Funding Healthcare: How Cuts on Funding Affect the Underserved

Access to healthcare, medical coverage, and the structure of state funding have been topics at the center of recent policy debates. Most recently, the Republican-backed repeal of the Affordable Care Act — the Graham-Cassidy proposal — has been at the forefront of these discussions. Among other measures, the bill would have slashed Medicaid expansion and private insurance subsidies, instead giving “block grants” to states, leaving the minutiae of funding allocation to states’ own discretion. While the Senate is not voting on the bill, which lacks the 50 required votes to pass, the discussion on healthcare access and the future of coverage in our own state remains relevant.

California is one of the largest beneficiaries of ACA expansions implemented to include more low-income adults in the eligibility pool for health insurance. Almost 3.7 million were newly eligible for Medi-Cal enrollment in 2016 alone, and nearly 71% of those covered are people of color. Medi-Cal is the state version of the national Medicare program that gives low-income families health insurance.

Here in the San Francisco Bay Area, the need for continued funding of these programs is clear. Despite the large increase in enrollment for those statewide, Bay Area residents faced with barriers that make access to consistent care difficult. In a report put out by the peer-reviewed Public Health Reports, health inequities in the region confronted by residents are related to “historical and current disinvestment through public policies.” Areas that have especially benefited from expansions, like Alameda County, which saw a nearly 123,000 increase in Medi-Cal enrollment in 2016 also face problems of access related to these factors. Affordable housing, living conditions and transportation are among the largest problems residents face every day. Low income people of color in the Bay Area also rely heavily on transportation services like AC Transit, which has faced cuts in service and as recently as July 2017, a rise in fares. A number of senior and disabled riders also depend on these services to access their appointments. As a result of cuts to transit services, riders in this demographic are often late or even miss their appointments.

In a 2016 Kaiser Foundation Hospital report on the Oakland and Richmond service areas, people of color were also found to be less likely to have insurance and “consistent primary care.” Complaints of cost of care, expensive co-pays, and waiting times were cited as concerns of those in the region. Cuts to federally-funded state health programs would disproportionately affect these residents, who already face a combination of stressors in finding care. When coupled with the high costs of living, housing, and transportation in the Bay Area, funding cuts would harm the locally underserved and complicate an already existing health issue that is in need of public attention.