Access. In 2018, that proved the overarching theme for health care in the North State, the Golden State and the United States.
Republicans who failed to erase the Affordable Care Act in Congress took strides to erode the law that’s brought coverage to millions through executive orders from the White House and legislation removing some of the ACA’s underpinnings (such as the individual mandate that keeps public insurance exchanges viable). A federal judge in Texas declared the ACA unconstitutional this month, though that ruling—under appeal—is expected to be overturned.
Amid the uncertainty and attacks, enrollment has fluctuated; most strikingly, coverage among children has dropped dramatically, impeding access to care. That’s especially significant in rural, medically underserved communities such as Butte County, where government-funded and -subsidized insurance comprises the bulk of coverage.
The Camp Fire provided another blow. Butte County lost its third-largest hospital, serving its second-largest community, for at least a year—and all the providers surrounding Adventist Health Feather River found themselves without facilities in one day. Displaced patients sought prescriptions and physicians; everyone in the region sought relief from smoke, scrambling for masks with the right filtration if not seeking refuge outside the soot zone.
In myriad ways, access indeed defined 2018. Here are 10 top issues of the year locally, each with that connection.
1. Medi-Cal for whom?
Persistent threats to the ACA prompted fewer people to sign up for insurance through Covered California, the state marketplace that includes expanded Med-Cal plans. The number of uninsured children rose for the first time in a decade.
Covered California enrollment for 2019 suddenly surged in mid-December, prompting the exchange to extend its deadline a week. However, the state—which partially matches federal Medicaid dollars to fund Medi-Cal—made relatively modest allocations to expand coverage in the 2018-19 budget.
2. Opioid crisis hits home
With a death rate nearly three times higher than the state average, Butte County has a problem with opioid overdoses. Public Health Officer Andy Miller advocated for community-set guidelines for narcotic prescriptions with the goal of a 65 percent reduction in total dosage; physicians in primary care and emergency medicine adopted the guidelines in January, amid increased pressure on doctors and pharmacists from regulatory agencies.
Patients, particularly those with chronic conditions, found themselves caught in the middle. A national advocacy group with local members called Don’t Punish Pain rallied for relief in Sacramento and other capitols.
3. Fire afflictions
The Camp Fire may have devastated Paradise in a day, but its toll on health may yet remain unaccounted. Microscopic particles in the smoke—reaching concentrations twice as bad as the worst-polluted cities on Earth—irritated eyes, noses, throats and lungs. More seriously, doctors say, the particles penetrated tissues and reached the bloodstream, inflaming blood vessels, thereby increasing the risk for heart attack and stroke among cardiac patients.
Medical professionals also expect to see cases of chronic breathing conditions as well as health issues among children and seniors. They’ve already treated diseases common in shelters, such as colds, flus and stomach viruses. Psychological effects, notably post-traumatic stress, could require help for years.
4. Feather River’s future
In the immediate aftermath of the Camp Fire, Adventist Health’s corporate leadership declined to commit firmly to reopening Feather River Hospital. The facilities on Pentz Road suffered significant damage; many buildings remained standing. Executives praised employees for safely evacuating all 69 patients but made no guarantees on the 101-bed hospital’s future.
A month later, Adventist Health had expanded its footprint in Chico, readied its Skyway medical building to reopen as soon as possible—last week (Dec. 20)—and announced plans to reopen the hospital, as early as 2020.
5. Anthem versus Enloe
After failing to agree on rates after six months, Enloe Medical Center and Anthem Blue Cross cut ties Nov. 1. That put Enloe “out of network” for Anthem subscribers, who’d have to pay a larger share of costs than when Enloe was “in network” or find another hospital. Enloe said Anthem pays 40 percent less than Blue Shield, another private insurer, and hadn’t increased reimbursements in eight of 12 years.
After the Camp Fire, the sides agreed to restore their contract through Dec. 31, 2018.
6. Single-payer rising?
Democrats love single-payer health care—aka Medicare for all. Yet, with the chance to pioneer a plan, Democratic legislators balked; California Senate Bill 562 died in the Assembly last summer, pulled by the speaker before any deliberation.
It’s regained steam since the November election, however: Gov.-Elect Gavin Newsom avidly supports single-payer, and a federal bill by Sen. Bernie Sanders has sign-on from, among many, Sen. Kamala Harris (D-Calif).
7. Places to go
Restrooms aren’t just a convenience, they’re a necessity. Without proper sanitation, public waterways grow polluted and disease spreads. Californians got a reminder when Hepatitis A spread among people exposed to human waste in San Diego, Los Angeles, Monterey and Santa Cruz.
Among the discussions of homelessness, public restrooms in Chico received scrutiny. The city closed, temporarily reopened, then closed again municipal bathrooms overnight. Butte County Public Health considers 24-hour restrooms with running water and soap to be important preventative measures for disease.
8. Mental health response
People battling mental illness can hit a crisis point at any time; Butte County Behavioral Health officials heard that message as they collected feedback for programs funded under the Mental Health Services Act (or MHSA). The department this year added a mobile crisis unit to accompany Chico police officers to incidents, but staffed the unit only 8 a.m. to 6:30 p.m.
Behavioral Health did expand mobile crisis response to the Ridge and Oroville in the fall.
9. Care for kids
With a rush of retirements over the past year—notably Drs. Pat Tedford, John Asarian and James Wood—Chico’s shortage of pediatricians loomed large. However, a new wave has arrived to stanch the riptide.
Northern Valley Indian Health, which moved its Children’s Health Center to a larger building, nearly doubled its number of providers (from six to 10); though he closed his office, Tedford sees patients there, too. Meanwhile, Chico Pediatrics (Asarian’s old practice) brought in Drs. Evbu Ogbeide and Anna Robertson, who also work hospital shifts at Enloe.
10. Good screens, bad screens
Local hospitals embraced technology to expand patients’ access to specialists. Enloe launched a regular series of Facebook Live webcasts in which practitioners, such as bariatric surgeon Erik Simchuk, address medical issues. Oroville Hospital started utilizing telemedicine in its emergency room through the mobile interactive unit RED (remote examination device)—allowing local doctors to connect with large medical centers where experts actually can see the patient.
Not all screen news was good, though: Studies came out linking smartphone use to feelings of depression and social disconnection, while pediatricians renewed their push for parental limits on screen time.