PD Editorial: California’ wise investment in medical care

California has steadily increased access to health care since the Affordable Care Act took effect five years ago, moving ever closer to the goal of universal coverage.

According to a Census Bureau report issued last fall, just 7.2% of Californians were without health insurance in 2017.

That's good news, but more people with insurance coverage means more people seek medical care. And California is facing a shortage of 4,100 physicians and thousands of other health care workers in the coming decade, according to a report published this year by the California Future Health Workforce Commission.

In many rural areas and low-income communities, residents say it's already difficult to get the care they need. With a third of the state's doctors approaching retirement age, the problem could become even more widespread.

California has taken some small steps to encourage providers to locate in underserved parts of the state. As we noted in February, a pilot program allows Healdsburg District Hospital to hire doctors directly, which typically is forbidden in California.

This past week, state health officials advanced a new remedy: paying off student loans for doctors willing to treat the neediest patients.

It works like this: The state will cover up to $300,000 in student debts in exchange for a five-year commitment that 30% of a physician's caseload will be people enrolled in Medi-Cal, the state's health insurance program for low-income residents.

The program, dubbed CalHealthCares, may not increase the number of doctors in the state. But with a 2018 survey finding an average debt of almost $200,000 for medical school graduates, it's a strong incentive for physicians to provide care for patients who often struggle to find a doctor.

More than 1,300 doctors and medical residents applied for the first of at least five rounds of the loan forgiveness program, which is funded from a tobacco tax increase approved by voters in 2016.

The lucky 247 physicians in the first group were chosen based on their geographic location and their medical specialties as well as their commitment to treat the underserved. Their combined debt: $58.6 million, an average of $237,250 each.

Dentists who commit to treating Denti-Cal patients also are eligible, and the first group to benefit will be named later this month. The incentive for dentists may be even stronger, with the 2018 survey finding average student debt of $287,000.

“By removing the burden of student loan debt,” state Health Care Services chief Jennifer Kent said, “this program will encourage more providers to make different choices when entering the health care market and be able to provide care for the Medi-Cal population.”

Medi-Cal enrollment has increased by more than 4 million people since the Affordable Care Act, which lowered the threshold for eligibility. Medi- Cal now plays for half of the births in the state and 58% of long-term care stays, according to CalMatters, a public interest journalism organization that reports on state government.

The state's expansion of Medi-Cal to undocumented children three years ago and, now, to undocumented adults ages 19 to 25 has generated plenty of controversy, but it's a small factor in the looming shortage of physicians. And it could help control costs by providing access to routine and preventive care.

California's big challenge is finding enough doctors to care for a population fast approaching 40 million people. Offering doctors help with student debt is a wise investment.

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