Two health care proposals will require Californians to decide how to spend revenue from Medi-Cal-related programs this November.
Propositions 34 and 35 seek to place limits on how revenue from federal prescription drug discount programs and taxes on insurance plans can be used. Both drug programs and tax dollars provide care for patients covered by Medi-Cal, the state’s version of Medicaid. Unlike the nationalized Medicare program for seniors, Medi-Cal primarily serves low-income Californians, said Naomi Zeude, assistant professor of health policy at the University of California, Los Angeles.
Richard Carpiano said Prop. 34 would limit spending for health care providers who participate in the federal drug discount program, allowing health care providers serving low-income patients to receive lower prices on prescription drugs from the federal government. Can be purchased and sold at retail price. Professor of Public Policy at the University of California, Riverside.
Providers are affected if: three criteria In addition to participating in federal drug discount programs and being a licensed health care provider, the company has spent more than $100 million on services other than direct patient care, operates apartment complexes, and has more than 500 It must have had a severe health and safety record. Violations against the unit.
Under Proposition 34, such providers would be required to spend 98% of their revenue from discount programs on direct patient care. Failure to do so could include loss of tax-free status and government subsidies, the government says. California Legislative Analyst Office.
However, only one organization, the AIDS Healthcare Foundation, is known to currently meet the three criteria listed. reject the proposal as a targeted attack. Susie Shannon, a spokesperson for the No Prop 34 campaign, believes that targeting health care providers who take advantage of drug discount programs is a conservative attack on reproductive health and advocacy organizations. He said that
Another reason the foundation was chosen may be board president Michael Weinstein’s involvement in the housing market, creating a new layer of conflict of interest that Carpiano called “suspicious.” .
This year, in addition to supporting suggestion 33Carpiano said AHF also sponsored unsuccessful rent control measures in 2018 and 2020, which would implement rent control statewide. The California Apartment Association, which opposes rent control, has poured $36.1 million into supporting the Proposition 34 movement, according to . Karmatters.
“He (Weinstein) has become the focus, or at least the ire, of housing special interests,” Carpiano said. “(AHF) seems to be playing a bit of a role in the field and realm of housing politics.”
Carpiano said the proposal, if passed, could increase access to health care for Medi-Cal beneficiaries by limiting funding to covered providers. But he added that AHF could challenge the proposal in court or even pull out of California altogether, leaving under-resourced patients without care. .
Carpiano said the politicization surrounding the proposal also obscures one of its potential benefits. If approved, the existing one will be enshrined. Medical Rx He added that he would incorporate the prescription drug program into state law and allow California agencies to work together to negotiate lower drug prices.
Carpiano said since the state is already using the program, there is no reason not to continue it permanently. But Shannon said he believes there is no new benefit in codifying Medi-Cal Rx and that including the condition is a ploy to get voters to approve it.
Proposition 35 has similarly mixed reviews, experts say.
The proposal would make permanent an existing tax on managed care organizations, such as Anthem Blue Cross and Blue Shield of California, that buy insurance on behalf of people enrolled in Medi-Cal, Zewde said. It is said that the purpose is to Revenue from these taxes is used to offset the costs of Medi-Cal, but also as a benchmark for determining how much funding the federal government provides to those managed care organizations. It works, said Riti Simkhada, a senior researcher in the United States. Center for Health Policy Research at UCLA.
The proposal also calls for establishing rules for how these tax revenues will be used going forward. The report said more funding would be allocated to health care providers and direct care programs, such as outpatient facilities and graduate medical education, while continuing Medi-Cal for children under 5 and community health workers. Other services such as insurance are not expected to increase. Laos.
Zewde said increased incentives may encourage more providers to accept Medi-Cal patients, but patients are often turned away because of low reimbursement.
“Medicaid payments are going to go down. … And a lot of providers are saying, ‘Okay, we can’t do that because it’s too low,'” she said. “They[Medi-Cal patients]are also a population that, on average, has more severe disease, so providers say, “I need more resources to properly treat them, but my salary is more expensive.” This means that it is not profitable to provide care for them.”
But Simcada said the allocation could also impose limits on the state budget, since funds from taxes may no longer be available for the state’s general fund (Gov. Gavin Newsom has (doing something) expressed opposition To.
The federal government would also have to approve a tax to match the state’s medical fund, Simkada said, adding that next year’s new presidential administration could be even more reluctant to offer that approval. LAO estimates that short-term costs to the national budget could reach up to $1 billion to $2 billion annually, with long-term effects uncertain.
“With all this uncertainty on the part of the federal government, this may be too risky, because you’re now saying we have to do it. We are bound by this,” Simkhada said. “For example, if the federal government says, ‘We’re no longer matching,’ that means California is in trouble.”
While the proposal lacks formal opposition, another concern is that it could disproportionately impact small managed care organizations, she added. Simkhada said large MCOs may benefit from increased reimbursements due to their large enrollment numbers, while smaller MCOs may not receive similar rewards.
Due to the complexity of health policy, both Simkhada and Zewde agreed that the proposals are difficult to understand, even for experts in the field.
For that reason, Zewde said he believes voters should not be forced to make such a choice.
“This doesn’t seem appropriate for a proposal,” she said. “Voters don’t have a good understanding of these questions. It just doesn’t seem to fit with a democratic way of presenting proposals.”
Los Angeles residents can vote in person on Nov. 5 at Ackerman Union, Hammer Museum, De Neve Plaza and other locations throughout the county. Voters can also submit a mail-in ballot as long as it is postmarked by Election Day.
