By: Erik Galicia

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Healthcare access in the San Joaquin Valley could change dramatically for people with the highest need if Congress approves its current blueprint for cutting $2 trillion in federal spending that the GOP-led House approved last week. Depending on how those cuts are made, Valley healthcare providers interviewed by The Fresno Bee say patients who rely on Medi-Cal could see their coverage reduced and avoid primary and preventive care until they have to seek treatment in emergency rooms.

Facilities that have a history of financial struggles, including hospitals, could face difficulties funding treatment, they say.

“If our main payer source is getting cut, or even not keeping up with the expense, we’ll face challenges,” said Madera Community Hospital CEO Steve Stark, who is working to reopen that facility after it closed more than two years ago.

Valley healthcare providers point to the budget blueprint’s call for the House Committee on Energy and Commerce to find ways, “within its jurisdiction,” to slash $880 billion over the next 10 years. Medicaid, the federal program that provides more than 60% of Medi-Cal’s budget, is within that committee’s jurisdiction.

Lawmakers have not yet revealed exactly how they plan to make those cuts. But budget experts have warned that it’s impossible to reach the $880 billion goal outlined in the budget blueprint without slashing into Medicaid. If that happens, the San Joaquin Valley could be hit especially hard because 2.2 million people across the eight-county area rely on Medicaid funding for their healthcare.

“It’s that simple,” he said. “With less money, which is what this is at the end of the day, you’re going to start to see pretty dramatic changes within the program.”

Medi-Cal accounts for a total of more than $150 billion in annual spending on healthcare for Californians. More than $100 billion of that total comes from Medicaid, making it a “crucial source of economic activity and revenue in the state,” Stremikis said.

Reduced federal funding for Medi-Cal would undermine the financial stability of hospitals, clinics, nursing homes and physician practices in the Valley, he said.

Madera hospital would face challenges

Madera Community Hospital’s closure in January 2023 has left the county — and a largely low-income Latino community — without a general acute care facility for adults for more than two years.

Past leadership attributed the hospital’s bankruptcy and closure, in-part, to low reimbursement rates from Medi-Cal. Stark, the CEO, said Medi-Cal will also cover the healthcare for more than 50% of the facility’s future patients.

“If our pre-closure (reimbursement) rates were low and they cut those even deeper, it would compound the financial challenges to overcome because the cost to do business continues to go up,” he said.

Overcoming those challenge could require a reduction in the hospital’s service offerings that are subsidized but run at a financial loss.

“We’ll have to look at some of those loss leaders and decide, ‘Are those things we can continue?’” Stark said.

Clinics concerned across the Valley

Worries are also high at clinic systems that serve patients from Bakersfield to Madera regardless of their insurance status or ability to pay.

“With a substantial portion of our funding coming from Medi-Cal reimbursements, cuts could lead to budget constraints that may force us to scale back services or reduce our workforce, including doctors and nurses,” physician and Clinica Sierra Vista CEO Olga Meave said in an email to The Bee.

She also noted a possible reduction in access to preventive care and management for chronic illnesses. As a result, patients’ illnesses could worsen and land them in emergency treatment, she said.

Camarena Health CEO Paulo Soares and United Health Centers CEO Justin Preas voiced similar concerns.

“Oftentimes, we need to send them (patients) out to specialists for specialty care — they may need to go somewhere else for some type of procedure or surgery,” Soares said. “When they’re uninsured, that really just becomes kind of an untenable situation for them…. A lot of patients will just wind up in the emergency room.”

Preas said the Valley’s emergency room resources are already stretched thin.

“They (hospitals) rely on primary care for us to keep people out of the emergency room,” he said. “So, this is devastating to people that have chronic conditions, and really is just a blow to everyone in the state.”

Valley Republican explains his vote

Every GOP congressman who represents a Valley district voted “yea” on the budget cut blueprint. That includes Rep. David Valadao, R-Delano, whose district has one of the highest Medicaid enrollment rates in the nation.

But in a statement to The Bee, Valadao said he “will only support a final bill that safeguards these essential programs,” referring to Medicaid and the Supplemental Nutritional Assistance Program.

He said the budget resolution he voted for last week is “an important procedural step to keep the legislative process moving and doesn’t include any specific policy provisions.”

“I’ve already spoken on the House floor to Majority Leader (Steve) Scalise, urging that the final budget package reflects the needs of Central Valley families and strengthens resources like Medicaid and SNAP,” he said. “As this process moves forward, I’ll keep fighting to protect access to healthcare and food security to ensure my constituents aren’t left behind.”

Rep. Jim Costa, D-Fresno, whose district also ranks high in Medi-Cal beneficiary rates, took aim at the GOP budget resolution during a Tuesday night news conference after President Donald Trump’s address to Congress.

“President Trump (previously) said that he wasn’t going to touch Medicaid, he wasn’t going to touch Social Security,” Costa said. “If this reconciliation package passes as it’s currently planned, I think we’re going to see significant impacts in those areas.”

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