Bridge to Health Reform 'undoable' in San Luis Obispo

Forty-seven California counties have provided health care to more than 335,000 people through the “Bridge to Reform” program.  San Luis Obispo is a case study in one county that has decided not to participate.

We have reported on the Bridge to Reform, also known as the Low Income Health Program, or the Health Care Coverage Initiative, since its early phases. I was the reporter of our first piece, which looked at Kern County’s efforts to build the bridge. A follow-up examined the challenges of implementing the program in the far reaches of rural California.

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

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

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

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

The idea is for counties to implement the Bridge to Reform ahead of a huge expansion in federally funded Medicaid (in California, called Medi-Cal) coverage scheduled for 2014.

That expansion, in which the feds pay no less than 90 percent of the cost, is via the Affordable Care Act.  It could ultimately provide 11.2 million Americans -- including 1.9 million Californians -- health benefits they didn’t have before.

Anthony Wright, executive director of Health Access California, which advocates for expanded health coverage, found it hard to buy Hamm’s position that the county could not find a way to participate.

“There are obstacles, from resources, to politics, to bureaucratic inertia,” said Wright. “But this is just too good a deal to pass up.”

Wright admits that his perspective is shaped by his belief that the larger Medicaid expansion will indeed become reality in 2014. The Supreme Court, of course, could chart a new course; its ruling on health reform is expected in late June.

Arguments the justices heard, even after lower courts declined to hear them, included debate on whether the Medicaid expansion should be tossed out because it “coerced” states into participation by providing such a good deal.

Hamm said he once thought, like many other observers, that the Supreme Court would summarily dismiss arguments against the expansion. It now appears that the court is equally inclined to strike it down.

It is impossible to read the judicial tea leaves, and it’s tough to decide if a county should, or should not, take the plunge and help build the Bridge to Reform.   

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

Look for our stories in coming weeks that examine what the program has so far done for them.

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