shelter or hotel upon discharge. We must honor their choices as long as their needs are met.”\u003c/p>\n\u003cp>Pacyna also noted that eviction and discharge complaints represent a tiny fraction of the hundreds of thousands of residents released from the state’s nursing homes each year.\u003c/p>\n\u003cp>Nationally, discharge and eviction complaints have remained more or less steady in recent years after rising significantly between 2000 and 2007, according to data collected by the federal government. Still, these complaints remain the top grievance reported to nursing home ombudsmen as the number of overall complaints about everything from abuse to access to information has dropped in the past decade.\u003c/p>\n\u003cp>The rate of complaints can vary considerably by state. Jamie Freschi, the Illinois state ombudsman, says discharge and eviction complaints have more than doubled in her state since 2011.\u003c/p>\n\u003cp>She recalled one wheelchair-bound nursing resident who was in severe pain from osteoarthritis, scoliosis and fibromyalgia when she was discharged from a nursing home and sent to a homeless shelter. After the shelter rejected her because it could not accommodate her wheelchair, the resident went to a motel, which kicked her out when she ran out of money. She has since cycled between the emergency room and the streets, Freschi said.\u003c/p>\n\u003cp>“It’s an example of a really, really broken system, all the way around,” Freschi said.\u003c/p>\n\u003cp>Advocates say such decisions are often money-driven: Medicare covers patients for just a short time after they are released from hospitals. After that, these critics say, many nursing homes don’t want to accept the lower rates paid by Medicaid, the public insurance program for low-income residents.\u003c/p>\n\u003cp>Even when they appeal and win, advocates say, it doesn’t always help the patient. The Centers for Medicare & Medicaid Services has advised California on two occasions — including this past summer — that it must enforce decisions from appeals hearings. (The state contends that it uses a variety of strategies to enforce the law.)\u003c/p>\n\u003cp>Last month, the California Long-Term Care Ombudsman Association joined with the legal wing of the AARP Foundation to \u003ca href=\"https://www.documentcloud.org/documents/4199718-2017-10-02-Complaint.html\" target=\"_blank\" rel=\"noopener\">sue a Sacramento nursing home\u003c/a>, alleging it had improperly discharged an 83-year-old woman with Alzheimer’s — requiring the nursing home to readmit her.\u003c/p>\n\u003cp>“The facilities are getting the message that they don’t have to follow the rules here, so they’re emboldened,” said Matt Borden, a San Francisco attorney helping with the lawsuit.\u003c/p>\n\u003cp>Willis and her advocates were convinced that Courtyard Care Center broke the rules in her case.\u003c/p>\n\u003cp>Willis “did not leave Courtyard ‘voluntarily’ in just about any sense of the word,” said Tony Chicotel, a staff attorney with California Advocates for Nursing Home Reform.\u003c/p>\n\u003cp>At a hearing in April, held at the nursing home and attended by a reporter, Chicotel and an ombudsman argued that Willis’ discharge violated legal requirements, including lack of written notice. They asked that she be immediately readmitted.\u003c/p>\n\u003cp>According to hearing documents, Willis’ documented medical problems were many: an aneurysm, an ulcer, difficulty walking, muscle weakness, gastritis, anemia and heart and kidney disease. During her stay at the nursing home, she said, she’d fallen and hit her head while visiting the doctor, resulting in a severe concussion.\u003c/p>\n\u003cp>For their part, Courtyard staffers explained that Medicaid wouldn’t cover Willis anymore based on their assessment of her condition. They said she had “almost returned to her prior level of functioning.”\u003c/p>\n\u003cp>During the hearing, Willis repeatedly told those in attendance that she felt dizzy and nauseated. Her head pounded. “I’m not good,” she said. Afterward, she begged for a ride to the emergency room, where she was admitted with a torn aorta and bleeding ulcer.\u003c/p>\n\u003cp>She was still in the hospital when the hearing officer issued her decision a few days later. Eventually, she was released to another nursing home, which also discharged her after a month, she said. Then she resumed sleeping on friends’ couches. She chose not to file another appeal.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“This time in my life,” Willis said, “it’s very discouraging.”\u003c/p>\n\n","blocks":[],"excerpt":"Complaints about allegedly improper evictions and discharges from nursing homes in California have risen 70 percent in the last five years. ","status":"publish","parent":0,"modified":1517982528,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":35,"wordCount":1499},"headData":{"title":"Complaints Rise in California as Nursing Homes Evict Poor Patients | KQED","description":"Complaints about allegedly improper evictions and discharges from nursing homes in California have risen 70 percent in the last five years. ","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"362214 https://ww2.kqed.org/stateofhealth/?p=362214","disqusUrl":"https://ww2.kqed.org/stateofhealth/2017/12/19/complaints-rise-in-california-as-nursing-homes-evict-poor-patients/","disqusTitle":"Complaints Rise in California as Nursing Homes Evict Poor Patients","audioUrl":"https://www.kqed.org/.stream/anon/radio/tcr/2018/02/NursingHomeEvictionsFeibel.mp3","nprByline":"\u003cb>Jocelyn Wiener\u003c/b>\u003c/br>California Healthline","path":"/stateofhealth/362214/complaints-rise-in-california-as-nursing-homes-evict-poor-patients","audioDuration":null,"audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Anita Willis says the social worker offered her a painful choice: She could either leave the San Jose, Calif., nursing home where she’d spent a month recovering from a stroke — or come up with $336 a day to stay on.\u003c/p>\n\u003cp>She had until midnight to decide.\u003c/p>\n\u003cp>Willis’ Medicaid managed-care plan had told the home that it was cutting off payment because she no longer qualified for such a high level of care. If Willis, 58, stayed and paid the daily rate, her Social Security disability money would run out in three days. But if she left, she had nowhere to go. She’d recently become homeless after a breakup and said she couldn’t even afford a room-and-board setting.\u003c/p>\n\u003cp>In tears, she said, she agreed to leave. Thus began a months-long odyssey from budget motels to acquaintances’ couches to hospital ERs — at least five emergency visits in all, she said. Sometimes, her 25-year-old daughter drove down from Sacramento, and Willis slept in her daughter’s car.\u003c/p>\n\u003cp>“They kicked me out in the cold,” said Willis, a former Head Start teacher.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Complaints about allegedly improper evictions and discharges from nursing homes are on the rise in California, Illinois and other states, according to government data. These concerns are echoed in lawsuits and by ombudsmen and consumer advocates.\u003c/p>\n\u003cp>In California alone, such complaints have jumped 70 percent in five years, reaching 1,504 last year, said Joseph Rodrigues, the state-employed Long-Term Care Ombudsman, who for 15 years has overseen local ombudsman programs, which are responsible for resolving consumer complaints.\u003c/p>\n\u003cp>Around the country, ombudsmen say many patients like Willis end up with no permanent housing or regular medical care after being discharged. Even when the discharges are deemed legal, these ombudsmen say, they often are unethical.\u003c/p>\n\u003cp>“It’s a growing problem,” said Leza Coleman, executive director of the California Long-Term Care Ombudsman Association. Coleman says the practice stems from skilled nursing facilities’ desire for better compensation for their services and from the shortage of other affordable long-term care options that might absorb less severe cases.\u003c/p>\n\u003cp>In Willis’ case, she ultimately lost her appeal to return to the nursing home, Courtyard Care Center. A state hearing judge determined that she had left the home voluntarily because she refused the opportunity to pay to remain there.\u003c/p>\n\u003cp>Top administrators at Sava Senior Care, which owns Courtyard, did not return repeated calls for comment.\u003c/p>\n\u003cp>Among other recent cases of allegedly improper discharges:\u003c/p>\n\u003cul>\n\u003cli>In October, California’s attorney general moved to prevent a Bakersfield nursing home administrator from working with elderly and disabled people, while he awaits trial on charges of elder abuse and wrongful discharge. State prosecutors said one patient was falsely informed that she owed the home money, then sent to an independent living center even though she could not “walk or toilet on her own.” The administrator did not return messages left at the nursing home.\u003c/li>\n\u003cli>A \u003ca href=\"http://www.marylandattorneygeneral.gov/News%20Documents/State_v_NMS_Complaint.pdf\" target=\"_blank\" rel=\"noopener\">pending lawsuit\u003c/a> by Maryland’s attorney general alleges a nursing home chain, Neiswanger Management Services (NMS), illegally evicted residents, sending them to homeless shelters or other inadequate facilities to free up bed space for higher-paying patients. NMS countersued state regulators, alleging they are trying to drive the chain out of business.\u003c/li>\n\u003cli>Last month, a 73-year-old woman with diabetes and heart failure \u003ca href=\"http://canhr.org/newsroom/newdev_archive/2017/PDFs/Complaint-JohnsonMoore-Dumping.pdf\" target=\"_blank\" rel=\"noopener\">sued a Fresno, Calif., nursing home\u003c/a> for allegedly \u003ca href=\"http://www.fresnobee.com/news/local/article182618836.html\" target=\"_blank\" rel=\"noopener\">leaving her with an open wound on a sidewalk\u003c/a> in front of a relative’s home. The suit said conditions in the residence were unsafe and a family member refused to allow her inside. The state cited the home in July and issued a $20,000 fine.\u003c/li>\n\u003c/ul>\n\u003cp>Of course, not all complaints or lawsuits are well-founded. Federal law allows a nursing home to discharge or evict a patient when it cannot meet the resident’s needs or the person no longer requires services; if the resident endangers the health and safety of other individuals; or if the patient has failed, after reasonable and appropriate notice, to pay.\u003c/p>\n\u003cp>The law also generally requires a home to provide 30 days’ notice before discharging a patient involuntarily and requires all discharges be safe and orderly.\u003c/p>\n\u003cp>Deborah Pacyna, spokeswoman for the California Association of Health Facilities, a trade organization that represents nursing homes, questions why nursing homes should be responsible for providing a safety net for the indigent and homeless.\u003c/p>\n\u003cp>“Nursing home residents reflect society,” she said in a written statement. “Some nursing home residents live in homeless shelters or hotels. They may request that they go back ‘home,’ or to their local shelter or hotel upon discharge. We must honor their choices as long as their needs are met.”\u003c/p>\n\u003cp>Pacyna also noted that eviction and discharge complaints represent a tiny fraction of the hundreds of thousands of residents released from the state’s nursing homes each year.\u003c/p>\n\u003cp>Nationally, discharge and eviction complaints have remained more or less steady in recent years after rising significantly between 2000 and 2007, according to data collected by the federal government. Still, these complaints remain the top grievance reported to nursing home ombudsmen as the number of overall complaints about everything from abuse to access to information has dropped in the past decade.\u003c/p>\n\u003cp>The rate of complaints can vary considerably by state. Jamie Freschi, the Illinois state ombudsman, says discharge and eviction complaints have more than doubled in her state since 2011.\u003c/p>\n\u003cp>She recalled one wheelchair-bound nursing resident who was in severe pain from osteoarthritis, scoliosis and fibromyalgia when she was discharged from a nursing home and sent to a homeless shelter. After the shelter rejected her because it could not accommodate her wheelchair, the resident went to a motel, which kicked her out when she ran out of money. She has since cycled between the emergency room and the streets, Freschi said.\u003c/p>\n\u003cp>“It’s an example of a really, really broken system, all the way around,” Freschi said.\u003c/p>\n\u003cp>Advocates say such decisions are often money-driven: Medicare covers patients for just a short time after they are released from hospitals. After that, these critics say, many nursing homes don’t want to accept the lower rates paid by Medicaid, the public insurance program for low-income residents.\u003c/p>\n\u003cp>Even when they appeal and win, advocates say, it doesn’t always help the patient. The Centers for Medicare & Medicaid Services has advised California on two occasions — including this past summer — that it must enforce decisions from appeals hearings. (The state contends that it uses a variety of strategies to enforce the law.)\u003c/p>\n\u003cp>Last month, the California Long-Term Care Ombudsman Association joined with the legal wing of the AARP Foundation to \u003ca href=\"https://www.documentcloud.org/documents/4199718-2017-10-02-Complaint.html\" target=\"_blank\" rel=\"noopener\">sue a Sacramento nursing home\u003c/a>, alleging it had improperly discharged an 83-year-old woman with Alzheimer’s — requiring the nursing home to readmit her.\u003c/p>\n\u003cp>“The facilities are getting the message that they don’t have to follow the rules here, so they’re emboldened,” said Matt Borden, a San Francisco attorney helping with the lawsuit.\u003c/p>\n\u003cp>Willis and her advocates were convinced that Courtyard Care Center broke the rules in her case.\u003c/p>\n\u003cp>Willis “did not leave Courtyard ‘voluntarily’ in just about any sense of the word,” said Tony Chicotel, a staff attorney with California Advocates for Nursing Home Reform.\u003c/p>\n\u003cp>At a hearing in April, held at the nursing home and attended by a reporter, Chicotel and an ombudsman argued that Willis’ discharge violated legal requirements, including lack of written notice. They asked that she be immediately readmitted.\u003c/p>\n\u003cp>According to hearing documents, Willis’ documented medical problems were many: an aneurysm, an ulcer, difficulty walking, muscle weakness, gastritis, anemia and heart and kidney disease. During her stay at the nursing home, she said, she’d fallen and hit her head while visiting the doctor, resulting in a severe concussion.\u003c/p>\n\u003cp>For their part, Courtyard staffers explained that Medicaid wouldn’t cover Willis anymore based on their assessment of her condition. They said she had “almost returned to her prior level of functioning.”\u003c/p>\n\u003cp>During the hearing, Willis repeatedly told those in attendance that she felt dizzy and nauseated. Her head pounded. “I’m not good,” she said. Afterward, she begged for a ride to the emergency room, where she was admitted with a torn aorta and bleeding ulcer.\u003c/p>\n\u003cp>She was still in the hospital when the hearing officer issued her decision a few days later. Eventually, she was released to another nursing home, which also discharged her after a month, she said. Then she resumed sleeping on friends’ couches. She chose not to file another appeal.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“This time in my life,” Willis said, “it’s very discouraging.”\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/362214/complaints-rise-in-california-as-nursing-homes-evict-poor-patients","authors":["byline_stateofhealth_362214"],"categories":["stateofhealth_11","stateofhealth_14","stateofhealth_1"],"tags":["stateofhealth_3207","stateofhealth_3208","stateofhealth_2808","stateofhealth_99","stateofhealth_2519","stateofhealth_2829"],"affiliates":["stateofhealth_3036"],"featImg":"stateofhealth_362215","label":"stateofhealth_3036"},"stateofhealth_361251":{"type":"posts","id":"stateofhealth_361251","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"361251","score":null,"sort":[1506638042000]},"guestAuthors":[],"slug":"congress-cold-shoulder-sends-shivers-through-community-health-centers","title":"Congress’ Cold Shoulder Sends Shivers Through Community Health Centers","publishDate":1506638042,"format":"standard","headTitle":"California Healthline | State of Health | KQED News","labelTerm":{"term":3036,"site":"stateofhealth"},"content":"\u003cp>One community health center in New York has frozen hiring. Another in Missouri can’t get a bank loan to expand.