Closing California’s Health Care Chasm

Peter Long, Ph.D.

I’ve always told people that I grew up in Forest Hill, Maryland, in a town of less than 400 people. However, a colleague recently pointed out to me that my “town” is actually just an unincorporated community in Hartford County. Beyond fundamentally revising my personal narrative, the comment reinforced the fact that I spent the majority of my childhood in an area often (and accurately) described as “the sticks.”
In this area, without any formal government structure, we were seemingly far from everything – including health care. There were few doctors within 15 miles of our home. I’m grateful today that this didn’t stop my mother from prioritizing high-quality care. In nearby Baltimore, world-class healthcare facilities and providers were easily accessible and readily available. So, for immunizations, broken bones, fevers, and colds, my mom would drive us 45 minutes each way to see the chair of pediatrics at Johns Hopkins Medical Center. She even established a monthly payment plan in order to afford the visits. I grew up in one Maryland, but received health care in a completely different one.

In a recent blog post, David Blumenthal, president of The Commonwealth Fund, observed this prevailing inequity in our healthcare system. He makes the case that there are two Americas divided geographically by persistent differences in people’s access to affordable, high-quality health care. Reinforcing this idea, economist Tyler Cowen recently predicted on NPR that inequality in the US will in fact get worse – not better - if we continue on the current path.
In California, the state where I currently live, our community health centers and hospitals are working diligently to prepare for health reform in January 2014. Despite their best efforts, we continue to observe longstanding variations in our population’s health.  It is evident that we still live in two very separate and unequal Californias:

  • There is a California in which residents have access to an abundant range of services, enjoy robust medical outcomes and quality-of-life indicators, and live in healthy environments.
  • Then there is the California where residents often can’t get the care they need; one which posts troubling quality-of-life statistics, and where uninsurance rates and chronic disease incidence remain markedly high.

The variations can be stark. For instance, in Bakersfield at the southern end of the Central Valley, only 69 percent of adults have health insurance. While in San Mateo, an affluent Bay Area county, 84 percent are insured. Similarly, the infant mortality rate in San Jose is an average 4 per 1,000 live births, but in Fresno, it is 65 percent higher at 6.6.
For us, these numbers are not simply the statistics of failure, they serve as a compass to guide us in our efforts to improve access to care for all.

We believe that expanding access to, and transforming systems of, care across the state is essential to rebalancing these disparate Californias. Our investments include longstanding support for community health centers, which remain a vital resource in counties with high rates of uninsurance and poverty. And in rural regions, where the financial and operational performance of health centers still falters in comparison to their urban counterparts, our focused investments are paramount to ensuring that all Californians, no matter their income or location, can get the care they need.
From core operating support to funding for innovative approaches that link physical and mental health care, the grants Blue Shield of California Foundation is making today aim to create a more equitable healthcare system in the future. A recent grant to San Joaquin County helped public and private providers develop a landmark Health Data Exchange to enhance care coordination for low-income patients and improve efficiency system-wide. And a new Foundation-funded eConsult system in LA County leverages telemedicine to improve low-income patients’ access to specialty care and ultimately bridge the gaps between rural and urban patients in that region.
The Foundation has also been a longstanding and significant funder of Low Income Health Programs (LIHPs) in California. Through these programs, more than 600,000 low-income adults – more than any other state - have now been enrolled in health insurance coverage, many for the very first time. LIHPs provide California with a unique head-start on Medicaid expansion, as these participants will automatically be enrolled in Medi-Cal starting in January 2014.
By focusing our grantmaking in the areas of California where many patients are still left behind, Blue Shield of California Foundation is working to create a healthcare system in which everyone can access high-quality, affordable care for themselves and their children – without having to drive 45 minutes or establish a payment plan to get it.
As we move forward, it is essential that we take advantage of key provisions in the Affordable Care Act to extend coverage to those previously-uninsured and hard-to-reach patients. Building upon this base, with innovative approaches to payment and care delivery across the safety net, we have the potential to bring the two parts together, and achieve a united and vibrant California.

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