Cost, access take a toll on valley health care

By TIM MORAN
tmoran@modbee.com

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Dr. Del Morris has seen both sides of the canyon that separates health care for the well-to-do and the poor.

He practiced in a Seattle-area clinic where everyone was employed and insured. "I call it my yuppie practice," he said.

Today, he is medical director for the Health Services Agency in Stanislaus County, where an estimated 150,000 people -- nearly a third of the population -- do not have private health insurance.

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"I've seen the well-insured. I've seen the world from different sides," Morris said.

Nationally, there are 47 million people without health insurance, and tens of millions more who may be a paycheck away from losing coverage.

Who's at risk? The working poor and even middle-class men and women whose employers don't offer health insurance; young people stretching a budget by gambling that they will stay healthy; or just people who got sick, lost their job and their health benefits along with it.

Only a small percentage are homeless or substance abusers.

For these people, the county- operated clinics and nonprofit systems such as Golden Valley Health Centers are a fraying lifeline.

"When people talk about this being the greatest health care system in the world, they are not talking about this system, these patients," Morris said.

Stanislaus County goes well beyond the state mandate to treat the medically indigent adult population. The Health Services Agency and the clinics it operates also serve Medi-Cal, Medicare, medically indigent and uninsured patients.

But the system is strained to the breaking point, hemorrhaging millions of dollars of red ink that threatens funding for areas such as law enforcement, justice administration, parks, planning and community development, and animal services.

The county's health care crisis is echoed throughout the San Joaquin Valley, the state and the nation. Politicians at the federal and state levels, presidential contenders and Sacramento legislators are grappling with possible solutions.

The problems are particularly acute in the San Joaquin Valley, where a variety of interrelated factors converge to make health care access difficult and expensive:

California has a shortage of doctors, and the valley is worse off than the rest of the state. The shortage includes primary care doctors but is most severe for specialists.

California's reimbursement rate for Medi-Cal patients is one of the lowest in the nation. The rates are determined according to a state's per capita income, and California's is high. But the San Joaquin Valley lags far behind. Medi-Cal is California's version of the federal Medicaid program, which is administered by the states. It provides health care reimbursement for the uninsured who qualify under the financial guidelines.

The Northern San Joaquin Valley suffers more than its share of chronic disease. Stan- islaus County ranks near the bottom (the worst) of the state's 58 counties for coronary heart disease, diabetes, cancer, sexually transmitted diseases and infant deaths.

"When you look at the numbers, there is an enormous burden of chronic disease," said John Walker, Stanislaus County public health officer.

The Northern San Joaquin Valley demographics are rapidly changing. Stanislaus County's population has doubled since 1980, and the birth rate is more than double the death rate. About 52 percent of the babies born in Stanislaus County are eligible for Medi-Cal, according to HSA officials.

About 22 percent of Stanislaus County residents were eligible for Medi-Cal as of April. In San Joaquin County, eligibility was 21.3 percent, and almost 29 percent in Merced County. Statewide, the number was less than 18 percent. More than 300,000 people in the three counties were eligible for Medi-Cal as of April.