\u003c/p>\n\u003cp>The nation’s 1,400 community health centers are carefully watching expenses in case the financial rescue they hope Congress delivers this week doesn’t arrive. With four days left in the government’s fiscal year, Congress has not voted on reauthorizing billions of dollars now going to community health centers and other health programs for the 2018 budget year that starts Sunday.\u003c/p>\n\u003cp>“The anxiety level is increasing on almost a daily basis,” said Dan Hawkins, senior vice president of the National Association of Community Health Centers (NACHC) in Washington, D.C. “There is broad support and agreement in Congress that it should get done, but we are working against a ticking clock and a crowded legislative calendar.”\u003c/p>\n\u003cp>For the past two weeks, the GOP’s scramble to repeal the Affordable Care Act before the month ends pushed other health care matters off the congressional agenda. That effort ended Tuesday when Senate Republicans said they would not seek a vote this week because they lacked enough support to pass the bill.\u003c/p>\n\u003cp>It’s not clear if lawmakers’ lighter agenda will now leave room for funding health centers or deciding other issues, such as renewing the Children’s Health Insurance Program (CHIP), which also expires Saturday. At a hearing Monday, Senate Finance Committee Chairman Orrin Hatch (R-Utah) urged his colleagues to work with the Senate’s health committee to settle the matter. NACHC officials privately express optimism that a deal might come later in October if not by Sunday.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Community health centers operate in more than 9,500 locations, serving 27 million people, according to the NACHC. They are the main source of health care for many low-income Americans — and the only source of primary care in many underserved areas.\u003c/p>\n\u003cp>Health centers provide preventive care, counseling, dentistry and primary care to everyone, whether or not they can pay. A sliding fee scale based on income and family size is available to patients without insurance.\u003c/p>\n\u003cp>In 2015, nearly 1 in 6 Medicaid beneficiaries received health center services, the Kaiser Family Foundation \u003ca href=\"http://www.kff.org/medicaid/issue-brief/community-health-centers-recent-growth-and-the-role-of-the-aca/\">reported\u003c/a> this year. (Kaiser Health News is an editorially independent program of the foundation.)\u003c/p>\n\u003cp>“The end result is these are people who will be locked out of health care” without new funding, Hawkins said.\u003c/p>\n\u003cp>Community health centers gained billions of dollars in federal revenue under the ACA, which created a special trust fund to support them from 2011 through 2015. The Community Health Center Fund was extended in 2015 for two years with an additional $3.6 billion annually.\u003c/p>\n\u003cp>That money represents 70 percent of all federal grants to health centers and about a fifth of their annual revenue. Medicaid reimbursements account for the largest share, about 40 percent.\u003c/p>\n\u003cp>One beneficiary is Pamela Richardson, a 60-year-old patient of Valley Community Healthcare in North Hollywood, California, who suffers from an iron absorption disorder called hereditary hemochromatosis. She was unable to get health insurance before Obamacare prohibited insurers from excluding people with preexisting medical conditions. The clinic helped her sign up for coverage through the Medi-Cal expansion.\u003c/p>\n\u003cp>Once Richardson was covered, she received long-delayed primary care, which revealed she had “scary high” blood pressure and a lump in one breast (which proved benign). “When you don’t have insurance you don’t get breast exams. You don’t have Pap smears,” she \u003ca href=\"http://khn.org/news/californias-community-clinics-big-aca-beneficiaries-worry-about-their-future/\">told\u003c/a> a KHN reporter earlier this year. “I wish people had a little more patience with Obamacare. Once you get what’s wrong with you under control, the cost would come down.”\u003c/p>\n\u003cp>California has by far the most federally funded health centers and they serve 6.2 million Californians, according to CaliforniaHealth+ Advocates, which represents state clinics. They have received over $1.6 billion from 2011 through 2016 from the Community Health Center Fund, more than any other state, the Congressional Research Service \u003ca href=\"https://www.everycrsreport.com/files/20170113_R43911_852eca9ca6e96b41176e6609d8cb068ba7e770ed.pdf\">reported\u003c/a> in January.\u003c/p>\n\u003cp>If health centers receive no new funds for 2018, the ensuing financial crunch would cost 51,000 jobs, force the centers to close 2,800 locations and cause 9 million people to lose health care services, according to a budget document that the Health and Human Services Department gave Congress in July.\u003c/p>\n\u003cp>Uncertainty about what Congress will do now is already causing problems. Hawkins said his members call him and his staff every day, fretting about employment contracts, lease agreements and equipment rentals that run past Oct. 1.\u003c/p>\n\u003cp>Neighborhood Health in Nashville, Tennessee, has federal grant money that will carry it through Jan. 31, but CEO Mary Bufwack said some of her 180 staff members live paycheck to paycheck and are getting nervous about Neighborhood’s stability.\u003c/p>\n\u003cp>Bufwack is worried the health center won’t receive money it needs to replace a clinic, a project now being planned.\u003c/p>\n\u003cp>She fears that a new doctor she recruited to join Neighborhood next June will take another job before she can get his signature on an employment contract. And she doesn’t want to do that until she’s sure about her budget.\u003c/p>\n\u003cp>Mostly, she worries that whatever Congress gives her will be only for one year.\u003c/p>\n\u003cp>“We’re already worried about next Sept. 30,” Bufwack said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"http://www.kaiserhealthnews.org/\">Kaiser Health News\u003c/a> (KHN) is a national health policy news service. It is an editorially independent program of the \u003ca href=\"http://www.kff.org/\">Henry J. Kaiser Family Foundation\u003c/a>.\u003c/p>\n\n","blocks":[],"excerpt":"The clinics, which serve many poor people, are tightening spending in case Congress doesn’t approve new funding for them before the government’s 2018 fiscal year starts Sunday. California has the most at stake.","status":"publish","parent":0,"modified":1506640984,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":24,"wordCount":939},"headData":{"title":"Congress’ Cold Shoulder Sends Shivers Through Community Health Centers | KQED","description":"The clinics, which serve many poor people, are tightening spending in case Congress doesn’t approve new funding for them before the government’s 2018 fiscal year starts Sunday. California has the most at stake.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"361251 https://ww2.kqed.org/stateofhealth/?p=361251","disqusUrl":"https://ww2.kqed.org/stateofhealth/2017/09/28/congress-cold-shoulder-sends-shivers-through-community-health-centers/","disqusTitle":"Congress’ Cold Shoulder Sends Shivers Through Community Health Centers","nprByline":"\u003ca href=\"http://khn.org/news/author/rachel-bluth/\" rel=\"noopener\" target=\"_blank\">\u003cstrong>Rachel Bluth\u003c/strong>\u003c/a>, Kaiser Health News","path":"/stateofhealth/361251/congress-cold-shoulder-sends-shivers-through-community-health-centers","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>One community health center in New York has frozen hiring. Another in Missouri can’t get a bank loan to expand.\u003c/p>\n\u003cp>The nation’s 1,400 community health centers are carefully watching expenses in case the financial rescue they hope Congress delivers this week doesn’t arrive. With four days left in the government’s fiscal year, Congress has not voted on reauthorizing billions of dollars now going to community health centers and other health programs for the 2018 budget year that starts Sunday.\u003c/p>\n\u003cp>“The anxiety level is increasing on almost a daily basis,” said Dan Hawkins, senior vice president of the National Association of Community Health Centers (NACHC) in Washington, D.C. “There is broad support and agreement in Congress that it should get done, but we are working against a ticking clock and a crowded legislative calendar.”\u003c/p>\n\u003cp>For the past two weeks, the GOP’s scramble to repeal the Affordable Care Act before the month ends pushed other health care matters off the congressional agenda. That effort ended Tuesday when Senate Republicans said they would not seek a vote this week because they lacked enough support to pass the bill.\u003c/p>\n\u003cp>It’s not clear if lawmakers’ lighter agenda will now leave room for funding health centers or deciding other issues, such as renewing the Children’s Health Insurance Program (CHIP), which also expires Saturday. At a hearing Monday, Senate Finance Committee Chairman Orrin Hatch (R-Utah) urged his colleagues to work with the Senate’s health committee to settle the matter. NACHC officials privately express optimism that a deal might come later in October if not by Sunday.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Community health centers operate in more than 9,500 locations, serving 27 million people, according to the NACHC. They are the main source of health care for many low-income Americans — and the only source of primary care in many underserved areas.\u003c/p>\n\u003cp>Health centers provide preventive care, counseling, dentistry and primary care to everyone, whether or not they can pay. A sliding fee scale based on income and family size is available to patients without insurance.\u003c/p>\n\u003cp>In 2015, nearly 1 in 6 Medicaid beneficiaries received health center services, the Kaiser Family Foundation \u003ca href=\"http://www.kff.org/medicaid/issue-brief/community-health-centers-recent-growth-and-the-role-of-the-aca/\">reported\u003c/a> this year. (Kaiser Health News is an editorially independent program of the foundation.)\u003c/p>\n\u003cp>“The end result is these are people who will be locked out of health care” without new funding, Hawkins said.\u003c/p>\n\u003cp>Community health centers gained billions of dollars in federal revenue under the ACA, which created a special trust fund to support them from 2011 through 2015. The Community Health Center Fund was extended in 2015 for two years with an additional $3.6 billion annually.\u003c/p>\n\u003cp>That money represents 70 percent of all federal grants to health centers and about a fifth of their annual revenue. Medicaid reimbursements account for the largest share, about 40 percent.\u003c/p>\n\u003cp>One beneficiary is Pamela Richardson, a 60-year-old patient of Valley Community Healthcare in North Hollywood, California, who suffers from an iron absorption disorder called hereditary hemochromatosis. She was unable to get health insurance before Obamacare prohibited insurers from excluding people with preexisting medical conditions. The clinic helped her sign up for coverage through the Medi-Cal expansion.\u003c/p>\n\u003cp>Once Richardson was covered, she received long-delayed primary care, which revealed she had “scary high” blood pressure and a lump in one breast (which proved benign). “When you don’t have insurance you don’t get breast exams. You don’t have Pap smears,” she \u003ca href=\"http://khn.org/news/californias-community-clinics-big-aca-beneficiaries-worry-about-their-future/\">told\u003c/a> a KHN reporter earlier this year. “I wish people had a little more patience with Obamacare. Once you get what’s wrong with you under control, the cost would come down.”\u003c/p>\n\u003cp>California has by far the most federally funded health centers and they serve 6.2 million Californians, according to CaliforniaHealth+ Advocates, which represents state clinics. They have received over $1.6 billion from 2011 through 2016 from the Community Health Center Fund, more than any other state, the Congressional Research Service \u003ca href=\"https://www.everycrsreport.com/files/20170113_R43911_852eca9ca6e96b41176e6609d8cb068ba7e770ed.pdf\">reported\u003c/a> in January.\u003c/p>\n\u003cp>If health centers receive no new funds for 2018, the ensuing financial crunch would cost 51,000 jobs, force the centers to close 2,800 locations and cause 9 million people to lose health care services, according to a budget document that the Health and Human Services Department gave Congress in July.\u003c/p>\n\u003cp>Uncertainty about what Congress will do now is already causing problems. Hawkins said his members call him and his staff every day, fretting about employment contracts, lease agreements and equipment rentals that run past Oct. 1.\u003c/p>\n\u003cp>Neighborhood Health in Nashville, Tennessee, has federal grant money that will carry it through Jan. 31, but CEO Mary Bufwack said some of her 180 staff members live paycheck to paycheck and are getting nervous about Neighborhood’s stability.\u003c/p>\n\u003cp>Bufwack is worried the health center won’t receive money it needs to replace a clinic, a project now being planned.\u003c/p>\n\u003cp>She fears that a new doctor she recruited to join Neighborhood next June will take another job before she can get his signature on an employment contract. And she doesn’t want to do that until she’s sure about her budget.\u003c/p>\n\u003cp>Mostly, she worries that whatever Congress gives her will be only for one year.\u003c/p>\n\u003cp>“We’re already worried about next Sept. 30,” Bufwack said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"http://www.kaiserhealthnews.org/\">Kaiser Health News\u003c/a> (KHN) is a national health policy news service. It is an editorially independent program of the \u003ca href=\"http://www.kff.org/\">Henry J. Kaiser Family Foundation\u003c/a>.\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/361251/congress-cold-shoulder-sends-shivers-through-community-health-centers","authors":["byline_stateofhealth_361251"],"categories":["stateofhealth_11","stateofhealth_15","stateofhealth_14","stateofhealth_1"],"tags":["stateofhealth_3037","stateofhealth_2808","stateofhealth_99","stateofhealth_2519"],"affiliates":["stateofhealth_3036"],"featImg":"stateofhealth_361253","label":"stateofhealth_3036"},"stateofhealth_361160":{"type":"posts","id":"stateofhealth_361160","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"361160","score":null,"sort":[1506368071000]},"guestAuthors":[],"slug":"devastating-cuts-to-come-how-california-would-suffer-under-gop-health-plan","title":"'Devastating' Cuts to Come: How California Would Suffer Under GOP Health Plan","publishDate":1506368071,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>State officials are sounding the alarm over a last-minute push by Republican Senators to \"replace and replace\" the Affordable Care Act. Health officials warn it's the worst proposal yet, with California set to \u003ca href=\"http://www.dhcs.ca.gov/Documents/Graham_Cassidy_Impact_Memo_DHCS_092217.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">lose billions of dollars\u003c/a>.\u003c/p>\n\u003cp>\"Simply stated, this proposal is the most devastating of the three federal health care proposals that we have evaluated this year,\" said Jennifer Kent, Director of the Department of Health Care Services.\u003c/p>\n\u003cp>The two previous plans debated in Congress only partially dismantled the structures that undergird the Affordable Care Act.\u003c/p>\n\u003cp>But the new Graham-Cassidy proposal would blow up those ACA structures, and retract the money that currently pays for them, starting in 2020. After lopping off more than $200 billion from the retracted money, the federal government would use a new formula to scatter the remaining funds across the 50 states and District of Columbia.\u003c/p>\n\u003cp>Prominent losers in this scenario include states like California that eagerly embraced the Affordable Care Act. Health consulting firm Avalere \u003ca href=\"http://avalere.com/expertise/life-sciences/insights/graham-cassidy-heller-johnson-bill-would-reduce-federal-funding-to-sta\" target=\"_blank\" rel=\"noopener noreferrer\">predicts\u003c/a> 34 states and DC would experience funding cuts, and 16 states would see an increase.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cstrong>What Graham-Cassidy does, starting in 2020:\u003c/strong>\u003c/p>\n\u003cp>\u003cspan style=\"text-decoration: underline\">Ends payments\u003c/span> for Medicaid expansion, which allowed 3.8 million Californians to join Medi-Cal.\u003c/p>\n\u003cp>\u003cspan style=\"text-decoration: underline\">Ends federal subsidies\u003c/span> for private insurance coverage sold through \"Covered California,\" which cover more than one million Californians.