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Community members and health care providers from Plumas District Hospital gather in the Quincy library community meeting room May 17 to learn about the state of health care. Those leading the discussion, at the table from left are: Mimi Hall, Plumas County Public Health director; Peggy Wheeler, California Hospital Association vice president; and T Abraham, Hospital Council of Northern and Central California regional vice president. Photo by Debra Moore

The state of health care

Local forum addresses what it means to Plumas County

Who knew the state of health care could be so complicated? Those gathered at the Quincy Library on May 17 — both the experts and concerned community members — did.

Quincy resident Nance Reed, 77, had a lot of questions about the future of health care and figured that others did as well. So she turned to Plumas District Hospital CEO Jeff Kepple and Public Health Director Mimi Hall for answers.

“I didn’t plan on the Sacramento folks coming,” Reed said of the health care forum that was subsequently arranged.

But come they did at the request of Hall and Kepple to present the latest available information. Peggy Wheeler, a vice president with the California Hospital Association, and T Abraham, a regional vice president with the Hospital Council of Northern and Central California, who attended the forum, are not strangers to Plumas County.

Both have been here before and attended a LAFCo meeting where collaboration and/or consolidation of health care districts throughout Plumas was discussed.

Wheeler is an advocate for California’s 60 rural hospitals, 34 of which are critical access facilities such as Plumas District Hospital.

Abraham represents 45 hospitals in 18 counties including all three Plumas hospitals.

“Health care today is complicated, political and regulated,” Abraham said as he began his presentation.

Part of his and Wheeler’s job is to track legislation that could impact health care. Abraham described a record number of bills before the state legislature — 2,500, 25 percent of which could have some impact.

Abraham said that the biggest issue facing California is its “incredibly large Medi-Cal population.” California was one of the states to expand its Medicaid program under the Affordable Care Act and now there are 14 million Californians enrolled.

According to Abraham, the good news is that 91 percent of Californians have health insurance, but it comes at a cost. The reimbursement rates for Medi-Cal recipients don’t cover the costs of providing services, which severely impacts local health care providers such as Plumas District Hospital.

Abraham said that the recently passed congressional American Health Care Act would dramatically impact the state as it would cap federal funding for Medicaid, thus Medi-Cal. “It would cost California $12 billion a year,” he said.

Wheeler noted that in addition to the costs, a number of covered services were cut in the congressional plan. “If cuts are enacted in the current proposal, it would have tremendous impact.”

However, after spending a recent week in Washington, D.C., Abraham is optimistic that the Senate will scrap the house plan and write its own. “We see that as good news,” he said.

Wheeler also reeled off a list of items that she sees as good news in the current state of health care: improved quality, better diagnostic tools, advancements in treatment options, no consideration of cuts to Medicare and excellent local health care.

“You’re lucky,” she said. “You’ve got three great hospitals. They work together and they work with the county.”

She also suggested to the audience that, “the ultimate control of your health and your health care costs is you.”

Local impacts

Plumas County Public Health Director Mimi Hall focused on the local impacts of the American Health Care Act and the proposed changes to Medicaid/Medi-Cal.

As of April 2017, 6,300 Plumas County residents were eligible for Medi-Cal and she estimated that 2,000 of those could lose their coverage. That’s because while now the system is open ended, it would be capped.

Hall said that presents a “problem in Plumas” where there is a “high level of elderly, a high level of poverty.”

Under the Affordable Care Act, Medi-Cal expanded eligibility to childless adults age 19-64. “A lot of county employees qualify for Medi-Cal,” Hall said. “They meet the definition of working poor; they fit in the poverty level.”

While capping coverage might save federal dollars, ultimately those people will still require medical care. Wheeler said that means individuals will wait longer to seek care, which can result in higher costs to the system.

An audience member asked how all of these changes would impact the viability of Plumas District Hospital.

CEO Dr. Jeff Kepple said that the hospital and clinics were seeing more patients, but weren’t being reimbursed for the costs. An intergovernmental transfer system helps backfill Medi-Cal losses, but it requires substantial upfront money to participate.

He said the hospital also continues to offer obstetric care at a substantial cost, but he remains committed to offering the service. Kepple hopes that the addition of transitional care beds will help the hospital.

Wheeler commended Plumas District’s ability to survive. “Nearly 800 rural hospitals have closed,” she said, including the last hospital in Colusa County.

The session was videotaped so those who were not able to attend the forum can view it online on YouTube. Copies will also be made available at the local libraries, the public health department and the hospitals.

Nance Reed, the individual who set the forum in motion, said afterward, “I learned so much, so did others.”

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