Medi-Cal Fee Cuts Threaten Program, Task Force Told

A bipartisan task force of legislators exploring ways to solve Medi-Cal’s $280-million budget deficit Tuesday was told that many doctors, hospitals and other health providers will stop providing care to the indigent if fee cuts proposed by Gov. Deukmejian are enacted.

At a public hearing in Los Angeles, the recently formed group was told that those who now provide care to Medi-Cal’s 3 million beneficiaries are already in dangerously short supply.

The Deukmejian Administration has proposed a 10% cut in fees paid to physicians and other providers, plus a $150-million general cut in the program’s $5-billion annual budget as ways to solve the program’s financial problems.

The 10% fee cut, which had been scheduled to take effect on Monday, has been delayed as a result of lawsuits filed by the California Medical Assn. and the California Pharmacists Assn.

Example Cited

Citing as an example of how hospitals and doctors are being insufficiently paid as it is, Jeffrey Kirschner, chairman of the board of the Hospital Council of Southern California, said physicians who treat children at a clinic at Orthopaedic Hospital in Los Angeles are receiving $5.40 per visit, which is far below the usual fee of $30 to $35 for private patients. If the cut goes through, Kirschner said, the doctor’s fee for a Medi-Cal visit would be reduced to $4.90 per visit.

He said that the hospital sees 20,000 outpatients a year, 49% of whom are Medi-Cal beneficiaries.

As a consequence of the state program’s falling fee structure, Kirschner said, only two of the 108 physicians on Orthopaedic Hospital’s staff now see Medi-Cal patients in their separate private practices.

The task force was named two weeks ago by the Assembly Speaker Willie Brown (D-San Francisco) and Senate President Pro Tem David Roberti (D-Los Angeles) to work with Deukmejian to solve the program’s budget problems. It consists of six Democrats and four Republicans.

More Hearings Planned

Another hearing is to be held today in San Diego, with additional sessions to be held later in Orange County and elsewhere around the state, according to Assemblyman Bruce Bronzan (D-Fresno), who co-chairs the panel with Sen. Alfred E. Alquist (D-Santa Clara).

Michael Genest, a member of the state legislative analyst’s staff, presented the task force on Tuesday with more than a dozen charts containing statistical data indicating that Medi-Cal expenditures have not been excessive, as is claimed by critics.

Genest said total Medi-Cal expenditures have grown as a result of population increases and inflation. But he noted that the percentage of state spending for Medi-Cal and a related program has not changed. One chart showed that while such spending accounted for nearly 12% of the general fund in 1978-79, the estimate for the current year is about 10%.

Other data presented by Genest showed that California spends less for each Medi-Cal beneficiary than the national average and 10 other largest states. For every $1,000 in personal income for each person in California, the state spends $2.57 for indigent health care. That compares with a national average of $2.95. Genest said New York state, for example, spends $7.09.

System Called Indefensible

“We don’t have a system that is defensible, we have a system that is in collapse,” Bronzan said.

Asked to comment on Genest’s data, Steve Cubanski, deputy director of the state Department of Health Services, which administers the Medi-Cal program, said it seems to be an “excellent document.”

“We have been running a lean and mean program,” Cubanski said in response to prodding by Alquist and Bronzan. “We are doing a good job protecting the public trust and giving service.”

Cubanski said that in the next few weeks his department will be exploring with the governor’s office additional ways of revamping the program to save money without affecting the quality or availability of care.

Dr. Toni Chavez, who said she is one of only two pediatricians in Compton treating Medi-Cal patients, told the legislators that she treats 40 to 60 patients a day and has to turn away 10 to 20 more a day because she does not have time.