\u003c/p>\n\u003cp>\u003cspan style=\"text-decoration: underline\">Removes guarantees\u003c/span> that insurance plans cannot charge higher prices to patients with pre-existing conditions to pay more for coverage, or must offer plans that include a basic suite of services, such as prescriptions, maternity care, and mental health treatment. States could opt out of many of these protections, although most experts agree that California would try to maintain them.\u003c/p>\n\u003cp>But that could be an empty promise, warns Peter Lee, executive director of Covered California. Even if California continued the protections for sick people, the insurance market could collapse as healthy people stop buying coverage when federal subsidies end.\u003c/p>\n\u003cp>\u003cstrong>California's \u003ca href=\"http://laborcenter.berkeley.edu/the-gops-last-ditch-effort-to-repeal-the-affordable-care-act-is-the-worst-one-yet-for-california/\" target=\"_blank\" rel=\"noopener noreferrer\">projected losses\u003c/a>:\u003c/strong>\u003c/p>\n\u003cp>\u003cspan style=\"text-decoration: underline\">Number of uninsured:\u003c/span> More than 10 million Californians will lose health coverage by 2027, according to an \u003ca href=\"http://www.coveredca.com/news/pdfs/CoveredCA_Potential_Impacts_Graham-Cassidy-9-25-17.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">new analysis \u003c/a>by Covered California. (UC Berkeley has a \u003ca href=\"http://laborcenter.berkeley.edu/projected-health-insurance-coverage-loss-by-county-2027-under-graham-cassidy/\" target=\"_blank\" rel=\"noopener noreferrer\">breakdown\u003c/a> by Congressional district and county).\u003c/p>\n\u003cp>\u003cem>That's nearly 1 in 4 Californians under age 65, worse than pre-Obamacare levels. \u003c/em>\u003c/p>\n\u003cp>\u003cspan style=\"text-decoration: underline\">Federal funds loss:\u003c/span> Total losses for health care in California ratchet up to $28 billion/year by 2026, then increase dramatically to $57.5 billion a year later, in 2027. That's equivalent to more than a third of all General Fund spending in California's budget.\u003c/p>\n\u003cp>\u003cspan style=\"text-decoration: underline\">Medi-Cal changes:\u003c/span> In addition to changes to the Affordable Care Act, the Graham-Cassidy proposal radically changes how traditional Medicaid, dating back to 1965, is funded. 14 million Californians depend on Medi-Cal coverage, and it's particularly critical for people with disabilities and residents of nursing homes.\u003c/p>\n\u003cp>California stands to lose the most money of all the states.\u003c/p>\n\u003cp>Supporters of the new plan's redistribution formulas explain that it's a matter of fairness to all states.\u003c/p>\n\u003cp>“Four states get 40 percent of the money under Obamacare: New York, California, Massachusetts, and Maryland,\" said Senator Lindsey Graham. \"Our goal is by 2026 to make sure every patient in every state gets the same contribution, roughly, from the federal government.”\u003c/p>\n\u003cp>Opponents of the repeal efforts point out that California gets more money under the law because it has the largest population in the country, and because it embraced the Affordable Care Act's funding opportunities.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Other states such as Texas didn't get as much money under the ACA not because the distribution wasn't fair, but because officials in those states refused to expand Medicaid to more residents, so they didn’t pull down the federal money to pay for that. Under the new plan, Texas will get $35 billion more in federal funds by 2026.\u003c/p>\n\n","blocks":[],"excerpt":"After a decade, more than 10 million Californians will lose insurance coverage as money moves to other states. ","status":"publish","parent":0,"modified":1506374897,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":22,"wordCount":650},"headData":{"title":"'Devastating' Cuts to Come: How California Would Suffer Under GOP Health Plan | KQED","description":"After a decade, more than 10 million Californians will lose insurance coverage as money moves to other states. ","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"361160 https://ww2.kqed.org/stateofhealth/?p=361160","disqusUrl":"https://ww2.kqed.org/stateofhealth/2017/09/25/devastating-cuts-to-come-how-california-would-suffer-under-gop-health-plan/","disqusTitle":"'Devastating' Cuts to Come: How California Would Suffer Under GOP Health Plan","path":"/stateofhealth/361160/devastating-cuts-to-come-how-california-would-suffer-under-gop-health-plan","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>State officials are sounding the alarm over a last-minute push by Republican Senators to \"replace and replace\" the Affordable Care Act. Health officials warn it's the worst proposal yet, with California set to \u003ca href=\"http://www.dhcs.ca.gov/Documents/Graham_Cassidy_Impact_Memo_DHCS_092217.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">lose billions of dollars\u003c/a>.\u003c/p>\n\u003cp>\"Simply stated, this proposal is the most devastating of the three federal health care proposals that we have evaluated this year,\" said Jennifer Kent, Director of the Department of Health Care Services.\u003c/p>\n\u003cp>The two previous plans debated in Congress only partially dismantled the structures that undergird the Affordable Care Act.\u003c/p>\n\u003cp>But the new Graham-Cassidy proposal would blow up those ACA structures, and retract the money that currently pays for them, starting in 2020. After lopping off more than $200 billion from the retracted money, the federal government would use a new formula to scatter the remaining funds across the 50 states and District of Columbia.\u003c/p>\n\u003cp>Prominent losers in this scenario include states like California that eagerly embraced the Affordable Care Act. Health consulting firm Avalere \u003ca href=\"http://avalere.com/expertise/life-sciences/insights/graham-cassidy-heller-johnson-bill-would-reduce-federal-funding-to-sta\" target=\"_blank\" rel=\"noopener noreferrer\">predicts\u003c/a> 34 states and DC would experience funding cuts, and 16 states would see an increase.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cstrong>What Graham-Cassidy does, starting in 2020:\u003c/strong>\u003c/p>\n\u003cp>\u003cspan style=\"text-decoration: underline\">Ends payments\u003c/span> for Medicaid expansion, which allowed 3.8 million Californians to join Medi-Cal.\u003c/p>\n\u003cp>\u003cspan style=\"text-decoration: underline\">Ends federal subsidies\u003c/span> for private insurance coverage sold through \"Covered California,\" which cover more than one million Californians.\u003c/p>\n\u003cp>\u003cspan style=\"text-decoration: underline\">Removes guarantees\u003c/span> that insurance plans cannot charge higher prices to patients with pre-existing conditions to pay more for coverage, or must offer plans that include a basic suite of services, such as prescriptions, maternity care, and mental health treatment. States could opt out of many of these protections, although most experts agree that California would try to maintain them.\u003c/p>\n\u003cp>But that could be an empty promise, warns Peter Lee, executive director of Covered California. Even if California continued the protections for sick people, the insurance market could collapse as healthy people stop buying coverage when federal subsidies end.\u003c/p>\n\u003cp>\u003cstrong>California's \u003ca href=\"http://laborcenter.berkeley.edu/the-gops-last-ditch-effort-to-repeal-the-affordable-care-act-is-the-worst-one-yet-for-california/\" target=\"_blank\" rel=\"noopener noreferrer\">projected losses\u003c/a>:\u003c/strong>\u003c/p>\n\u003cp>\u003cspan style=\"text-decoration: underline\">Number of uninsured:\u003c/span> More than 10 million Californians will lose health coverage by 2027, according to an \u003ca href=\"http://www.coveredca.com/news/pdfs/CoveredCA_Potential_Impacts_Graham-Cassidy-9-25-17.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">new analysis \u003c/a>by Covered California. (UC Berkeley has a \u003ca href=\"http://laborcenter.berkeley.edu/projected-health-insurance-coverage-loss-by-county-2027-under-graham-cassidy/\" target=\"_blank\" rel=\"noopener noreferrer\">breakdown\u003c/a> by Congressional district and county).\u003c/p>\n\u003cp>\u003cem>That's nearly 1 in 4 Californians under age 65, worse than pre-Obamacare levels. \u003c/em>\u003c/p>\n\u003cp>\u003cspan style=\"text-decoration: underline\">Federal funds loss:\u003c/span> Total losses for health care in California ratchet up to $28 billion/year by 2026, then increase dramatically to $57.5 billion a year later, in 2027. That's equivalent to more than a third of all General Fund spending in California's budget.\u003c/p>\n\u003cp>\u003cspan style=\"text-decoration: underline\">Medi-Cal changes:\u003c/span> In addition to changes to the Affordable Care Act, the Graham-Cassidy proposal radically changes how traditional Medicaid, dating back to 1965, is funded. 14 million Californians depend on Medi-Cal coverage, and it's particularly critical for people with disabilities and residents of nursing homes.\u003c/p>\n\u003cp>California stands to lose the most money of all the states.\u003c/p>\n\u003cp>Supporters of the new plan's redistribution formulas explain that it's a matter of fairness to all states.\u003c/p>\n\u003cp>“Four states get 40 percent of the money under Obamacare: New York, California, Massachusetts, and Maryland,\" said Senator Lindsey Graham. \"Our goal is by 2026 to make sure every patient in every state gets the same contribution, roughly, from the federal government.”\u003c/p>\n\u003cp>Opponents of the repeal efforts point out that California gets more money under the law because it has the largest population in the country, and because it embraced the Affordable Care Act's funding opportunities.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Other states such as Texas didn't get as much money under the ACA not because the distribution wasn't fair, but because officials in those states refused to expand Medicaid to more residents, so they didn’t pull down the federal money to pay for that. Under the new plan, Texas will get $35 billion more in federal funds by 2026.\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/361160/devastating-cuts-to-come-how-california-would-suffer-under-gop-health-plan","authors":["11314"],"categories":["stateofhealth_15","stateofhealth_14","stateofhealth_1"],"tags":["stateofhealth_294","stateofhealth_2808","stateofhealth_99","stateofhealth_2519","stateofhealth_3105"],"featImg":"stateofhealth_361209","label":"stateofhealth"},"stateofhealth_358411":{"type":"posts","id":"stateofhealth_358411","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"358411","score":null,"sort":[1501028621000]},"guestAuthors":[],"slug":"on-precipice-of-senate-vote-east-bay-health-clinic-fears-for-thousands-of-patients","title":"On Precipice of Senate Vote, East Bay Health Clinic Fears for Thousands of Patients","publishDate":1501028621,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>\u003cspan style=\"font-weight: 400\">U.S. senators voted 51-50 on Tuesday to begin debate on a controversial health care bill that could unwind the 7-year-old Affordable Care Act, and possibly revamp the way Medicaid has been funded for the past 52 years. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The GOP leaders have not determined exactly \u003ca href=\"https://www.vox.com/policy-and-politics/2017/7/25/16027526/senate-health-care-bill-debate-explained\" target=\"_blank\" rel=\"noopener noreferrer\">what version\u003c/a> of the bill will be brought up for a vote after 20 hours of scheduled debate. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">But two of the bills being considered would cut federal funding for Medicaid, the insurance program for low-income adults and children, pregnant women and people with disabilities. Since 1965, Medicaid has been administered by the states, but paid for through a combination of state and federal funds. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">In California, the program is called Medi-Cal, and it covers one in three Californians. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Doctors, nurses and staff members at \u003c/span>\u003ca href=\"http://www.tvhc.org/\" target=\"_blank\" rel=\"noopener noreferrer\">\u003cspan style=\"font-weight: 400\">Tiburcio Vasquez Health Center\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> (TVHC) in Hayward have been speaking with KQED over the past month about how the proposed cuts of billions of dollars for Medi-Cal would affect the clinic's work as the safety-net provider of last resort for vulnerable patients. \u003c/span>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“Both [bills] would be just terrible for our patients,\" said Chief Medical Officer Dr. Porshia Mack, after Tuesday's \"motion to proceed\" vote. \"If it’s 'repeal and delay,' there’s no guarantee that they’d come up with a bill to cover those people that would lose insurance.”\u003c/span>\u003c/p>\n\u003cp>\u003cstrong>'Less people will have coverage. Bottom line.' \u003c/strong>\u003c/p>\n\u003cfigure id=\"attachment_358426\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003cimg class=\"wp-image-358426\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/07/RS26075_David-B-Vliet-NCB-pic-qut-1020x1096.jpg\" alt=\"David B. Vliet is the Chief Executive Officer of Tiburcio Vasquez Health Center. He says if Obamacare is dismantled, less people will have health coverage.\" width=\"300\" height=\"322\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/07/RS26075_David-B-Vliet-NCB-pic-qut-1020x1096.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/RS26075_David-B-Vliet-NCB-pic-qut-160x172.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/RS26075_David-B-Vliet-NCB-pic-qut-800x860.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/RS26075_David-B-Vliet-NCB-pic-qut-768x825.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/RS26075_David-B-Vliet-NCB-pic-qut-1180x1268.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/RS26075_David-B-Vliet-NCB-pic-qut-960x1032.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/RS26075_David-B-Vliet-NCB-pic-qut-240x258.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/RS26075_David-B-Vliet-NCB-pic-qut-375x403.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/RS26075_David-B-Vliet-NCB-pic-qut-520x559.jpg 520w\" sizes=\"(max-width: 300px) 100vw, 300px\">\u003cfigcaption class=\"wp-caption-text\">David B. Vliet is the chief executive officer of Tiburcio Vasquez Health Center. He says if Obamacare is dismantled, fewer people will have health coverage.\u003c/figcaption>\u003c/figure>\n\u003cp>Recently, KQED health reporter Laura Klivans sat down with TVHC’s CEO to learn more about the day-to-day work of a large urban community health center and how potential cuts to Medi-Cal could affect that.\u003c/p>\n\u003cp>\u003ci>\u003cspan style=\"font-weight: 400\">This interview was edited for brevity and clarity.\u003c/span>\u003c/i>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003cstrong>Name:\u003c/strong> David B. Vliet\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003cstrong>Title:\u003c/strong> Chief executive officer at Tiburcio Vasquez Health Center, a federally supported clinic with locations in Hayward, Union City and Fremont. \u003c/span>\u003c/p>\n\u003cp>\u003cb>Q: Tell me a bit about the scope of the programs here.\u003c/b>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003cstrong>A:\u003c/strong> We are pretty much a typical, run-of-the-mill community health center. We are \u003c/span>\u003ca href=\"https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/fqhcfactsheet.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">\u003cspan style=\"font-weight: 400\">federally qualified\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">, which essentially compels us to take care of any member of the community that needs health care without regard to their ability to pay. We have pediatrics, internal medicine, family practice, women's health and dental. We also have a very large WIC — \u003c/span>\u003cspan style=\"font-weight: 400\">\u003ca href=\"https://www.fns.usda.gov/wic/women-infants-and-children-wic\" target=\"_blank\" rel=\"noopener noreferrer\">Women, Infants, and Children\u003c/a> —\u003c/span>\u003cspan style=\"font-weight: 400\"> program. \u003c/span>\u003c/p>\n\u003cp>\u003cb>Q: Can you tell me a little bit about your own background and how you ended up as the CEO of Tiburcio Vasquez Health Center?\u003c/b>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003cstrong>A:\u003c/strong> This is a movement that goes back to the civil rights movement. So we have a large number of people who have been in this work for a long time. I'm relatively new to the community health center world. I have about 16 years.