Update: Prop 35, a measure to lock in future spending on Medi-Cal, passed on election night. The proposition makes it so that an existing tax on health insurers is permanently allocated to Medi-Cal. It passed with nearly 67% of the vote.
California has expanded its Medicaid program, Medi-Cal, to all residents regardless of immigration status over the past eight years. Close to one million undocumented immigrants are now eligible for Medi-Cal through the expansion, according to the UC Berkeley Labor Center.
But many realized that scheduling a health care appointment is a challenge despite their insurance. Adults on Medi-Cal are more than twice as likely to report difficulties finding a doctor or specialized care provider compared to those on an employment-based health care plan, according to the California Health Care Foundation.
A complicated health measure on the November 5 ballot aims to increase access to health care for people enrolled in Medi-Cal. Californians will vote on Proposition 35, a plan to lock in tax dollars spent on Medi-Cal. Proponents of the measure say the permanent funding of Medi-Cal will increase payments to physicians, encourage more doctors to accept Medi-Cal patients, and reduce wait times. Opponents, however, argue that the lack of flexibility in how those funds are spent could lead to state-level cuts to other programs.
Prop 35 emerged after it became clear that the California legislature and Governor Gavin Newsom would not be able to keep their commitments to the health care industry in the state budget passed this year, said Adriana Ramos-Yamamoto, a senior policy analyst at the California Budget and Policy Center. “Because they didn’t get their priorities included in the most recent budget agreement… they decided to move forward with this ballot initiative,” she said.
The Tiburcio Vasquez Health Center provides care primarily to people with low incomes, many of whom are insured by Medi-Cal. The clinic announced on Oct. 4 that it fully supports Prop 35. The demand for health care appointments is far greater than what the center can provide, said Andrea Schwab-Galindo, the organization’s CEO. “Coverage does not equate to access,” she said. Prop 35, she added, will “bring in needed revenue into the health care system that will allow health centers and clinics like ours to increase primary care and specialty care appointment availability for our patients.”
On Sept. 27, El Tímpano asked SMS subscribers, most of whom are Spanish-speaking immigrants in the East Bay, if they had experienced long wait times for doctors’ appointments, and how this impacted their health. More than 50 people responded, several describing wait times of up to six months and even delayed surgeries because of the limited availability of specialists.
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Supporters of Prop 35 have raised more than $52 million, and include big names like Planned Parenthood, the American Academy of Pediatrics California, and the California Medical Association. The proposition also has local support from La Clinica de la Raza, a community health care clinic that serves low-income residents in the East Bay.
Opponents of Prop 35 have not raised money or launched an official campaign against it, but have vocally expressed concerns that the measure would negatively affect other programs intended to connect vulnerable populations to health care. The most vocal critics include The Children’s Partnership, a state-wide organization that advocates for young people, and the California Pan-Ethnic Health Network (CPEHN), a coalition of organizations that advocate for health equity in communities of color.
“I think we all agree that Medi-Cal needs to be improved, that there needs to be investment in Medi-Cal, that we need to make it serve children, families, seniors, individuals, better. There’s no disagreement on the end game here, but really, this is about the details,” said Kiran Savage-Sangwan, CPEHN executive director.
Prop 35 would make it so that an existing tax on managed health care plans would permanently go towards Medi-Cal. Currently, insurance providers pay a tax to the state and the federal government matches those taxed dollars. Lawmakers decide how to spend the money, in some cases adding it to the state’s general fund.
This year, as the state faces a multi-million dollar deficit, Governor Gavin Newsom passed a budget that will include provider rate increases, funding for community health workers, and implement multi-year continuous Medi-Cal coverage for young children – but only if Prop 35 fails.
If Prop 35 passes, it would undo most of that portion of the budget’s spending plan. Instead, those tax dollars would be reallocated to Medi-Cal providers. In future years, how that tax would be spent is locked in by Prop 35, removing the room for negotiation that some health equity advocates wish to preserve. Newsom has not taken a public stance on the measure, but did say at a July press conference that the proposition “hamstrings our ability to have the kind of flexibility that’s required at the moment we’re living in.”
“The proposition would do away with what the legislature and the governor have agreed to,” said Mayra Alvarez, president of The Children’s Partnership. “We want to be able to work together with the legislature, with providers, with community members, to determine how those resources would be used. All of us should have set the table, particularly folks that depend on Medi-Cal themselves… We lose that opportunity if this proposition moves forward.”
