By Jeeni Criscenzo
It has been my dream, since my husband and I first started dating, to go with him to visit the ancient Maya sites that I wrote about 25 years ago in my novel, Place of Mirrors. Though we planned the trip several times, including for our honeymoon, one thing after another has caused us to postpone it.
A few months ago I got an email about an upcoming rafting expedition down the Usumacinta River that would stop at all of the sites I wanted to visit. We had met the guide for that trip, Rocky Contos, two years earlier, before I broke my leg.
He had suggested that we could get a reduced rate if we would work the trip – I could do cooking and my husband could do translating and assist with various chores. If we got some others to join us, it would cost almost nothing.
I read that email several times, feeling my heart getting heavier with each re-read as it sunk in that we might never be able to do it, even if we had the money and time. My knee never healed properly from that broken leg and there is no way I could manage the walking and climbing involved in the trip. I felt a deep sadness as I let that dream slip away – I’d missed the opportunity to share a journey that meant so much to me, with my favorite travelling companion – my husband. Worse things happen to people, I consoled myself.
Shortly after breaking my leg, funding for my husband’s position with a non-profit ended, also ending his job and our health insurance. Fortunately Covered California (California’s version of Affordable Health Care) had just started and we were able to get health insurance through that program. Without it, we would have been screwed. I had a pre-existing condition so COBRA would have been our only option and the cost was prohibitive.
While the Covered California plan gave us coverage, the co-pay for twice weekly physical therapy was more than we could possibly afford on unemployment. I tried doing the exercises myself at home, but it didn’t work. Walking, especially downhill, has become progressively more painful.
Meanwhile we found ourselves in that window where we were too young for Medicare, but the jobs we applied for were going to much younger applicants. Last December, my husband and I received a letter informing us that we didn’t earn enough money the previous year, so we were being moved to Medi-Cal. That should have been helpful, but our new Covered California doctor didn’t accept Medi-Cal patients so we had to find a new primary care physician.
Medi-Cal had assigned us to an insurance group and a doctor, but when I called her I was told she also wasn’t taking new Medi-Cal patients. A search on the Health Net Medi-Cal website turned up only 6 primary care physicians accepting new patients within 25 miles of our home.
My initial plan was to check out each of those doctors’ ratings and call the one with the best review. None of them had a Yelp rating higher than 2 stars (out of five) and the comments for four of them were downright scary. I ended up calling all 6 – none of them were accepting new patients.
That was 7 months ago. Neither I nor my husband has seen a doctor since moving to Medi-Cal except by going to a clinic or when I had a serious bout of bronchitis, going to the emergency room. When I asked a doctor at the clinic about my knee, he said the screws probably have to come out. “Often people reject the hardware,” he explained. “Great! I said. “Can you refer me to a surgeon?”
“No,” he replied, “You will need your primary care physician to do that.” The very same primary care physician who doesn’t exist.
[California] reimbursement rates are 47th worst in the nation. Medi-Cal reimbursement for an average doctor visit is $41.48, compared to Medicare which pays $102.45
There is hope on my horizon. My husband is now both employed and on Medicare! This means our household income is sufficient for me to go back to Covered California. Since he chose Kaiser Permanente for his Medicare Insurance, having a family member on Kaiser means that I can switch to that HMO which has their own providers. I don’t know about the quality of care, or the time I will have to wait for an appointment, but at least, as of August 1st, I will finally have health insurance that includes providers!
Maybe if I actually get a primary care physician who can refer me to the right specialist, I can pull that dream journey back out of the “Fuhgeddaboudit” file.
My story isn’t unique. And for millions of Californians who rely on Medi-Cal, who have come to the realization that having health insurance doesn’t mean you have health care, the consequences have been far more tragic than me realizing I may never go on my dream journey.
Draconian cuts made to Medi-Cal funding in 2011, when California’s budget was in the recession toilet, are part of the reason it’s impossible to find healthcare providers willing to accept Medi-Cal patients. Reimbursement rates are 47th worst in the nation. Medi-Cal reimbursement for an average doctor visit is $41.48, compared to Medicare which pays $102.45.
Add to this the explosive growth of Medi-Cal under Covered California – the state’s health plan under the Affordable Care Act, and the fact that managed-care plans have narrowed their networks of doctors and hospitals to hold down premiums, and you have millions of enrollees without access to care.
Part of the blame needs to be put on the Medi-Cal managed-care programs that contract with the state to coordinate and provide care. According to an audit released last month of Medi-Cal managed-care programs, provider directories are riddled with errors and the Department of Health Care Services hasn’t regulated plans to guarantee access to doctors. The audit found that the state wasn’t verifying data summited by the plans.