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">I got here because having lived in Mexico as a younger man, I saw a very desperate need for health care. I wanted to actually have my own mobile clinic that would go into the rural areas of Florida to deliver health care, like a bus that was outfitted. And very long story short, I decided that if I was going to raise money to do that I’d have to get an undergraduate degree in that area. I sort of slipstreamed into health administration in Florida. Then I moved to Texas, where I was introduced in 2002 to the community health center model, and fell in love with it. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">In Austin, Texas, I ran the \u003c/span>\u003ca href=\"http://communitycaretx.org/\" target=\"_blank\" rel=\"noopener noreferrer\">\u003cspan style=\"font-weight: 400\">community health centers\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> for about 10 years. I learned that this is really important, rewarding work because we get to impact the health outcomes of the community and see people be well. A lot of people will walk around with their diabetes out of control or slight depression or a toothache. And the fact that we're able to address that in a systematic way, to me is very exciting. \u003c/span>\u003c/p>\n\u003cp>\u003cb>Q: Coming from Texas to a state like California, what are some of the things you've noticed about how health care is different at a community clinic level? \u003c/b>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003cstrong>A:\u003c/strong> Similar to Travis County [where Austin, Texas, is located], Alameda County is also very progressive. And the community’s very committed to serving people even without documentation, because there is a return on investment when you do that. The overall cost of care longitudinally is reduced when you take care of people \u003c/span>\u003ci>\u003cspan style=\"font-weight: 400\">when\u003c/span>\u003c/i>\u003cspan style=\"font-weight: 400\"> they need to be taken care of. So I think there are a lot of similarities, but the political atmosphere certainly is much different in Texas.\u003c/span>\u003c/p>\n\u003cp>\u003cb>Q: What do you find to be unique about Tiburcio Vasquez? \u003c/b>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003cstrong>A:\u003c/strong> We began our health care journey back in the early '70s taking care of families that were busy making America great in agriculture, in the fields. As their families grew and they got ill, we were there in a very simple form. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">[Community Health Centers] take care of around \u003c/span>\u003ca href=\"http://www.kff.org/report-section/community-health-centers-recent-growth-and-the-role-of-the-aca-issue-brief/\" target=\"_blank\" rel=\"noopener noreferrer\">\u003cspan style=\"font-weight: 400\">24 million\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> patients across the United States. We're a significant safety-net model and we've enjoyed bipartisan support for many years.\u003c/span>\u003c/p>\n\u003cp>\u003cb>Q: How have the additional dollars from the Medi-Cal expansion helped Tiburcio Vasquez?\u003c/b>\u003c/p>\n\u003cp>\u003cstrong>A:\u003c/strong> We opened up a new health center in San Leandro. We're able to add exam rooms, and add dental chairs, and hire staff, and then see more patients. But there were dollars that did other things, [for example], the conversion to the electronic health record so that we're no longer on paper charts.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">If those [Medi-Cal dollars] go away, we will continue to have to take care of communities whether the funding is there or not. Those dollars really do have a return on investment, in that when we are able to make sure that Mr. Smith or Mrs. Rodriguez doesn't show up in the ER with tooth pain, everyone in the community enjoys lower costs because of that.\u003c/span>\u003c/p>\n\u003cp>\u003cb>Q: If the ACA gets dismantled, what's the impact going to be for Tiburcio Vasquez? \u003c/b>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003cstrong>A: \u003c/strong>Less people will have coverage. Bottom line. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Health centers are here, and have been for 50-odd years. We have funding from the federal government and have enjoyed bipartisan support. But that has not always been enough. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The Medicaid expansion assures -- particularly for adults who were not covered previously, working adults -- they're able to come in here and get preventive care. If there is a reduction in Medicaid, some of those folks in our county could be pushed off Medicaid and will probably go back on some sort of county plan. \u003c/span>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">At our health center, roughly 5,000 folks that did not have coverage before currently have Medicaid. That number will go away under the contraction of Medicaid under the proposed new bill. \u003c/span>\u003c/p>\n\n","blocks":[],"excerpt":"'Less people will have coverage. Bottom line.' An interview with the CEO of Tiburcio Vasquez Health Center in Hayward.","status":"publish","parent":0,"modified":1501030308,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":32,"wordCount":1160},"headData":{"title":"On Precipice of Senate Vote, East Bay Health Clinic Fears for Thousands of Patients | KQED","description":"'Less people will have coverage. Bottom line.' An interview with the CEO of Tiburcio Vasquez Health Center in Hayward.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"358411 https://ww2.kqed.org/stateofhealth/?p=358411","disqusUrl":"https://ww2.kqed.org/stateofhealth/2017/07/25/on-precipice-of-senate-vote-east-bay-health-clinic-fears-for-thousands-of-patients/","disqusTitle":"On Precipice of Senate Vote, East Bay Health Clinic Fears for Thousands of Patients","path":"/stateofhealth/358411/on-precipice-of-senate-vote-east-bay-health-clinic-fears-for-thousands-of-patients","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cspan style=\"font-weight: 400\">U.S. senators voted 51-50 on Tuesday to begin debate on a controversial health care bill that could unwind the 7-year-old Affordable Care Act, and possibly revamp the way Medicaid has been funded for the past 52 years. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The GOP leaders have not determined exactly \u003ca href=\"https://www.vox.com/policy-and-politics/2017/7/25/16027526/senate-health-care-bill-debate-explained\" target=\"_blank\" rel=\"noopener noreferrer\">what version\u003c/a> of the bill will be brought up for a vote after 20 hours of scheduled debate. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">But two of the bills being considered would cut federal funding for Medicaid, the insurance program for low-income adults and children, pregnant women and people with disabilities. Since 1965, Medicaid has been administered by the states, but paid for through a combination of state and federal funds. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">In California, the program is called Medi-Cal, and it covers one in three Californians. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Doctors, nurses and staff members at \u003c/span>\u003ca href=\"http://www.tvhc.org/\" target=\"_blank\" rel=\"noopener noreferrer\">\u003cspan style=\"font-weight: 400\">Tiburcio Vasquez Health Center\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> (TVHC) in Hayward have been speaking with KQED over the past month about how the proposed cuts of billions of dollars for Medi-Cal would affect the clinic's work as the safety-net provider of last resort for vulnerable patients. \u003c/span>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“Both [bills] would be just terrible for our patients,\" said Chief Medical Officer Dr. Porshia Mack, after Tuesday's \"motion to proceed\" vote. \"If it’s 'repeal and delay,' there’s no guarantee that they’d come up with a bill to cover those people that would lose insurance.”\u003c/span>\u003c/p>\n\u003cp>\u003cstrong>'Less people will have coverage. Bottom line.' \u003c/strong>\u003c/p>\n\u003cfigure id=\"attachment_358426\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003cimg class=\"wp-image-358426\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/07/RS26075_David-B-Vliet-NCB-pic-qut-1020x1096.jpg\" alt=\"David B. Vliet is the Chief Executive Officer of Tiburcio Vasquez Health Center. He says if Obamacare is dismantled, less people will have health coverage.\" width=\"300\" height=\"322\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/07/RS26075_David-B-Vliet-NCB-pic-qut-1020x1096.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/RS26075_David-B-Vliet-NCB-pic-qut-160x172.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/RS26075_David-B-Vliet-NCB-pic-qut-800x860.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/RS26075_David-B-Vliet-NCB-pic-qut-768x825.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/RS26075_David-B-Vliet-NCB-pic-qut-1180x1268.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/RS26075_David-B-Vliet-NCB-pic-qut-960x1032.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/RS26075_David-B-Vliet-NCB-pic-qut-240x258.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/RS26075_David-B-Vliet-NCB-pic-qut-375x403.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/RS26075_David-B-Vliet-NCB-pic-qut-520x559.jpg 520w\" sizes=\"(max-width: 300px) 100vw, 300px\">\u003cfigcaption class=\"wp-caption-text\">David B. Vliet is the chief executive officer of Tiburcio Vasquez Health Center. He says if Obamacare is dismantled, fewer people will have health coverage.\u003c/figcaption>\u003c/figure>\n\u003cp>Recently, KQED health reporter Laura Klivans sat down with TVHC’s CEO to learn more about the day-to-day work of a large urban community health center and how potential cuts to Medi-Cal could affect that.\u003c/p>\n\u003cp>\u003ci>\u003cspan style=\"font-weight: 400\">This interview was edited for brevity and clarity.\u003c/span>\u003c/i>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003cstrong>Name:\u003c/strong> David B. Vliet\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003cstrong>Title:\u003c/strong> Chief executive officer at Tiburcio Vasquez Health Center, a federally supported clinic with locations in Hayward, Union City and Fremont. \u003c/span>\u003c/p>\n\u003cp>\u003cb>Q: Tell me a bit about the scope of the programs here.\u003c/b>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003cstrong>A:\u003c/strong> We are pretty much a typical, run-of-the-mill community health center. We are \u003c/span>\u003ca href=\"https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/fqhcfactsheet.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">\u003cspan style=\"font-weight: 400\">federally qualified\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">, which essentially compels us to take care of any member of the community that needs health care without regard to their ability to pay. We have pediatrics, internal medicine, family practice, women's health and dental. We also have a very large WIC — \u003c/span>\u003cspan style=\"font-weight: 400\">\u003ca href=\"https://www.fns.usda.gov/wic/women-infants-and-children-wic\" target=\"_blank\" rel=\"noopener noreferrer\">Women, Infants, and Children\u003c/a> —\u003c/span>\u003cspan style=\"font-weight: 400\"> program. \u003c/span>\u003c/p>\n\u003cp>\u003cb>Q: Can you tell me a little bit about your own background and how you ended up as the CEO of Tiburcio Vasquez Health Center?\u003c/b>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003cstrong>A:\u003c/strong> This is a movement that goes back to the civil rights movement. So we have a large number of people who have been in this work for a long time. I'm relatively new to the community health center world. I have about 16 years.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">I got here because having lived in Mexico as a younger man, I saw a very desperate need for health care. I wanted to actually have my own mobile clinic that would go into the rural areas of Florida to deliver health care, like a bus that was outfitted. And very long story short, I decided that if I was going to raise money to do that I’d have to get an undergraduate degree in that area. I sort of slipstreamed into health administration in Florida. Then I moved to Texas, where I was introduced in 2002 to the community health center model, and fell in love with it. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">In Austin, Texas, I ran the \u003c/span>\u003ca href=\"http://communitycaretx.org/\" target=\"_blank\" rel=\"noopener noreferrer\">\u003cspan style=\"font-weight: 400\">community health centers\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> for about 10 years. I learned that this is really important, rewarding work because we get to impact the health outcomes of the community and see people be well. A lot of people will walk around with their diabetes out of control or slight depression or a toothache. And the fact that we're able to address that in a systematic way, to me is very exciting. \u003c/span>\u003c/p>\n\u003cp>\u003cb>Q: Coming from Texas to a state like California, what are some of the things you've noticed about how health care is different at a community clinic level? \u003c/b>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003cstrong>A:\u003c/strong> Similar to Travis County [where Austin, Texas, is located], Alameda County is also very progressive. And the community’s very committed to serving people even without documentation, because there is a return on investment when you do that. The overall cost of care longitudinally is reduced when you take care of people \u003c/span>\u003ci>\u003cspan style=\"font-weight: 400\">when\u003c/span>\u003c/i>\u003cspan style=\"font-weight: 400\"> they need to be taken care of. So I think there are a lot of similarities, but the political atmosphere certainly is much different in Texas.\u003c/span>\u003c/p>\n\u003cp>\u003cb>Q: What do you find to be unique about Tiburcio Vasquez? \u003c/b>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003cstrong>A:\u003c/strong> We began our health care journey back in the early '70s taking care of families that were busy making America great in agriculture, in the fields. As their families grew and they got ill, we were there in a very simple form. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">[Community Health Centers] take care of around \u003c/span>\u003ca href=\"http://www.kff.org/report-section/community-health-centers-recent-growth-and-the-role-of-the-aca-issue-brief/\" target=\"_blank\" rel=\"noopener noreferrer\">\u003cspan style=\"font-weight: 400\">24 million\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> patients across the United States. We're a significant safety-net model and we've enjoyed bipartisan support for many years.\u003c/span>\u003c/p>\n\u003cp>\u003cb>Q: How have the additional dollars from the Medi-Cal expansion helped Tiburcio Vasquez?\u003c/b>\u003c/p>\n\u003cp>\u003cstrong>A:\u003c/strong> We opened up a new health center in San Leandro. We're able to add exam rooms, and add dental chairs, and hire staff, and then see more patients. But there were dollars that did other things, [for example], the conversion to the electronic health record so that we're no longer on paper charts.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">If those [Medi-Cal dollars] go away, we will continue to have to take care of communities whether the funding is there or not. Those dollars really do have a return on investment, in that when we are able to make sure that Mr. Smith or Mrs. Rodriguez doesn't show up in the ER with tooth pain, everyone in the community enjoys lower costs because of that.\u003c/span>\u003c/p>\n\u003cp>\u003cb>Q: If the ACA gets dismantled, what's the impact going to be for Tiburcio Vasquez? \u003c/b>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003cstrong>A: \u003c/strong>Less people will have coverage. Bottom line. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Health centers are here, and have been for 50-odd years. We have funding from the federal government and have enjoyed bipartisan support. But that has not always been enough. