County Health Care

Reduced funding for MediCal county administration, with Alameda County suffering a $1.2 million decrease;

Elimination of advertising for MediCal Healthy Families Program and grants to community based organizations; 88 2002-2003 ALAMEDA COUNTY CIVIL GRAND JURY FINAL REPORT____ _______________________________________ Health Committee

The governor’s veto of the Legislature’s $22.1 augmentation for a 2-month bridge from MediCal to the Healthy Families Program for parents and children. The Alameda Alliance for Health is projecting a $5 million loss for the current year and has adjusted its budget accordingly. In an attempt to continue coverage, the Alliance has established a provider network. With the Alliance’s mixed model network, including a continuum of direct solo physician contracts, Alliance members have choices in their health care. However, the Alliance still has problems recruiting specialty physicians in areas such as rheumatology, orthopedic surgery, dermatology, neurology and urology. There is also a shortage of physicians willing to contract in the Tri-Valley area. The high cost of living in the Bay Area and concerns regarding the financial viability of provider groups affect the recruitment of physicians. The Alliance may respond to budget cuts by reducing or eliminating coverage. The major provider of health services for the under- and un-insured is the ACMC. Unlike the community-based organizations, the ACMC is obligated to provide medical services regardless of budget cutbacks. The cutbacks faced by the community-based organizations will result in an increased service burden at ACMC. However, the ACMC itself is facing severe cutbacks. Major cuts to both inpatient and outpatient services have already been approved for the Fairmont facility. Substantial reductions and services are also expected at the ACMC itself which will further limit access to County health care services. CONCLUSION An estimated 44 million Americans are without health insurance in the United States. This issue needs to be addressed at both the national and state level and requires sufficient resources and adequate funding. However, the immediate day-to-day effects of the health care crisis remain with the county. 89 2002-2003 ALAMEDA COUNTY CIVIL GRAND JURY FINAL REPORT____ _______________________________________ Health Committee The increase in number of uninsured and underinsured, the state budget deficit, and lack of health care reform will put overwhelming pressure on local organizations such as the Alameda Alliance for Health and all of its subprograms. Reduction of MediCal enrollment and coverage, closure of the ACMC clinics and elimination of previously covered services does not reduce the needs of the people who will still seek health care, wait longer and have more critical health needs. These patients can rapidly overload the ER and this will impact the ability of the ACMC to respond to large-scale disasters, natural or otherwise. The burden will fall upon Alameda County, as the provider of last resort, which faces the problem of reduced funding and greater demand. The Grand Jury encourages the staff of the ACMC to continue addressing all issues associated with uninsured patients who use the emergency room as their primary source of medical care. The Grand Jury is impressed with the quality of the leadership of the organizations interviewed. Nevertheless, the widening gap between resources and need will have a negative impact on the health of all citizens of Alameda County.