Patricia Nell Warren

California Set to Kill Medi-Cal Recipients

Filed By Patricia Nell Warren | May 02, 2008 3:10 PM | comments

Filed in: Living, Politics
Tags: budget cuts, health care reform, Medi-Cal, Medicaid

This is a shocking headline, right? I made it up just to get attention, right? Wrong.

The California legislature recently passed Assembly Bill X35 and Assembly Bill X36, containing provisions that will kill people if put into effect in July. In the former, Sections 13 and 14 make a 10% cut in Medi-Cal services across the board. In the latter, Section 2 withholds the state's share of COLA cost-of-living raises for four months. The provisions affect millions of Californians (nearly 2 million in Los Angeles County alone) as well as their service providers.

Final result: the deaths of hundreds, perhaps thousands, of vulnerable citizens -- elderly, disabled and poor of all ages, notably children with special medical needs. Their lives depend on these services, ranging from hospital care to treatment prescriptions.

Many potential victims are people of color. One is a gay Latino poet I know, age 30, who has been on SSI since a teen because of frail health. Unable to work, he does some volunteering and labors on a huge book of poetry that I hope to see published someday because it's brilliant writing. SSI wasn't enough to cover housing, so for many years after being diagnosed with HIV, he lived with his family and made himself useful by doing child care. In 2007, after languishing on the L.A. County list for HOPWA housing for many years, he finally got a tiny studio apartment with no stove - he has to cook on a hot plate. "At least I'm not on the street," he told me. But now the COLA cut will take a bloody slice out of his SSI.

On April 21, reacting to this dire threat, two private attorneys -- chief counsel Lynn Carman and former assistant U.S. attorney Stanley Friedman -- filed suit against Medi-Cal in California superior court and Los Angeles County court. Their class-action lawsuit represents The Independent Living Center of Southern California, the Gray Panthers of Sacramento, the Gray Panthers of San Francisco, two pharmacies, and two private citizens who are Medi-Cal recipients. Plaintiffs seek an injunction that will prevent this lethal legislation from going into effect in July.

According to co-counsel Carman in her press release, the plaintiffs say, "Thousands of Medi-Cal recipients will either die or be forced into nursing homes or other institutions, just in order to survive, if these cuts go into effect." Plaintiffs also charge that the legislation violates the Americans with Disabilities Act by making it impossible for disabled people affected by the cuts to go on living independently.

According to a release by noted San Francisco public-health activist Patrick Monette-Shaw, who is a friend of mine, "The proposed reduction in Medi-Cal provider rates would, in turn, reduce participation by primary care physicians, specialists, dentists, and pharmacies in both the Medi-Cal fee-for-service program and the Medi-Cal managed care programs....A 10% loss in Medi-Cal reimbursement to the City would be significant for San Francisco -- since it faces a reported $338 million budget deficit for fiscal year 2008-2009."

For years Patrick has been a gadfly in San Francisco over major cutback of beds in Laguna Honda Hospital, that offers skilled nursing and assisted living. For years the city has been plagued by a steady erosion of beds, owing to rising costs and hospital closings. LLH was the only hospital left that provided this type of care for the elderly and disabled. In 1999 concerned voters authorized 1200 new beds at LHH. But in 2004 the city council arbitrarily slashed that to 780 beds without voter consent. Most of the hospital's services are paid for by Medi-Cal; over one third of the patients are black. Even before the new budget cuts, rising costs were putting LHH services out of reach of Medi-Cal recipients.

Now, as Patrick points out, the new state-wide 10-percent cuts will narrow LHH's accessibility even more.

According to the San Francisco Adult Day Services Network, "Those now receiving day services will have limited choices when these centers close. They can go to nursing homes, protected from the cuts that have fallen on community-based providers. Or, if left alone to fend for themselves, their physical and mental health will deteriorate and they will wind up in overburdened emergency rooms, the most expensive setting for primary medical care.... Ultimately the 10% cut generates no savings at all, for it will lead to greater costs to California than the cut itself will save." According to a recent survey, within 90 days of the cut going into effect, at least 400 people would be discharged from their present care.

If these deaths start happening, they will not be the first that can be directly traceable to government cutbacks in healthcare. Far from it. As the recession slowly kicked in, budget cuts have been happening at state and federal levels for some years now. The rising death toll has been almost anonymous, out there on the fringes. Among the victims: poor people with AIDS, who started dying when access to ADAP was narrowed. In August 2003, the Charleston Gazette noted that three West Virginians had died since February while waiting for treatment. The state program covered treatment for tuberculosis and pneumonia as well as AIDS. "People are now starting to die while they're on the waiting list," the state ADAP director said. "It's a crisis that will continue."

But the Charleston newspaper didn't even bother to report the victims' names. So much for the value of human life.

So -- while the United States obsessively notes the name and home town of every soldier who dies a combat death in Iraq, our system is unwilling to put faces on the elderly, poor, disabled and homeless civilians who die quietly amidst the socio/financial wars that are bombing the American dream to rubble. This new California legislation, if it is allowed to stand, will kick the home-front death toll into a higher gear.