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The Medicaid expansion assures -- particularly for adults who were not covered previously, working adults -- they're able to come in here and get preventive care. If there is a reduction in Medicaid, some of those folks in our county could be pushed off Medicaid and will probably go back on some sort of county plan. \u003c/span>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">At our health center, roughly 5,000 folks that did not have coverage before currently have Medicaid. That number will go away under the contraction of Medicaid under the proposed new bill. \u003c/span>\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/358411/on-precipice-of-senate-vote-east-bay-health-clinic-fears-for-thousands-of-patients","authors":["8648"],"categories":["stateofhealth_11","stateofhealth_2442","stateofhealth_15","stateofhealth_14","stateofhealth_2746","stateofhealth_1"],"tags":["stateofhealth_2808","stateofhealth_99","stateofhealth_2519","stateofhealth_3136","stateofhealth_3132"],"featImg":"stateofhealth_356501","label":"stateofhealth"},"stateofhealth_353997":{"type":"posts","id":"stateofhealth_353997","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"353997","score":null,"sort":[1499896205000]},"guestAuthors":[],"slug":"latino-patients-sue-state-over-separate-and-unequal-healthcare","title":"Latino Patients Sue State Over 'Separate and Unequal' Health Care","publishDate":1499896205,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>Latino Medi-Cal patients are suing the state, alleging the health program for low-income Californians is a separate and unequal system of health care.\u003c/p>\n\u003cp>Because the majority of Medi-Cal patients are Latino – 7.2 million out of 13 million total enrollees – the \u003ca href=\"http://www.seiu-uhw.org/wp-content/blogs.dir/166/files/2016/07/Medi-Cal-Complaint-2017-07-12.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">lawsuit\u003c/a> alleges that delays in access to care, and denials of care, amount to civil rights violations.\u003c/p>\n\u003cp>“Medi-Cal participants suffer from greater pain, illness, and undiagnosed and untreated serious medical conditions—with significant impact to their overall health—than do their fellow Californians with other insurance,” the complaint says.\u003c/p>\n\u003cp>That’s been true for Gloria de Jesus, 16, who waited months to see a neurologist after being diagnosed with epilepsy. Her brother, Andrew, often lands in the emergency room because he can’t get his asthma prescription filled on time. Their mother, Rebecca Binsfeld, says she can’t find a pediatrician in Sacramento who takes their Medi-Cal coverage.\u003c/p>\n\u003cp>“They gave me a booklet, and in the booklet it has hundreds of doctors’ names and numbers, but you call and they’re not accepting new patients,” she says.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Binsfeld, who suffers from lupus, waited 10 months to see a rheumatologist (she’s supposed to see one every four months), and a year to see an ophthalmologist (she’s supposed to go every six months, to check for blindness associated with her medications). The delays in care led to several lupus flares, episodes during which Binsfeld experiences extreme fatigue, pain in her joints, and headaches. Repeated flares can cause organ damage or kidney disease.\u003c/p>\n\u003cp>“I just want better health care. I want to be able to call the doctor if I’m not feeling well and to be able to be seen,” Binsfeld says. “I want everybody else on Medi-Cal to be treated the same as those that have private insurance.”\u003c/p>\n\u003cp>The lawsuit alleges several shortcomings in the Medi-Cal program that lead to these delays, namely “extremely low” reimbursement rates and burdensome paperwork that forces doctors to limit the number of low-income patients they see.\u003c/p>\n\u003cp>“As the number of Latinos has grown in the program, the state has cut funding,” says Darin Ranahan, an attorney from the Oakland law firm \u003ca href=\"http://feinbergjackson.com/\" target=\"_blank\" rel=\"noopener noreferrer\">Feinberg, Jackson, Worthman and Wasow\u003c/a>, representing the plaintiffs. “Simply put, if you disinvest from a program as it’s coming to serve more and more people of color, that’s a form of race discrimination.”\u003c/p>\n\u003cp>The state is also failing to adequately monitor the program and ensure that patients are being seen in a timely manner, Ranahan says. For example, state regulations require patients to get urgent care within 48 hours, primary care within 10 days, and specialty appointments within 15 days.\u003c/p>\n\u003cp>“What we’ve seen, repeatedly, is people on Medi-Cal are not able to get appointments within these times,” Ranahan says.\u003c/p>\n\u003cp>The state Department of Health Care Services countered, saying it routinely monitors patient access to care in the Medi-Cal program, and that neither the state, nor federal health officials, had identified any systemic problems.\u003c/p>\n\u003cp>Beyond that, the state said it's position on the allegations was outlined in \u003ca href=\"///Users/aprildembosky/Downloads/AG%20Response%20Letter%205.10.16.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">a letter\u003c/a> the state attorney general wrote last year, after health advocates and union representatives from SEIU filed \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/12/15/advocates-allege-medi-cal-violates-latinos-civil-rights/\" target=\"_blank\" rel=\"noopener noreferrer\">a similar complaint\u003c/a> with the U.S. Department of Health and Human Services Office for Civil Rights in December 2015.\u003c/p>\n\u003cp>The letter says the state's reimbursement rates have been thoroughly reviewed and approved by federal officials, and that rates are uniform for all providers and patients. It says Latino beneficiaries are treated the same as all Medi-Cal beneficiaries.\u003c/p>\n\u003cp>“We work hard to serve all beneficiaries equally,” Jennifer Kent, director of the Department of Health Care Services, said in a 2015 statement responding to the original complaint. “We are committed to serving all vulnerable populations with vital health services.”\u003c/p>\n\u003cp>The department also cited a \u003ca href=\"http://www.blueshieldcafoundation.org/sites/default/files/publications/downloadable/BSCF%20Delivering%20Promise%20Full%20Report%20Web.pdf\">January 2015 survey\u003c/a> by the Blue Shield of California Foundation that showed satisfaction gaps between whites and Latinos, which were identified in 2011, have been eliminated or dramatically narrowed. Overall satisfaction with Medi-Cal was 90 percent.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Federal officials did not act on the original complaint, and advocates say that’s why they are now filing the lawsuit directly against the state.\u003c/p>\n\n","blocks":[],"excerpt":"Latino patients say waiting months to see a doctor violates their civil rights.","status":"publish","parent":0,"modified":1499982431,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":19,"wordCount":753},"headData":{"title":"Latino Patients Sue State Over 'Separate and Unequal' Health Care | KQED","description":"Latino patients say waiting months to see a doctor violates their civil rights.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"353997 https://ww2.kqed.org/stateofhealth/?p=353997","disqusUrl":"https://ww2.kqed.org/stateofhealth/2017/07/12/latino-patients-sue-state-over-separate-and-unequal-healthcare/","disqusTitle":"Latino Patients Sue State Over 'Separate and Unequal' Health Care","path":"/stateofhealth/353997/latino-patients-sue-state-over-separate-and-unequal-healthcare","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Latino Medi-Cal patients are suing the state, alleging the health program for low-income Californians is a separate and unequal system of health care.\u003c/p>\n\u003cp>Because the majority of Medi-Cal patients are Latino – 7.2 million out of 13 million total enrollees – the \u003ca href=\"http://www.seiu-uhw.org/wp-content/blogs.dir/166/files/2016/07/Medi-Cal-Complaint-2017-07-12.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">lawsuit\u003c/a> alleges that delays in access to care, and denials of care, amount to civil rights violations.\u003c/p>\n\u003cp>“Medi-Cal participants suffer from greater pain, illness, and undiagnosed and untreated serious medical conditions—with significant impact to their overall health—than do their fellow Californians with other insurance,” the complaint says.\u003c/p>\n\u003cp>That’s been true for Gloria de Jesus, 16, who waited months to see a neurologist after being diagnosed with epilepsy. Her brother, Andrew, often lands in the emergency room because he can’t get his asthma prescription filled on time. Their mother, Rebecca Binsfeld, says she can’t find a pediatrician in Sacramento who takes their Medi-Cal coverage.\u003c/p>\n\u003cp>“They gave me a booklet, and in the booklet it has hundreds of doctors’ names and numbers, but you call and they’re not accepting new patients,” she says.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Binsfeld, who suffers from lupus, waited 10 months to see a rheumatologist (she’s supposed to see one every four months), and a year to see an ophthalmologist (she’s supposed to go every six months, to check for blindness associated with her medications). The delays in care led to several lupus flares, episodes during which Binsfeld experiences extreme fatigue, pain in her joints, and headaches. Repeated flares can cause organ damage or kidney disease.\u003c/p>\n\u003cp>“I just want better health care. I want to be able to call the doctor if I’m not feeling well and to be able to be seen,” Binsfeld says. “I want everybody else on Medi-Cal to be treated the same as those that have private insurance.”\u003c/p>\n\u003cp>The lawsuit alleges several shortcomings in the Medi-Cal program that lead to these delays, namely “extremely low” reimbursement rates and burdensome paperwork that forces doctors to limit the number of low-income patients they see.\u003c/p>\n\u003cp>“As the number of Latinos has grown in the program, the state has cut funding,” says Darin Ranahan, an attorney from the Oakland law firm \u003ca href=\"http://feinbergjackson.com/\" target=\"_blank\" rel=\"noopener noreferrer\">Feinberg, Jackson, Worthman and Wasow\u003c/a>, representing the plaintiffs. “Simply put, if you disinvest from a program as it’s coming to serve more and more people of color, that’s a form of race discrimination.”\u003c/p>\n\u003cp>The state is also failing to adequately monitor the program and ensure that patients are being seen in a timely manner, Ranahan says. For example, state regulations require patients to get urgent care within 48 hours, primary care within 10 days, and specialty appointments within 15 days.\u003c/p>\n\u003cp>“What we’ve seen, repeatedly, is people on Medi-Cal are not able to get appointments within these times,” Ranahan says.\u003c/p>\n\u003cp>The state Department of Health Care Services countered, saying it routinely monitors patient access to care in the Medi-Cal program, and that neither the state, nor federal health officials, had identified any systemic problems.\u003c/p>\n\u003cp>Beyond that, the state said it's position on the allegations was outlined in \u003ca href=\"///Users/aprildembosky/Downloads/AG%20Response%20Letter%205.10.16.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">a letter\u003c/a> the state attorney general wrote last year, after health advocates and union representatives from SEIU filed \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/12/15/advocates-allege-medi-cal-violates-latinos-civil-rights/\" target=\"_blank\" rel=\"noopener noreferrer\">a similar complaint\u003c/a> with the U.S. Department of Health and Human Services Office for Civil Rights in December 2015.\u003c/p>\n\u003cp>The letter says the state's reimbursement rates have been thoroughly reviewed and approved by federal officials, and that rates are uniform for all providers and patients. It says Latino beneficiaries are treated the same as all Medi-Cal beneficiaries.\u003c/p>\n\u003cp>“We work hard to serve all beneficiaries equally,” Jennifer Kent, director of the Department of Health Care Services, said in a 2015 statement responding to the original complaint. “We are committed to serving all vulnerable populations with vital health services.”\u003c/p>\n\u003cp>The department also cited a \u003ca href=\"http://www.blueshieldcafoundation.org/sites/default/files/publications/downloadable/BSCF%20Delivering%20Promise%20Full%20Report%20Web.pdf\">January 2015 survey\u003c/a> by the Blue Shield of California Foundation that showed satisfaction gaps between whites and Latinos, which were identified in 2011, have been eliminated or dramatically narrowed. Overall satisfaction with Medi-Cal was 90 percent.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Federal officials did not act on the original complaint, and advocates say that’s why they are now filing the lawsuit directly against the state.\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/353997/latino-patients-sue-state-over-separate-and-unequal-healthcare","authors":["3205"],"categories":["stateofhealth_14"],"tags":["stateofhealth_2808","stateofhealth_3129","stateofhealth_99","stateofhealth_2519"],"featImg":"stateofhealth_24898","label":"stateofhealth"},"stateofhealth_348688":{"type":"posts","id":"stateofhealth_348688","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"348688","score":null,"sort":[1498775776000]},"guestAuthors":[],"slug":"nursing-homes-worry-proposed-medicaid-cuts-will-force-cuts-closures","title":"Nursing Homes Worry Proposed Medicaid Cuts Will Force Cuts, Closures","publishDate":1498775776,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>The Senate vote on the health care bill has been pushed back, but it still has a lot of people in the nursing home industry worried. About two-thirds of nursing home residents are paid for by Medicaid. And the Congressional Budget Office \u003ca href=\"https://www.cbo.gov/system/files/115th-congress-2017-2018/costestimate/52849-hr1628senate.pdf\">found\u003c/a> that the Senate health care bill would cut Medicaid by more than $770 billion over the next decade.\u003c/p>\n\u003cp>That could mean trouble for people like 88-year-old Betty Redlin. She's lived at the \u003ca href=\"http://victoriacarecenter.com/\">Victoria Care Center\u003c/a> in Ventura, Calif. for about 2 1/2 years.\u003c/p>\n\u003cp>She explains that she fell and broke her hip and never regained her ability to walk. \"I was living with my granddaughter,\" she says, \"and my doctor won't [allow] going back to her place.\"\u003c/p>\n\u003cp>Betty had a career as a bookkeeper. She also raised three children. Now she's spent everything she had. There's no way she could afford the roughly $80,000 a year this nursing home costs. (That fee is pretty standard for nursing homes.) So it's Medicaid that enables her to stay here.\u003c/p>\n\u003cp>\"There's nothing I can do about it,\" she says. \"It's gotta be [Medicaid] or [I'm] out on the street. One or the other.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe src=\"https://www.npr.org/player/embed/534764940/534764941\" width=\"100%\" height=\"290\" frameborder=\"0\" scrolling=\"no\" title=\"NPR embedded audio player\" class=\"iframe-class\">\u003c/iframe>\u003c/p>\n\u003cp>John Gardner, executive director of the Victoria Care Center, says that most of the long-term care residents like Redlin are on Medicaid or, as it's called in California, Medi-Cal.\u003c/p>\n\u003cp>\"If you look at what it costs to provide that service and what we get from Medi-Cal, we're actually losing a little bit of money every day on that.\" He says they make up the difference with short-term residents who have Medicare, which pays more than Medicaid does. Private pay patients also pay more than Medicaid.\u003c/p>\n\u003cp>Gardner says he's an optimist. Whatever Congress does, he doesn't think that Victoria Care Center would close down, though there might have to be cuts in staff and in the costs of food and supplies. Also, Gardner says that Victoria Care Center is part of a chain of 200 facilities, which could cushion the blow.\u003c/p>\n\u003cp>But not everyone is as optimistic as he is. According to the \u003ca href=\"https://www.ahcancal.org/Pages/Default.aspx\">American Health Care Association\u003c/a> (AHCA), a national trade group for nursing homes, the current Senate bill's cuts to Medicaid could mean that a typical nursing home would eventually run deficits of hundreds of thousands of dollars a year. James Gomez is the CEO of The \u003ca href=\"http://www.cahf.org/\">California Association of Health Facilities\u003c/a>, the AHCA's California chapter.\u003c/p>\n\u003cp>[contextly_sidebar id=\"mrVakER0R6f0AToNbkAK83dprja2VTaO\"]\u003c/p>\n\u003cp>\"If you can't break even or make a few dollars, you're not going to keep running your business,\" says Gomez. And that could lead to closures. \"So access [to nursing home beds] will become a huge issue.\"\u003c/p>\n\u003cp>The repercussions of cuts and closures would be felt across the nation's health care system, says Katie Smith Sloan, the president of \u003ca href=\"http://www.leadingage.org/\">Leading Age\u003c/a>, which represents non-profit nursing homes and other services for older adults.\u003c/p>\n\u003cp>\"People who are in nursing homes are there because they need the kind of services that a nursing home provides\" says Sloan. \"Without those services, they'll be forced to get that kind of care in a hospital, which will simply increase costs to Medicare.