Working with We Care For California, a coalition of California’s leading healthcare providers and organizations, I had high hopes that we could not only restore those cuts, but fully fund Medi-Cal. The coalition launched a campaign earlier this year urging legislators to fund Medi-Cal in the new budget. In fact, I was in some of the commercials! (Website: Medi-Cal is Me)
In early June, I joined more than 4,000 Medi-Cal beneficiaries, health care providers and organizations who rallied in Sacramento and lobbied legislators to include fully funding Medi-Cal in the budget. That didn’t happen.
However, the governor called for a special legislative session to address Medi-Cal funding this September. This past weekend, I met with other leaders in the Medi-Cal Matters campaign to discuss efforts to reach out to legislators on this committee with a plan to fully fund Medi-Cal. The money’s got to come from somewhere and there are encouraging ideas on the table for this.
Even though my Medi-Cal nightmare is almost over, I’m glad I had this opportunity to see first-hand how bad the situation is for so many people, and I’m committed to helping to solve the problem. Look for updates on this plan in upcoming articles here in this column.
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Jeeni- I’m sorry your knee is preventing you from embarking on a lifelong dream journey. Please don’t give up!
Our bodies have incredible abilities to heal, and there are alternative modes of physical therapies (if you haven’t already researched these options) that may make this trip possible.
I’ve referred many friends to some exceptional healers, including those I’ve used to avoid surgery myself. They have experienced relief from chronic pain- and then referred others (downside: long waiting time to see these practitioners again…).
Please let me know if you would like suggestions for options other than surgery and traditional PT.
In addition to the wait for an appointment with alternative healers, is the cost. If I had the money, I would have continued with the physical therapy. Reality in this country is that healthcare is for those who can afford it. With Obamacare, everyone else can now get health insurance – but not necessarily health care. What we need is universal, single-payer healthcare. Take the money-grubbing insurance companies out of the picture. Think about it – what do they actually do besides put their greedy hands in the till?
I have worked for ten years trying to make Single Payer a reality, finally our chapter was disbanded for lack of participation and interest from the public. only three people attended the meetings regularly, the president, the secretary and myself as the treasurer.
Several other groups were formed but soon also evaporated.
Doesn’t the public at large realize that health care is a human right and that we are the only industrialized nation without a Single Payer system. Have we become so moronic a citizenry that we work against our own benefit?
If you want to know more about the Usumacinta trip I still dream of taking someday, visit Rocky Contos’ facebook page (http://www.facebook.com/rocky.contos) or his website at http://www.SierraRios.org. Rocky and his wife live here in San Diego and are super nice folks.
This is a great tip. Thanks.
I know everyone has their own unique situation regarding medical services. The system is not easy to navigate. IN my experience with Kaiser, Scripps, et al I am finding the most useful to be at UCSD medical. You select a primary care physician form their huge databank and have annual check-ups or for special problems always get a referral to a specialist in the large UCSD system. I have used it for knees, broken arm, etc and always find it to be great service.The referral from teh primary care always gets you in early and they can see what was done and offer other services as well.
I can make a pitch for Kaiser, for the same reasons you mention in your letter, Jim. I have a co-pay of $20 for each visit to a doctor and really cheap meds, and sometimes the co-pay doesn’t exist because the trip to my doctor is considered a follow-up to an earlier procedure. I get referred to a specialist quickly and the M.D.’s at Kaiser, in my opinion, are superior, and only once have I felt the visit was shortened and perfunctory.
Kaiser feels right.
thank you Jeeni for this very informative article on an issue that I agree is very urgent. Universal Medicare for all seems the simpler, less expensive, and more just alternative to our current system of “only interested in profit” insurance companies.
Jeeni, thank you for sharing your story. It clearly illustrates a crucial truth too many people don’t understand, that “having health insurance doesn’t mean you have health care.”
It’s long past time for serious reform to ensure everyone has access to health care, not insurance. The money now pouring into for-profit health insurance could cover a lot of care in a simplified, insurer-free system, whether we call it single-payer or Medicare for All.
The healthcare system in the United States is a disgrace. It is disorganized, plagued with profit-takers, and provider network requirements exclude many patients in need of care from seeing a doctor or specialist. When is enough enough?!?! Obamacare is only a first step in an unfortunately long process of getting to a single payer system. Both Clinton and Sanders have strongly stated that ACA needs to be improved. Ultimately, I believe they both feel the single payer system is the best and if either is elected, they will work toward that end. In the meantime, millions of people in need of medical care are living without it.
Sad but not uncommon story. Health insurance is never medical care, even with commercial enrollees.Your story reenforces the practical as well as moral reason we need universal single payer Medicare for All health system
God bless A-me-ri-ca, land that I loooooooooooooove. Stand beside her, and guide her through the greed that reigns down
from above!!!!!!!!!!!!!!!!!!!!!!!!!!!