Paradoxically, California state law has the effect of prohibiting elderly, chronically ill and disabled people from taking their own lives if they find themselves living in unrelieved misery and pain owing to poor health. Assisted suicide is still illegal in California, and the "pro-life" folks fight hard to keep it that way. Even an unassisted suicide attempt can get you institutionalized and put on heavy medication that is intended to keep you from doing it again. But hey -- if you're a public official, it's apparently okay to cause other Californians to die in health misery.

Surely the California legislators who voted for these provisions know what the fallout will be -- but they apparently don't care. None of them live out in the open where this legislative machine-gun fire can find them and their families, and mow them down. They all have their nice sheltered lives, their big salaries and health insurance and perks. Their excuse is that "we're in a recession and California is facing a $16 billion shortfall, so cuts have to be made somewhere." Rather than cut the pork and pet projects that enrich so many of them, they voted for cutting life services to people they know are the least able to fight back. In the secrecy of their hard little hearts, these pols might even think that the deaths of a few thousand nobodies who are a drain on the public purse would probably be a good thing.

Governor Schwarzenegger signed the bills without a squawk. Indeed, Schwarzenegger led the charge, proposing his own $650 million in cuts to Medi-Cal and the Healthy Families Program. He also proposed to save millions by making applicants for state-sponsored healthcare apply four times a year instead of once... which would have squeezed some people off the Medi-Cal rolls and wouldn't have saved the state a penny.

Time was that the Golden State touched off national trends the positive way. We were supposedly the bellwether, the bleeding-heart liberal state. We led the way in everything from stem-cell research to safe-schools policy for LGBT children. But those days are over. And California won't be the only state killing people to save money. As I write this, least 20 other states have made big cuts in healthcare. Florida just slashed its health safety-net by $1 billion. (At least Sunshine State legislators had the decency to cut their own salaries by 5 percent.)

Watch for this trend to come to your own neighborhood. The local news-feed won't show you the growing pile of bodies, of course. But the intent of the trend is clear. It's social cleansing without death squads -- eugenics done with a gavel.

So I hope the courts wipe up the floor with this lethal legislation. America's governing bodies need to be put on notice that they have to find some other way of balancing the budget besides killing people.


The Carman/Friedman lawsuit doesn't yet have a website to contact for ongoing information. Bilerico readers interested in making contributions, or knowing more, can contact:

LYNN S. CARMAN, State Bar 028860
Medicaid Defense Fund
28 Newport Landing Drive
Novato, CA 94949-8214
Telephone: (415) 927-4023
Facsimile: (415) 499-1687

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California is supposed to be on the cutting edge of progressivism, but this sounds horrible. I don't know what programs other states have that are like this, so I can't compare, but I always find it telling that they're so good at cutting others' salaries and not their own.

Robert Ganshorn Robert Ganshorn | May 3, 2008 8:23 AM

This is only the beginning of the divide Alex. Persons (not you of course) of your generation do not support Social Security/Disability in the same way my generation was taught. What Patricia is saying is equally true every time someone floats "privatizing" Social Security.

Well, I have a solution and it is not as far fetched as it may first sound. Sweden owns health care resorts in Asia that Swedish doctors can prescibe for patients to go to to "destress."

I suggest that for profit health care centers be set up in Asia to care for long term health care needs and we send the ill, tired, poor and unwilling to them. They would receive better care than they are presently in California and since the drugs are without profit to the American health care machine we get to slap them in the face too. Doesn't that sound like fun?

I'm imagining beaches, palm trees and willing and helpful nurses (unlike what anyone would receive in the United States) at a budget cost of one third of current expenditure. For me to get health coverage is over $600.00 monthly in Florida(and they act like they are doing me a favor) and $96.00 in Thailand. The hospitals here are excellent and they truly take exceptional care of patients because Asians believe that elderly people are wise and worthy of respect. Caring for the less fortunate assures you a better next life. Consideration sorely lacking in America.

I would also suggest that we scrape anything incovenient off the Statue of Liberty as well. It doesn't matter anyway. No one is allowed inside her any more either. The tired, the poor and the huddled masses yearning to breathe free need to go elsewhere.

Thanks for covering this, Patricia. I hope more people get involved to oppose this.

Robert Banshorn is right -- this trend extends into other areas as well, like privatization of Social Security. America is rapidly becoming a heartless culture where there is little concern for those who can't afford to take care of their own needs. You can look back through history and find examples of governments that narrowed political freedom yet still acknowledged some responsibility for their people's welfare. The Roman Empire had its evils, yet the state maintained a vast system of bakeries that provided bread for everyone in the city every day. When the Holy Roman Empire came along, it too had its evils, yet some Catholic monarchies encouraged monastic orders to create hospitals and services for the poor, in order to activate Christian teachings. It was the mark of a good king or queen to show "mercy" for his people. The growing lack of mercy in the U.S. -- and the enormous amount of corruption that soaks up funds that might be used for humanitarian purposes -- is truly disturbing in a country that supposedly stands for what we say it does.

For at least the past 60 years, Americans have retired to Mexico for the lower cost of living, so the proposal has precedent. And, already, the middle class are going overseas for procedures they can't afford with their current coverage or lack thereof.