\"\u003c/p>\n\u003cp>Reining in Medicaid has been on conservatives' to-do list for a long time. House Speaker Paul Ryan has said he's \u003ca href=\"http://www.cnbc.com/2017/03/20/paul-ryan-has-wanted-to-reform-medicaid-since-his-frat-days.html\">dreamed of it\u003c/a> since his college days. Robert Moffit, a senior fellow in health policy studies at the conservative \u003ca href=\"http://www.heritage.org/\">Heritage Foundation\u003c/a>, argues that the program isn't being used as intended.\u003c/p>\n\u003cp>\"Do we want Medicaid, which was a program designed for the poor and the indigent, to become a kind of backdoor mechanism to establish a middle class entitlement for long-term care? Medicaid was never really intended to do that,\" says Moffit.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The Senate bill is likely to change. But leader Mitch McConnell has indicated that Medicaid cuts will still be part of it.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Nursing+Homes+Worry+Proposed+Medicaid+Cuts+Will+Force+Cuts%2C+Closures&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n","blocks":[],"excerpt":"Two-thirds of nursing home residents are paid for by Medicaid.","status":"publish","parent":0,"modified":1498776331,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":true,"iframeSrcs":["https://www.npr.org/player/embed/534764940/534764941"],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":19,"wordCount":676},"headData":{"title":"Nursing Homes Worry Proposed Medicaid Cuts Will Force Cuts, Closures | KQED","description":"Two-thirds of nursing home residents are paid for by Medicaid.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"348688 https://ww2.kqed.org/stateofhealth/?p=348688","disqusUrl":"https://ww2.kqed.org/stateofhealth/2017/06/29/nursing-homes-worry-proposed-medicaid-cuts-will-force-cuts-closures/","disqusTitle":"Nursing Homes Worry Proposed Medicaid Cuts Will Force Cuts, Closures","nprByline":"\u003ca href=\"http://www.npr.org/people/2100677/ina-jaffe\" target=\"_blank\">Ina Jaffe\u003c/a>","nprImageAgency":"Ina Jaffe/NPR","nprStoryId":"534764940","nprApiLink":"http://api.npr.org/query?id=534764940&apiKey=MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004","nprHtmlLink":"http://www.npr.org/sections/health-shots/2017/06/28/534764940/proposed-medicaid-cuts-likely-to-put-pressure-on-nursing-homes?ft=nprml&f=534764940","nprRetrievedStory":"1","nprPubDate":"Thu, 29 Jun 2017 13:53:00 -0400","nprStoryDate":"Wed, 28 Jun 2017 17:15:00 -0400","nprLastModifiedDate":"Thu, 29 Jun 2017 13:53:00 -0400","nprAudio":"https://ondemand.npr.org/anon.npr-mp3/npr/atc/2017/06/20170628_atc_proposed_medicaid_cuts_likely_to_put_pressure_on_nursing_homes.mp3?orgId=1&topicId=1128&d=213&p=2&story=534764940&t=progseg&e=534685874&seg=2&ft=nprml&f=534764940","nprAudioM3u":"http://api.npr.org/m3u/1534764941-043df7.m3u?orgId=1&topicId=1128&d=213&p=2&story=534764940&t=progseg&e=534685874&seg=2&ft=nprml&f=534764940","path":"/stateofhealth/348688/nursing-homes-worry-proposed-medicaid-cuts-will-force-cuts-closures","audioUrl":"https://ondemand.npr.org/anon.npr-mp3/npr/atc/2017/06/20170628_atc_proposed_medicaid_cuts_likely_to_put_pressure_on_nursing_homes.mp3?orgId=1&topicId=1128&d=213&p=2&story=534764940&t=progseg&e=534685874&seg=2&ft=nprml&f=534764940","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>The Senate vote on the health care bill has been pushed back, but it still has a lot of people in the nursing home industry worried. About two-thirds of nursing home residents are paid for by Medicaid. And the Congressional Budget Office \u003ca href=\"https://www.cbo.gov/system/files/115th-congress-2017-2018/costestimate/52849-hr1628senate.pdf\">found\u003c/a> that the Senate health care bill would cut Medicaid by more than $770 billion over the next decade.\u003c/p>\n\u003cp>That could mean trouble for people like 88-year-old Betty Redlin. She's lived at the \u003ca href=\"http://victoriacarecenter.com/\">Victoria Care Center\u003c/a> in Ventura, Calif. for about 2 1/2 years.\u003c/p>\n\u003cp>She explains that she fell and broke her hip and never regained her ability to walk. \"I was living with my granddaughter,\" she says, \"and my doctor won't [allow] going back to her place.\"\u003c/p>\n\u003cp>Betty had a career as a bookkeeper. She also raised three children. Now she's spent everything she had. There's no way she could afford the roughly $80,000 a year this nursing home costs. (That fee is pretty standard for nursing homes.) So it's Medicaid that enables her to stay here.\u003c/p>\n\u003cp>\"There's nothing I can do about it,\" she says. \"It's gotta be [Medicaid] or [I'm] out on the street. One or the other.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe src=\"https://www.npr.org/player/embed/534764940/534764941\" width=\"100%\" height=\"290\" frameborder=\"0\" scrolling=\"no\" title=\"NPR embedded audio player\" class=\"iframe-class\">\u003c/iframe>\u003c/p>\n\u003cp>John Gardner, executive director of the Victoria Care Center, says that most of the long-term care residents like Redlin are on Medicaid or, as it's called in California, Medi-Cal.\u003c/p>\n\u003cp>\"If you look at what it costs to provide that service and what we get from Medi-Cal, we're actually losing a little bit of money every day on that.\" He says they make up the difference with short-term residents who have Medicare, which pays more than Medicaid does. Private pay patients also pay more than Medicaid.\u003c/p>\n\u003cp>Gardner says he's an optimist. Whatever Congress does, he doesn't think that Victoria Care Center would close down, though there might have to be cuts in staff and in the costs of food and supplies. Also, Gardner says that Victoria Care Center is part of a chain of 200 facilities, which could cushion the blow.\u003c/p>\n\u003cp>But not everyone is as optimistic as he is. According to the \u003ca href=\"https://www.ahcancal.org/Pages/Default.aspx\">American Health Care Association\u003c/a> (AHCA), a national trade group for nursing homes, the current Senate bill's cuts to Medicaid could mean that a typical nursing home would eventually run deficits of hundreds of thousands of dollars a year. James Gomez is the CEO of The \u003ca href=\"http://www.cahf.org/\">California Association of Health Facilities\u003c/a>, the AHCA's California chapter.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>\"If you can't break even or make a few dollars, you're not going to keep running your business,\" says Gomez. And that could lead to closures. \"So access [to nursing home beds] will become a huge issue.\"\u003c/p>\n\u003cp>The repercussions of cuts and closures would be felt across the nation's health care system, says Katie Smith Sloan, the president of \u003ca href=\"http://www.leadingage.org/\">Leading Age\u003c/a>, which represents non-profit nursing homes and other services for older adults.\u003c/p>\n\u003cp>\"People who are in nursing homes are there because they need the kind of services that a nursing home provides\" says Sloan. \"Without those services, they'll be forced to get that kind of care in a hospital, which will simply increase costs to Medicare.\"\u003c/p>\n\u003cp>Reining in Medicaid has been on conservatives' to-do list for a long time. House Speaker Paul Ryan has said he's \u003ca href=\"http://www.cnbc.com/2017/03/20/paul-ryan-has-wanted-to-reform-medicaid-since-his-frat-days.html\">dreamed of it\u003c/a> since his college days. Robert Moffit, a senior fellow in health policy studies at the conservative \u003ca href=\"http://www.heritage.org/\">Heritage Foundation\u003c/a>, argues that the program isn't being used as intended.\u003c/p>\n\u003cp>\"Do we want Medicaid, which was a program designed for the poor and the indigent, to become a kind of backdoor mechanism to establish a middle class entitlement for long-term care? Medicaid was never really intended to do that,\" says Moffit.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The Senate bill is likely to change. But leader Mitch McConnell has indicated that Medicaid cuts will still be part of it.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Nursing+Homes+Worry+Proposed+Medicaid+Cuts+Will+Force+Cuts%2C+Closures&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/348688/nursing-homes-worry-proposed-medicaid-cuts-will-force-cuts-closures","authors":["byline_stateofhealth_348688"],"categories":["stateofhealth_2442","stateofhealth_15","stateofhealth_14","stateofhealth_1"],"tags":["stateofhealth_2808","stateofhealth_99","stateofhealth_218","stateofhealth_2519","stateofhealth_2829"],"featImg":"stateofhealth_348689","label":"stateofhealth"},"stateofhealth_348224":{"type":"posts","id":"stateofhealth_348224","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"348224","score":null,"sort":[1498603938000]},"guestAuthors":[],"slug":"californias-leaders-warn-health-bill-remains-a-dangerous-threat","title":"Feinstein: Health Care of 14 Million Californians At Risk Under GOP Plan","publishDate":1498603938,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>Though Senate Republicans decided Tuesday to delay a vote on their controversial health plan until after the July 4 recess, Democrats in California are calling on residents to keep up their resistance to the plan.\u003c/p>\n\u003cp>Gov. Jerry Brown joined Sens. Dianne Feinstein and Kamala Harris for a call with reporters early Tuesday. Brown said the GOP bill's proposed Medicaid cuts, and its rollback of Obamacare's insurance regulations, would be disastrous for millions of Californians.\u003c/p>\n\u003cp>Feinstein said one in three Californians are covered by Medi-Cal. The loss of funding could put up to 14 million Californians at risk of losing health coverage or critical medical services, she said.\u003c/p>\n\u003cp>\"One of the things we all try not to do is never turn the haves or the have-nots against each other ... and this bill does that,\" she said.\u003c/p>\n\u003cp>\"This is a bad plan through and through and through, she added. \"There aren’t one or two amendments that can fix it. So it’s got to be defeated.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Brown condemned the Senate bill, saying it \"will be the most divisive maneuver, cutting right into the heart of what is already a divided nation.\"\u003c/p>\n\u003cp>He noted it would cut billions of federal dollars from the Medi-Cal budget and that if California couldn't take care of low-income people, there would be ripple effects.\u003c/p>\n\u003cp>\"There's no doubt this bill will exacerbate homelessness, crime,\" Brown said. \"[The bill hurts] the kinds of people who really need help and are getting it under the Medi-Cal program.\"\u003c/p>\n\u003cp>The Senate is expected to reconvene on July 10, and the House or Representatives on July 11.\u003c/p>\n\u003cp>Congress needs to work on improving health care, not taking it away, said Feinstein, noting Democrats' strategy was \"to defeat this [GOP bill] solidly.\"\u003c/p>\n\u003cp>\"I've always believed there are a couple of things that maybe should be fixed in Obamacare, but the basic bill is a good bill. It has worked,\" she said.\u003c/p>\n\u003cp>In a statement late Tuesday, California Republican Rep. Ken Calvert said the Senate bill was like the House legislation that passed in May, aiming \"to refocus Medicaid on the most vulnerable Americans, while not pulling the rug out from anyone who has benefited from the Medicaid expansion.\"\u003c/p>\n\u003cp>That contradicts the \u003ca href=\"https://www.cbo.gov/system/files/115th-congress-2017-2018/costestimate/52849-hr1628senate.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">analysis\u003c/a> released Monday by the nonpartisan Congressional Budget Office. That report said the number of people covered by Medicaid would decrease by 15 million over the next decade, and federal payments for Medicaid would be cut by $772 billion.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"In the long run, massive expansions of expensive government programs like Medicaid are simply not fiscally sustainable,\" Calvert said.\u003c/p>\n\n","blocks":[],"excerpt":"Though Senate Republicans have delayed a vote on their health bill, California Dems are urging people to keep up the pressure.","status":"publish","parent":0,"modified":1498611249,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":16,"wordCount":452},"headData":{"title":"Feinstein: Health Care of 14 Million Californians At Risk Under GOP Plan | KQED","description":"Though Senate Republicans have delayed a vote on their health bill, California Dems are urging people to keep up the pressure.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"348224 https://ww2.kqed.org/stateofhealth/?p=348224","disqusUrl":"https://ww2.kqed.org/stateofhealth/2017/06/27/californias-leaders-warn-health-bill-remains-a-dangerous-threat/","disqusTitle":"Feinstein: Health Care of 14 Million Californians At Risk Under GOP Plan","path":"/stateofhealth/348224/californias-leaders-warn-health-bill-remains-a-dangerous-threat","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Though Senate Republicans decided Tuesday to delay a vote on their controversial health plan until after the July 4 recess, Democrats in California are calling on residents to keep up their resistance to the plan.\u003c/p>\n\u003cp>Gov. Jerry Brown joined Sens. Dianne Feinstein and Kamala Harris for a call with reporters early Tuesday. Brown said the GOP bill's proposed Medicaid cuts, and its rollback of Obamacare's insurance regulations, would be disastrous for millions of Californians.\u003c/p>\n\u003cp>Feinstein said one in three Californians are covered by Medi-Cal. The loss of funding could put up to 14 million Californians at risk of losing health coverage or critical medical services, she said.\u003c/p>\n\u003cp>\"One of the things we all try not to do is never turn the haves or the have-nots against each other ... and this bill does that,\" she said.\u003c/p>\n\u003cp>\"This is a bad plan through and through and through, she added. \"There aren’t one or two amendments that can fix it. So it’s got to be defeated.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Brown condemned the Senate bill, saying it \"will be the most divisive maneuver, cutting right into the heart of what is already a divided nation.\"\u003c/p>\n\u003cp>He noted it would cut billions of federal dollars from the Medi-Cal budget and that if California couldn't take care of low-income people, there would be ripple effects.\u003c/p>\n\u003cp>\"There's no doubt this bill will exacerbate homelessness, crime,\" Brown said. \"[The bill hurts] the kinds of people who really need help and are getting it under the Medi-Cal program.\"\u003c/p>\n\u003cp>The Senate is expected to reconvene on July 10, and the House or Representatives on July 11.\u003c/p>\n\u003cp>Congress needs to work on improving health care, not taking it away, said Feinstein, noting Democrats' strategy was \"to defeat this [GOP bill] solidly.\"\u003c/p>\n\u003cp>\"I've always believed there are a couple of things that maybe should be fixed in Obamacare, but the basic bill is a good bill. It has worked,\" she said.\u003c/p>\n\u003cp>In a statement late Tuesday, California Republican Rep. Ken Calvert said the Senate bill was like the House legislation that passed in May, aiming \"to refocus Medicaid on the most vulnerable Americans, while not pulling the rug out from anyone who has benefited from the Medicaid expansion.\"\u003c/p>\n\u003cp>That contradicts the \u003ca href=\"https://www.cbo.gov/system/files/115th-congress-2017-2018/costestimate/52849-hr1628senate.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">analysis\u003c/a> released Monday by the nonpartisan Congressional Budget Office. That report said the number of people covered by Medicaid would decrease by 15 million over the next decade, and federal payments for Medicaid would be cut by $772 billion.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"In the long run, massive expansions of expensive government programs like Medicaid are simply not fiscally sustainable,\" Calvert said.\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/348224/californias-leaders-warn-health-bill-remains-a-dangerous-threat","authors":["11314"],"categories":["stateofhealth_15","stateofhealth_14"],"tags":["stateofhealth_2808","stateofhealth_28","stateofhealth_99","stateofhealth_218","stateofhealth_2519","stateofhealth_2865","stateofhealth_365"],"featImg":"stateofhealth_348225","label":"stateofhealth"},"stateofhealth_346757":{"type":"posts","id":"stateofhealth_346757","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"346757","score":null,"sort":[1498162582000]},"guestAuthors":[],"slug":"analysis-why-senate-health-bill-is-even-meaner-for-california","title":"Analysis: Why Senate Health Bill Is Even 'Meaner' for California","publishDate":1498162582,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>At last, Republican senators have \u003ca href=\"https://ww2.kqed.org/news/2017/06/22/senate-republicans-reveal-obamacare-repeal-bill/\" target=\"_blank\" rel=\"noopener noreferrer\">unveiled their crafted-in-secret health bill\u003c/a>, and everyone, including other Republican senators, are scrambling to understand the 142-page \"\u003ca href=\"https://www.budget.senate.gov/imo/media/doc/SENATEHEALTHCARE.