Medi-Cal pervades Nov. 8 ballot

A physician flanked by the California flag. (Illustration: Niyazz, via Shutterstock).

Medi-Cal is on the November ballot, hiding in plain sight in three propositions.

These ballot measures could yield about $7.6 billion for the state’s health care program for low-income families, the disabled and children.

One measure, Proposition 52, would not add “new” money, but extend the current fees hospitals pay to receive more matching funds from the federal government. The other two propositions, 55 and 56, could provide up to $3.6 billion for Medi-Cal – an amount that is eligible for matching federal funds.

“Medi-Cal is a life line for almost 14 million Californians and a pillar in the healthcare we all rely on. But it’s underfunded,” said Anthony Wright, the executive director of Health Access California, which advocates for expanded health care. “We have yet to restore the cuts from the last recession, added Wright, whose group supports Proposition 55 and 56.

“We’re focused on getting this passed this (Prop. 55) November to make sure we prevent cuts that could come in the near future.” — Jennifer Wonnacott

Proposition 55 would extend the 2012 voter-approved “temporary” tax on those earning more than $250,000 by 12 years, expiring in 2030. It does not extend the sales tax, which will end in 2017. Like Proposition 30 from four years ago, 89 percent of the income tax revenue would go to K-12 education and 11 percent to community colleges.

Proponents say not extending this income tax would cost schools $4 billion.

“I think voters will recognize that Proposition 55 prevents cuts to education and other vital programs and stand up in support of education and our children,” said campaign spokesperson Jennifer Wonnacott. “We’re focused on getting this passed this November to make sure we prevent cuts that could come in the near future.”

Extending “the current taxes on the wealthiest is the best option to providing our schools and children with the resources they need,” Wonnacott said.

Proposition 55 has a complex formula that distributes excess money not used in voter-guaranteed school funding to the state’s “rainy day fund,” with the remaining going to Medi-Cal, up to $2 billion.

“Even though that’s not likely to be the focus of the campaign,” Wright said, “it is a crucial piece of the outcome of this election.”

“Prop 55 is not guaranteed money,” he said, “like all revenue, it’s based on the ebbs and flows of the economy.”

The California Hospitals Association also supports Proposition 55 and 56.

“It goes from 1 billion to zero pretty quick,” said CHA senior vice president Anne McLeod, referring to Proposition 55’s revenues.

Tobacco companies have raised about $35.6 million to oppose Proposition 56.

There is no formal opposition to Proposition 55, according to disclosure reports filed with the secretary of state’s office.

Proposition 56 would add a $2 tax to cigarettes, electronic cigarettes containing nicotine, and other tobacco products. The Finance Department estimates the tax would create $1.1 billion to $1.6 billion in revenue, most of which would go to Medi-Cal.

Wright said he sees Proposition 56 as a “public health measure.”

“When people are young they start smoking. If we can prevent them from starting, we save them from a lifetime of smoking,” Wright said.

Tobacco companies have raised about $35.6 million to oppose Proposition 56. Previous efforts to increase the tax in the Legislature and on the ballot have failed.

Proposition 52 is sponsored by the CHA, and it indefinitely extends the fee hospitals pay the state to receive more matching federal Medicaid funding. The program, started by the Legislature in 2009, would expire in 2018.

Hospitals pay about $5 billion to receive $4 billion in matching federal funds, McLeod said.

“[Proposition 52] memorializes this program and continues it as long as the federal government allows,” said CHA spokeswoman Jan Emerson-Shea. “It was clear to us that the state wouldn’t put up this money.”

The ballot measure also increases the vote needed in the Legislature to divert money from the program to other areas of the budget.

“You can see this was really born out of a real experience where the state during a difficult time pulled out more,” Emerson-Shea said. “This really ensures that money is used for what it is intended to do.”

Proposition 52 is opposed by the Service Employees International Union – United Healthcare Workers West, which has raised $11.5 million in opposition to the ballot measure. Nurses also are opposed.

“Prop. 52 takes resources from patients and communities and siphons it into the pockets of rich special interests, with no oversight, no accountability, and no guarantee it is even spent on health care. That’s wrong and makes nurses’ and doctors’ jobs harder,” says Nurse Practioner Virginia Anders-Ellmore, who signed official arguments opposing Proposition 52.

Health Access California and the CHA said the Legislature has made cuts to Medi-Cal provider rates and preventative care services, like dental, psychology, and vision. But Medi-Cal now covers more people, and physicians are not getting better wages, making them unwilling to accept more patients.

“The price of a good haircut is higher than what would be paid to a physician,” McLeod said.

Proposition 55 and 56 would probably make the larger impact to Medi-Cal access, McLeod said, as they will add money that will be eligible for matching federal funds.

Meanwhile, Wright said he is working with the Brown administration to develop reports that gather data and would show where to apply more investments.

Gov. Brown is more amenable to special funding, he said, rather than across the board funding.

“This is about an investment in a system that we all rely on,” Wright said.

While Emerson-Shea says these propositions will not solve the entire Medi-Cal funding, McLeod guesses it would change the state’s ranking from 48 to 43.

“And we should be proud of that,” McLeod said.

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