Valley reacts to Obama healthcare ruling

Central San Joaquin Valley health officials welcomed Thursday’s Supreme Court ruling largely upholding the national health care overhaul but said they worry there won’t be enough doctors to handle patients who will soon gain health coverage.

The consensus: Unless the state pays physicians more to see patients, an already severe doctor shortage could get worse and newly insured patients could have no place to turn but to already overcrowded hospital emergency rooms.

“I think we’re going to be looking at a potential crisis unless Medi-Cal addresses what they pay primary-care doctors,” said Tim Joslin, chief executive officer at Community Medical Centers, which operates regional medical centers in Fresno and Clovis.

Business leaders, meanwhile, worried about how health reform will work — and whether it will control rising health-care expenses.

“There’s little support for the Affordable Care Act among Fresno business owners,” said Al Smith, president and chief executive of the Fresno Chamber of Commerce. “Most of the business community here thinks the cost of health care will rise.”

Claude Laval, owner of a filtration equipment manufacturing business in Fresno with 120 employees, doubts health reform will “fix the basic problems of medicine, which is the cost structure and the way services are financed.”

But John Capitman, executive director of the Central Valley Health Policy Institute at Fresno State, believes health reform addresses those concerns. The Affordable Care Act, he said, “puts a lot of pressure on our system to become more efficient and more effective.”

The Valley has thousands of people — most of them low-income — who are uninsured and stand to benefit from the Affordable Care Act, health professionals said.

Carolyn Trovao, 61, of Fresno, retired from a health-insurance company late last year. She felt healthy and decided to skip an extension of her company insurance because it was too expensive — $1,300 a month. Two months later, she had a heart attack.

Trovao waited 16 hours before seeking care because she knew she wouldn’t be able to pay medical bills. Her son finally called an ambulance. She now owes the hospital $135,000.

Trovao said she was pleased the Supreme Court affirmed the health reform act, although she favors a Medicare-style plan for everyone.

“We finally have something working for people to have health care,” she said. “However, I think there’s a lot more to be done. It’s just a start.”

Some estimates show 980,000 people from San Joaquin to Kern counties will become eligible for insurance under the health reform act, including about 200,000 who will be eligible under an expansion of Medi-Cal, the state-federal insurance for low-income people, Capitman said.

Those people will gain access to coverage they did not have prior to health reform, said Stephen Schilling, chief executive officer of Clinica Sierra Vista, a Bakersfield-based community health center network with clinics in Fresno. Community health centers such as Clinica have been expanding to accommodate the expected increase in patients, Schilling said. The centers have used money from the Affordable Care Act to pay for the expansions.

A pressing problem will be finding doctors and other health-care providers for newly covered patients in the Valley, Schilling said. Having insurance, he said, doesn’t guarantee access to care.

The Valley has 45 primary-care doctors per 100,000 people and 74 specialists per 100,000. The recommended rate is 60-80 primary-care doctors and 85-105 specialists. Only the Riverside-San Bernardino area has a worse shortage, according to a 2011 California Medical Association report.

For people on Medi-Cal, the shortage of doctors is made worse because many physicians refuse to accept California’s low reimbursement rates.

Medi-Cal patients can wait weeks for appointments with doctors. In many cases, they turn instead to hospital emergency departments for care.

California health officials said a federal plan to increase pay for primary-care doctors in 2013 and 2014 should help. Medi-Cal rates will be increased to match Medicare rates, said Toby Douglas, director of the California Department of Health Care Services. “We hope that continues to improve the participation in the (Medi-Cal) program,” he said.

Dr. Adriana Padilla, a Fresno doctor and member of the California Academy of Family Physicians, said she understands doctors’ frustrations with government reimbursement, but adds that her patients have already benefited from provisions of the Affordable Care Act.

“I’m just pleased to see my Medicare patients have a lot of wellness procedures without co-pays,” she said. “And families are pleased to be able to insure their children over age 18 and under 26 on family health plans.”

By Barbara Anderson