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">Better Care Reconciliation Act of 2017\u003c/a>.\"\u003c/p>\n\u003cp>To know whether it's truly \"better care,\" and for which patients, if any, we still need the Congressional Budget Office to weigh in. But some California advocates say the “discussion draft” is clear enough to conclude that the bill would be “disproportionately devastating” for California’s health care system.\u003c/p>\n\u003cp>“If the House bill was mean, as the President termed it, the Senate bill was actually meaner and crueler,” said Anthony Wright, executive director of Health Access California. “It has harsher cuts, especially to the Medicaid program that covers 14 million Californians.\"\u003c/p>\n\u003cp>In the meantime, here are my five takeaways from the bill:\u003c/p>\n\u003cp>\u003cstrong>1. 'Repeal and Replace' Rhetoric Should Be … Repealed\u003c/strong>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>At this point, it’s inaccurate and misleading. The Republican bill doesn’t repeal all of President Obama's health care law known as the Affordable Care Act, or Obamacare. Nor does it replace it with anything. The bill maintains the basic mechanics of the ACA but rolls back the financial assistance and some of the consumer protections. In addition, a huge part of this bill has nothing to do with Obamacare: It proposes a radical dismemberment of Medicaid as we know it.\u003c/p>\n\u003cp>Let’s describe what the bill actually does: It’s an Obamacare \u003cem>rollback\u003c/em> and a Medicaid \u003cem>cutback\u003c/em>.\u003c/p>\n\u003cp>\u003cstrong>2. Much Less Aid for Medicaid\u003c/strong>\u003c/p>\n\u003cp>The Senate bill will phase out one of the ACA’s most visible accomplishments: the \u003cem>expansion\u003c/em> of Medicaid (Medi-Cal in California) to poor, uninsured adults. That means 3.7 million Californians who got Medi-Cal since 2014 will eventually lose it.\u003c/p>\n\u003cp>But there's more. The Senate plan will also cut funding for \u003cem>traditional\u003c/em> Medi-Cal, and the cuts will be deeper, over time, than even the House Republicans proposed.\u003c/p>\n\u003cp>In California, Medi-Cal covers one-third of all residents, half of all children, and two-thirds of seniors in nursing homes.\u003c/p>\n\u003cp>Who pays for their care if the feds pay less? The short answer is no one -- or state taxpayers.\u003c/p>\n\u003cp>\u003cstrong>3. What About Covered California? Could It help?\u003c/strong>\u003c/p>\n\u003cp>Not really. The Senate version tries to assuage pre-Medicare seniors (below age 65) who were alarmed that the House bill would have given them only a maximum tax credit of $4,000 to buy a plan, no matter the plan’s price. The Senate bill reverts to the ACA mechanism of offering tax credits based on income, not age. But, insurers can still charge older people five times what they charge younger people.\u003c/p>\n\u003cp>And tax credits would only be offered to people with incomes below 350 percent of the federal poverty level, down from the ACA’s 400 percent. Do you make $42,000-$48,000 a year? You would no longer qualify for any subsidies on Covered California.\u003c/p>\n\u003cp>That’s not all. Other complicated changes to the exchanges mean premiums and deductibles would go up, and special ACA grants that help reduce those deductibles disappear.\u003c/p>\n\u003cp>\u003cstrong>4. Winners? Or Just Losers: Pre-existing conditions vs. Planned Parenthood\u003c/strong>\u003c/p>\n\u003cp>The Senate bill appears to drop a wildly unpopular provision that is still in the House bill -- the possibility that your state might allow insurers to refuse to cover people with pre-existing conditions, or charge them much more. That seems like good news for cancer survivors and millions of others with chronic illnesses. They can't be denied coverage, or charged more up front.\u003c/p>\n\u003cp>But experts who have read the bill closely say there are loopholes that would allow individual states to loosen regulations on insurers -- enabling those insurers to carve away coverage that people with pre-existing conditions need. As Kaiser Health News \u003ca href=\"http://khn.org/news/promises-made-to-protect-preexisting-conditions-prove-hollow/\" target=\"_blank\">reports\u003c/a>: \u003c/p>\n\u003cblockquote>\u003cp>Somebody with cancer might be able to buy insurance but find it doesn’t cover expensive chemotherapy. A plan might pay for opioids to control pain but not recovery if a patient became addicted. People planning families might find it hard to get childbirth coverage.\u003c/p>\u003c/blockquote>\n\u003cp>The Senate bill also retains a proposal to eliminate all federal funding for Planned Parenthood, for one year. The feds never paid for abortions; this is money the organization uses for breast exams, contraception and testing for sexually transmitted diseases.\u003c/p>\n\u003cp>\u003cstrong>5. The Senate Bill Still Ignores Health Care’s Real Problem: Cost\u003c/strong>\u003c/p>\n\u003cp>The frustrations that many voters have with the Affordable Care Act are understandable. Very little in that law reduced health care spending, or got at the root causes of excessive charges -- though the ACA did slow down the growth rate compared to previous years.\u003c/p>\n\u003cp>It’s a valid criticism to point out that premiums continued to rise under the ACA, and quite sharply in some places. If you don’t qualify for any of the ACA assistance to shield you from those price increases, you -- or your employer -- are paying those increases out-of-pocket. It’s a difficult and chronic pre-existing condition of American health care.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>If you are interested in learning more about \u003cem>how\u003c/em> the U.S. health care system became so expensive for patients, I recommend \u003ca href=\"http://www.npr.org/books/titles/523005656/an-american-sickness-how-healthcare-became-big-business-and-how-you-can-take-it-\" target=\"_blank\" rel=\"noopener noreferrer\">this book\u003c/a>.\u003c/p>\n\n","blocks":[],"excerpt":"Five takeaways from the new draft bill, and why it's not really 'repeal and replace.'","status":"publish","parent":0,"modified":1498253090,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":27,"wordCount":887},"headData":{"title":"Analysis: Why Senate Health Bill Is Even 'Meaner' for California | KQED","description":"Five takeaways from the new draft bill, and why it's not really 'repeal and replace.'","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"346757 https://ww2.kqed.org/stateofhealth/?p=346757","disqusUrl":"https://ww2.kqed.org/stateofhealth/2017/06/22/analysis-why-senate-health-bill-is-even-meaner-for-california/","disqusTitle":"Analysis: Why Senate Health Bill Is Even 'Meaner' for California","path":"/stateofhealth/346757/analysis-why-senate-health-bill-is-even-meaner-for-california","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>At last, Republican senators have \u003ca href=\"https://ww2.kqed.org/news/2017/06/22/senate-republicans-reveal-obamacare-repeal-bill/\" target=\"_blank\" rel=\"noopener noreferrer\">unveiled their crafted-in-secret health bill\u003c/a>, and everyone, including other Republican senators, are scrambling to understand the 142-page \"\u003ca href=\"https://www.budget.senate.gov/imo/media/doc/SENATEHEALTHCARE.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">Better Care Reconciliation Act of 2017\u003c/a>.\"\u003c/p>\n\u003cp>To know whether it's truly \"better care,\" and for which patients, if any, we still need the Congressional Budget Office to weigh in. But some California advocates say the “discussion draft” is clear enough to conclude that the bill would be “disproportionately devastating” for California’s health care system.\u003c/p>\n\u003cp>“If the House bill was mean, as the President termed it, the Senate bill was actually meaner and crueler,” said Anthony Wright, executive director of Health Access California. “It has harsher cuts, especially to the Medicaid program that covers 14 million Californians.\"\u003c/p>\n\u003cp>In the meantime, here are my five takeaways from the bill:\u003c/p>\n\u003cp>\u003cstrong>1. 'Repeal and Replace' Rhetoric Should Be … Repealed\u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>At this point, it’s inaccurate and misleading. The Republican bill doesn’t repeal all of President Obama's health care law known as the Affordable Care Act, or Obamacare. Nor does it replace it with anything. The bill maintains the basic mechanics of the ACA but rolls back the financial assistance and some of the consumer protections. In addition, a huge part of this bill has nothing to do with Obamacare: It proposes a radical dismemberment of Medicaid as we know it.\u003c/p>\n\u003cp>Let’s describe what the bill actually does: It’s an Obamacare \u003cem>rollback\u003c/em> and a Medicaid \u003cem>cutback\u003c/em>.\u003c/p>\n\u003cp>\u003cstrong>2. Much Less Aid for Medicaid\u003c/strong>\u003c/p>\n\u003cp>The Senate bill will phase out one of the ACA’s most visible accomplishments: the \u003cem>expansion\u003c/em> of Medicaid (Medi-Cal in California) to poor, uninsured adults. That means 3.7 million Californians who got Medi-Cal since 2014 will eventually lose it.\u003c/p>\n\u003cp>But there's more. The Senate plan will also cut funding for \u003cem>traditional\u003c/em> Medi-Cal, and the cuts will be deeper, over time, than even the House Republicans proposed.\u003c/p>\n\u003cp>In California, Medi-Cal covers one-third of all residents, half of all children, and two-thirds of seniors in nursing homes.\u003c/p>\n\u003cp>Who pays for their care if the feds pay less? The short answer is no one -- or state taxpayers.\u003c/p>\n\u003cp>\u003cstrong>3. What About Covered California? Could It help?\u003c/strong>\u003c/p>\n\u003cp>Not really. The Senate version tries to assuage pre-Medicare seniors (below age 65) who were alarmed that the House bill would have given them only a maximum tax credit of $4,000 to buy a plan, no matter the plan’s price. The Senate bill reverts to the ACA mechanism of offering tax credits based on income, not age. But, insurers can still charge older people five times what they charge younger people.\u003c/p>\n\u003cp>And tax credits would only be offered to people with incomes below 350 percent of the federal poverty level, down from the ACA’s 400 percent. Do you make $42,000-$48,000 a year? You would no longer qualify for any subsidies on Covered California.\u003c/p>\n\u003cp>That’s not all. Other complicated changes to the exchanges mean premiums and deductibles would go up, and special ACA grants that help reduce those deductibles disappear.\u003c/p>\n\u003cp>\u003cstrong>4. Winners? Or Just Losers: Pre-existing conditions vs. Planned Parenthood\u003c/strong>\u003c/p>\n\u003cp>The Senate bill appears to drop a wildly unpopular provision that is still in the House bill -- the possibility that your state might allow insurers to refuse to cover people with pre-existing conditions, or charge them much more. That seems like good news for cancer survivors and millions of others with chronic illnesses. They can't be denied coverage, or charged more up front.\u003c/p>\n\u003cp>But experts who have read the bill closely say there are loopholes that would allow individual states to loosen regulations on insurers -- enabling those insurers to carve away coverage that people with pre-existing conditions need. As Kaiser Health News \u003ca href=\"http://khn.org/news/promises-made-to-protect-preexisting-conditions-prove-hollow/\" target=\"_blank\">reports\u003c/a>: \u003c/p>\n\u003cblockquote>\u003cp>Somebody with cancer might be able to buy insurance but find it doesn’t cover expensive chemotherapy. A plan might pay for opioids to control pain but not recovery if a patient became addicted. People planning families might find it hard to get childbirth coverage.\u003c/p>\u003c/blockquote>\n\u003cp>The Senate bill also retains a proposal to eliminate all federal funding for Planned Parenthood, for one year. The feds never paid for abortions; this is money the organization uses for breast exams, contraception and testing for sexually transmitted diseases.\u003c/p>\n\u003cp>\u003cstrong>5. The Senate Bill Still Ignores Health Care’s Real Problem: Cost\u003c/strong>\u003c/p>\n\u003cp>The frustrations that many voters have with the Affordable Care Act are understandable. Very little in that law reduced health care spending, or got at the root causes of excessive charges -- though the ACA did slow down the growth rate compared to previous years.\u003c/p>\n\u003cp>It’s a valid criticism to point out that premiums continued to rise under the ACA, and quite sharply in some places. If you don’t qualify for any of the ACA assistance to shield you from those price increases, you -- or your employer -- are paying those increases out-of-pocket. It’s a difficult and chronic pre-existing condition of American health care.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>If you are interested in learning more about \u003cem>how\u003c/em> the U.S. health care system became so expensive for patients, I recommend \u003ca href=\"http://www.npr.org/books/titles/523005656/an-american-sickness-how-healthcare-became-big-business-and-how-you-can-take-it-\" target=\"_blank\" rel=\"noopener noreferrer\">this book\u003c/a>.\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/346757/analysis-why-senate-health-bill-is-even-meaner-for-california","authors":["11314"],"categories":["stateofhealth_15","stateofhealth_14","stateofhealth_1"],"tags":["stateofhealth_38","stateofhealth_3117","stateofhealth_2808","stateofhealth_28","stateofhealth_99","stateofhealth_218","stateofhealth_2519","stateofhealth_2865","stateofhealth_365"],"featImg":"stateofhealth_346802","label":"stateofhealth"},"stateofhealth_342500":{"type":"posts","id":"stateofhealth_342500","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"342500","score":null,"sort":[1497468710000]},"guestAuthors":[],"slug":"medi-cal-patients-flocking-to-ers-more-than-before-aca","title":"Medi-Cal Patients Flocking to ERs More Than Before ACA","publishDate":1497468710,"format":"standard","headTitle":"California Healthline | State of Health | KQED News","labelTerm":{"term":3036,"site":"stateofhealth"},"content":"\u003cp>Medi-Cal patients are swamping California emergency rooms in greater numbers than they did before the Affordable Care Act took effect, despite predictions that the health law would ease the burden on ERs.\u003c/p>\n\u003cp>Emergency room visits by people on Medi-Cal rose 75 percent over five years, from 800,000 in the first quarter of 2012 to 1.4 million in the last quarter of 2016, \u003ca href=\"http://www.oshpd.ca.gov/documents/PressReleases/2017/ED-Encounters-by-Expected-Payer-2012-2016.pdf\" target=\"_blank\" rel=\"noopener\">according to data\u003c/a> recently released by the state’s Office of Statewide Health Planning and Development.\u003c/p>\n\u003cp>The most dramatic increase began roughly around the time the ACA expanded health care benefits in January 2014. More than \u003ca href=\"http://www.chcf.org/publications/2016/11/facts-figures-aca-ca\" target=\"_blank\" rel=\"noopener\">5 million\u003c/a> Californians have gained coverage under the ACA, either through the expansion of Medi-Cal, California’s version of the Medicaid program for low-income people, or by purchasing health plans from Covered California, the state’s Obamacare insurance exchange.\u003c/p>\n\u003cp>The architects and proponents of Obamacare had argued that once people got health coverage they would stop going to the ER so much, because they could visit primary care doctors instead. But in reality, people who were uninsured before the ACA were actually reluctant to go to the ER unless they were “about to die,” because they would be saddled with big bills, said state Sen. Richard Pan (D-Sacramento), a pediatrician. Under Medi-Cal, though, patients aren’t worried about those expenses.\u003c/p>\n\u003cp>And old habits die hard: A newly-insured patient accustomed to visiting the ER for treatment might not immediately switch to a primary care doctor who is, “just a name — not somebody you know,” Pan added.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Still, experts believe fewer Medi-Cal patients would be visiting the ER if there were more doctors willing to treat them.