A gain, and a setback, in county's march to health reform
California has gained a national reputation for forging ahead with implementing health reform – even as Congressional Republicans tug on its purse strings and federal courts debate its Constitutionality.
What’s often overlooked in this state-federal tug of war is that the actual work of reform -- the fiscal and organizational heavy lifting -- will be left to cash-strapped counties. On the ground in one of them, Kern County, the hurdles stand awfully high, even when progress is made.
My article published in The Bakersfield Californian this week reports that Kern has gained a key partner in setting up the care network that is needed to implement the legislation by 2014. The Clinica Sierra Vista network has agreed to contract with the county, allowing 12 of its clinics to provide a medical home to residents in rural corners of Kern. A reporting project by The Californian and the CHCF Center for Health Reporting last summer played a role in bringing the parties back to the negotiating table, after talks broke down.
With the development, however, Kern administrators also said that they had to rein in their initial goal of providing coverage to people making as much as 200 percent federal poverty level, or $44,700 annually for a family of four. True to its reputation as a flag-bearer for reform, California health officials successfully petitioned the federal government in November for $10 billion in matching funds to help these counties set up their reform networks. The counties get 50 cents in federal money for every dollar they spend on the effort.
But that’s where things get tough in Kern. With a county-run health system that has been in the red for years, Kern officials just can’t find enough money of their own to draw down the federal infusion they need. So Kern’s network, as it stands now, will only enroll people at 100 percent of federal poverty level, or $22,350 for a family of four.
That’s significant because the recession hit Kern County hard, as it did the rest of California. It’s not only lower-income families, but people in working- to middle-class income brackets that find themselves without health coverage in the recession’s aftermath.
“It’s often the things that need to happen the most that are the hardest to achieve,” said Jacey Cooper, senior project manager of Kern’s network, the Kern Medical Center Health Plan. “There is a lot of work to be done to prepare California, and this county, for health reform.”