\u003c/p>\n\u003cp>Though “we have seen a very strong increase in the number of Medi-Cal patients … the number of doctors willing to see Medi-Cal patients has not increased accordingly,” said Jan Emerson-Shea, vice president of external affairs for the \u003ca href=\"http://www.calhospital.org/\" target=\"_blank\" rel=\"noopener\">California Hospital Association\u003c/a>.\u003c/p>\n\u003cp>Dr. Marc Futernick, the immediate past president of the California American College of Emergency Physicians, agreed that “there aren’t adequate providers for the demands.” He said he believes Medi-Cal’s low payment rates for physicians play a role.\u003c/p>\n\u003cp>Historically, doctors across the country have been reimbursed less for treating Medicaid patients than those on private insurance or Medicare — especially in California, which \u003ca href=\"http://www.kff.org/medicaid/state-indicator/medicaid-fee-index/?currentTimeframe=0&sortModel=%7B%22colId%22:%22All%20Services%22,%22sort%22:%22desc%22%7D\" target=\"_blank\" rel=\"noopener\">ranks 47th\u003c/a> in the country in fee-for-service reimbursement rates.\u003c/p>\n\u003cp>This means the state’s doctors are less likely to accept Medi-Cal patients, who will then seek treatment wherever they can get it, Futernick said. The ER is always open and cannot legally turn people away, even though many of the Medi-Cal patients’ ills could be treated by primary care providers, Emerson-Shea said.\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe width=\"600\" height=\"338\" src=\"//datawrapper.dwcdn.net/5D3d9/1/\" frameborder=\"0\" scrolling=\"no\" class=\"iframe-class\">\u003c/iframe>\u003c/p>\n\u003cp>California doctors have long lobbied to increase Medi-Cal reimbursements. They are pushing hard to use some revenue from California’s recently passed tobacco tax to increase Medi-Cal rates. But Gov. Jerry Brown wants to use it more broadly for \u003ca href=\"http://www.latimes.com/politics/la-pol-sac-tobacco-tax-budget-20170316-story.html\" target=\"_blank\" rel=\"noopener\">overall Medi-Cal spending\u003c/a>.\u003c/p>\n\u003cp>Pan, the state senator, noted other factors that could explain the surge in ER use.\u003c/p>\n\u003cp>Health clinics, which see many Medi-Cal patients, generally cannot provide specialty care on site, he said. “What’s the quickest way to see a specialist? Send them to the emergency room.”\u003c/p>\n\u003cp>Moreover, many Medi-Cal patients work jobs without flexible hours or sick leave, which means they are not able to make appointments or visit health care providers during regular hours, Pan said.\u003c/p>\n\u003cp>“When I worked in the emergency room,” he recalled, “people would show up early in the morning with their kids who had an ear infection or cold or something and the parents would tell me, ‘Well, I have to go to work today or I’ll get fired.’”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>California is not the only state where the ACA has failed to produce a drop in ER use. A study \u003ca href=\"https://www.nytimes.com/2014/01/03/health/access-to-health-care-may-increase-er-visits-study-suggests.html\" target=\"_blank\" rel=\"noopener\">published in 2014\u003c/a> found that Oregon residents who won Medicaid coverage in a 2008 lottery made 40 percent more trips to the ER in the first 18 months they were covered than those who entered the lottery but were not selected.\u003c/p>\n\n","blocks":[],"excerpt":"Experts believe fewer Medi-Cal patients would be visiting the ER if there were more doctors willing to treat them.","status":"publish","parent":0,"modified":1497472683,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":true,"iframeSrcs":["//datawrapper.dwcdn.net/5D3d9/1/"],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":19,"wordCount":740},"headData":{"title":"Medi-Cal Patients Flocking to ERs More Than Before ACA | KQED","description":"Experts believe fewer Medi-Cal patients would be visiting the ER if there were more doctors willing to treat them.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"342500 https://ww2.kqed.org/stateofhealth/?p=342500","disqusUrl":"https://ww2.kqed.org/stateofhealth/2017/06/14/medi-cal-patients-flocking-to-ers-more-than-before-aca/","disqusTitle":"Medi-Cal Patients Flocking to ERs More Than Before ACA","nprByline":" Kellen Browning","path":"/stateofhealth/342500/medi-cal-patients-flocking-to-ers-more-than-before-aca","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Medi-Cal patients are swamping California emergency rooms in greater numbers than they did before the Affordable Care Act took effect, despite predictions that the health law would ease the burden on ERs.\u003c/p>\n\u003cp>Emergency room visits by people on Medi-Cal rose 75 percent over five years, from 800,000 in the first quarter of 2012 to 1.4 million in the last quarter of 2016, \u003ca href=\"http://www.oshpd.ca.gov/documents/PressReleases/2017/ED-Encounters-by-Expected-Payer-2012-2016.pdf\" target=\"_blank\" rel=\"noopener\">according to data\u003c/a> recently released by the state’s Office of Statewide Health Planning and Development.\u003c/p>\n\u003cp>The most dramatic increase began roughly around the time the ACA expanded health care benefits in January 2014. More than \u003ca href=\"http://www.chcf.org/publications/2016/11/facts-figures-aca-ca\" target=\"_blank\" rel=\"noopener\">5 million\u003c/a> Californians have gained coverage under the ACA, either through the expansion of Medi-Cal, California’s version of the Medicaid program for low-income people, or by purchasing health plans from Covered California, the state’s Obamacare insurance exchange.\u003c/p>\n\u003cp>The architects and proponents of Obamacare had argued that once people got health coverage they would stop going to the ER so much, because they could visit primary care doctors instead. But in reality, people who were uninsured before the ACA were actually reluctant to go to the ER unless they were “about to die,” because they would be saddled with big bills, said state Sen. Richard Pan (D-Sacramento), a pediatrician. Under Medi-Cal, though, patients aren’t worried about those expenses.\u003c/p>\n\u003cp>And old habits die hard: A newly-insured patient accustomed to visiting the ER for treatment might not immediately switch to a primary care doctor who is, “just a name — not somebody you know,” Pan added.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Still, experts believe fewer Medi-Cal patients would be visiting the ER if there were more doctors willing to treat them.\u003c/p>\n\u003cp>Though “we have seen a very strong increase in the number of Medi-Cal patients … the number of doctors willing to see Medi-Cal patients has not increased accordingly,” said Jan Emerson-Shea, vice president of external affairs for the \u003ca href=\"http://www.calhospital.org/\" target=\"_blank\" rel=\"noopener\">California Hospital Association\u003c/a>.\u003c/p>\n\u003cp>Dr. Marc Futernick, the immediate past president of the California American College of Emergency Physicians, agreed that “there aren’t adequate providers for the demands.” He said he believes Medi-Cal’s low payment rates for physicians play a role.\u003c/p>\n\u003cp>Historically, doctors across the country have been reimbursed less for treating Medicaid patients than those on private insurance or Medicare — especially in California, which \u003ca href=\"http://www.kff.org/medicaid/state-indicator/medicaid-fee-index/?currentTimeframe=0&sortModel=%7B%22colId%22:%22All%20Services%22,%22sort%22:%22desc%22%7D\" target=\"_blank\" rel=\"noopener\">ranks 47th\u003c/a> in the country in fee-for-service reimbursement rates.\u003c/p>\n\u003cp>This means the state’s doctors are less likely to accept Medi-Cal patients, who will then seek treatment wherever they can get it, Futernick said. The ER is always open and cannot legally turn people away, even though many of the Medi-Cal patients’ ills could be treated by primary care providers, Emerson-Shea said.\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe width=\"600\" height=\"338\" src=\"//datawrapper.dwcdn.net/5D3d9/1/\" frameborder=\"0\" scrolling=\"no\" class=\"iframe-class\">\u003c/iframe>\u003c/p>\n\u003cp>California doctors have long lobbied to increase Medi-Cal reimbursements. They are pushing hard to use some revenue from California’s recently passed tobacco tax to increase Medi-Cal rates. But Gov. Jerry Brown wants to use it more broadly for \u003ca href=\"http://www.latimes.com/politics/la-pol-sac-tobacco-tax-budget-20170316-story.html\" target=\"_blank\" rel=\"noopener\">overall Medi-Cal spending\u003c/a>.\u003c/p>\n\u003cp>Pan, the state senator, noted other factors that could explain the surge in ER use.\u003c/p>\n\u003cp>Health clinics, which see many Medi-Cal patients, generally cannot provide specialty care on site, he said. “What’s the quickest way to see a specialist? Send them to the emergency room.”\u003c/p>\n\u003cp>Moreover, many Medi-Cal patients work jobs without flexible hours or sick leave, which means they are not able to make appointments or visit health care providers during regular hours, Pan said.\u003c/p>\n\u003cp>“When I worked in the emergency room,” he recalled, “people would show up early in the morning with their kids who had an ear infection or cold or something and the parents would tell me, ‘Well, I have to go to work today or I’ll get fired.’”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>California is not the only state where the ACA has failed to produce a drop in ER use. A study \u003ca href=\"https://www.nytimes.com/2014/01/03/health/access-to-health-care-may-increase-er-visits-study-suggests.html\" target=\"_blank\" rel=\"noopener\">published in 2014\u003c/a> found that Oregon residents who won Medicaid coverage in a 2008 lottery made 40 percent more trips to the ER in the first 18 months they were covered than those who entered the lottery but were not selected.\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/342500/medi-cal-patients-flocking-to-ers-more-than-before-aca","authors":["byline_stateofhealth_342500"],"categories":["stateofhealth_2442","stateofhealth_14","stateofhealth_2746"],"tags":["stateofhealth_294","stateofhealth_3116","stateofhealth_2808","stateofhealth_99","stateofhealth_2519","stateofhealth_365"],"affiliates":["stateofhealth_3036"],"featImg":"stateofhealth_342585","label":"stateofhealth_3036"}},"programsReducer":{"possible":{"id":"possible","title":"Possible","info":"Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. Together in Possible, Hoffman and Finger lead enlightening discussions about building a brighter collective future. The show features interviews with visionary guests like Trevor Noah, Sam Altman and Janette Sadik-Khan. Possible paints an optimistic portrait of the world we can create through science, policy, business, art and our shared humanity. It asks: What if everything goes right for once? How can we get there? Each episode also includes a short fiction story generated by advanced AI GPT-4, serving as a thought-provoking springboard to speculate how humanity could leverage technology for good.","airtime":"SUN 2pm","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2023/08/possible-5gxfizEbKOJ-pbF5ASgxrs_.1400x1400.jpg","officialWebsiteLink":"https://www.possible.fm/","meta":{"site":"news","source":"Possible"},"link":"/radio/program/possible","subscribe":{"apple":"https://podcasts.apple.com/us/podcast/possible/id1677184070","spotify":"https://open.spotify.com/show/730YpdUSNlMyPQwNnyjp4k"}},"1a":{"id":"1a","title":"1A","info":"1A is home to the national conversation. 1A brings on great guests and frames the best debate in ways that make you think, share and engage.","airtime":"MON-THU 11pm-12am","imageSrc":"https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/1a.jpg","officialWebsiteLink":"https://the1a.org/","meta":{"site":"news","source":"npr"},"link":"/radio/program/1a","subscribe":{"npr":"https://rpb3r.app.goo.gl/RBrW","apple":"https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=1188724250&at=11l79Y&ct=nprdirectory","tuneIn":"https://tunein.com/radio/1A-p947376/","rss":"https://feeds.npr.org/510316/podcast.xml"}},"all-things-considered":{"id":"all-things-considered","title":"All Things Considered","info":"Every weekday, \u003cem>All Things Considered\u003c/em> hosts Robert Siegel, Audie Cornish, Ari Shapiro, and Kelly McEvers present the program's trademark mix of news, interviews, commentaries, reviews, and offbeat features. Michel Martin hosts on the weekends.","airtime":"MON-FRI 1pm-2pm, 4:30pm-6:30pm\u003cbr />SAT-SUN 5pm-6pm","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2021/10/ATC_1400.jpg","officialWebsiteLink":"https://www.npr.org/programs/all-things-considered/","meta":{"site":"news","source":"npr"},"link":"/radio/program/all-things-considered"},"american-suburb-podcast":{"id":"american-suburb-podcast","title":"American Suburb: The Podcast","tagline":"The flip side of gentrification, told through one town","info":"Gentrification is changing cities across America, forcing people from neighborhoods they have long called home. Call them the displaced. Now those priced out of the Bay Area are looking for a better life in an unlikely place. American Suburb follows this migration to one California town along the Delta, 45 miles from San Francisco. But is this once sleepy suburb ready for them?","imageSrc":"https://ww2.kqed.org/news/wp-content/uploads/sites/10/powerpress/1440_0018_AmericanSuburb_iTunesTile_01.jpg","officialWebsiteLink":"/news/series/american-suburb-podcast","meta":{"site":"news","source":"kqed","order":"13"},"link":"/news/series/american-suburb-podcast/","subscribe":{"npr":"https://rpb3r.app.goo.gl/RBrW","apple":"https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?mt=2&id=1287748328","tuneIn":"https://tunein.com/radio/American-Suburb-p1086805/","rss":"https://ww2.kqed.org/news/series/american-suburb-podcast/feed/podcast","google":"https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkMzMDExODgxNjA5"}},"baycurious":{"id":"baycurious","title":"Bay Curious","tagline":"Exploring the Bay Area, one question at a time","info":"KQED’s new podcast, Bay Curious, gets to the bottom of the mysteries — both profound and peculiar — that give the Bay Area its unique identity. And we’ll do it with your help! You ask the questions. You decide what Bay Curious investigates. 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We cover topics like how fed-up administrators are developing surprising tactics to deal with classroom disruptions; how listening to podcasts are helping kids develop reading skills; the consequences of overparenting; and why interdisciplinary learning can engage students on all ends of the traditional achievement spectrum. This podcast is part of the MindShift education site, a division of KQED News. KQED is an NPR/PBS member station based in San Francisco. 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Hosts Steve Inskeep, David Greene and Rachel Martin bring you the latest breaking news and features to prepare you for the day.","airtime":"MON-FRI 3am-9am","imageSrc":"https://ww2.kqed.org/app/uploads/2021/10/ME_1400.jpg","officialWebsiteLink":"https://www.npr.org/programs/morning-edition/","meta":{"site":"news","source":"npr"},"link":"/radio/program/morning-edition"},"onourwatch":{"id":"onourwatch","title":"On Our Watch","tagline":"Police secrets, unsealed","info":"For decades, the process for how police police themselves has been inconsistent – if not opaque. In some states, like California, these proceedings were completely hidden. After a new police transparency law unsealed scores of internal affairs files, our reporters set out to examine these cases and the shadow world of police discipline. On Our Watch brings listeners into the rooms where officers are questioned and witnesses are interrogated to find out who this system is really protecting. Is it the officers, or the public they've sworn to serve?","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/01/OOW_Tile_Final.png","imageAlt":"On Our Watch from NPR and KQED","officialWebsiteLink":"/podcasts/onourwatch","meta":{"site":"news","source":"kqed","order":"1"},"link":"/podcasts/onourwatch","subscribe":{"apple":"https://podcasts.apple.com/podcast/id1567098962","google":"https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5ucHIub3JnLzUxMDM2MC9wb2RjYXN0LnhtbD9zYz1nb29nbGVwb2RjYXN0cw","npr":"https://rpb3r.app.goo.gl/onourwatch","spotify":"https://open.spotify.com/show/0OLWoyizopu6tY1XiuX70x","tuneIn":"https://tunein.com/radio/On-Our-Watch-p1436229/","stitcher":"https://www.stitcher.com/show/on-our-watch","rss":"https://feeds.npr.org/510360/podcast.xml"}},"on-the-media":{"id":"on-the-media","title":"On The Media","info":"Our weekly podcast explores how the media 'sausage' is made, casts an incisive eye on fluctuations in the marketplace of ideas, and examines threats to the freedom of information and expression in America and abroad. 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