It’s a truism that bears repeating in California: Health care is ultimately about affordability and access. In both areas, the state is wanting.
At a time when state leaders have celebrated expanding health care coverage to all Californians, the somber reality is that many people are still reluctant or unable to see a doctor, no matter how much they’re hurting.
Too expensive. Too hard to find.
And while health care cost and access issues are by no means unique to one part of the state, residents in the heart of the Central Valley — majority Latino, nearly half at low income — are experiencing this problem in outsized ways. That’s according to their own responses to questions from those surveying the landscape.
“Central Valley residents experience cost-related access issues and carry medical debt at much higher rates than residents in other parts of the state,” said Kristof Stremikis, a market analyst with the California Health Care Foundation. (The CHCF is a financial supporter of Capital & Main.)
The 2024 edition of the California Health Care Foundation’s Health Policy Survey reveals statewide issues, to be sure. More than eight in 10 respondents said reducing what people pay for health care is either extremely or very important, and that state leaders should work on it. Almost as many felt the same about improving access to mental health care, an ongoing problem in California.
But it was when the surveyors drilled deep into the Central Valley, a region filled with middle- and lower-income wage earners, that the scope of the problem became clearer. It’s extensive.
For its annual survey, the CHCF works with the University of Chicago’s NORC (previously the National Opinion Research Center), which describes itself as an objective, nonpartisan organization with more than 80 years of experience in social science and data science research.
Last fall, in addition to the statewide survey, NORC’s pollsters provided a close focus on five Central Valley counties: Fresno, Kings, Madera, Mariposa and Tulare. NORC put the area at 1.8 million residents total, with 57% Latino and 45% low income (meaning they earn less than 200% of the federal poverty level, which this year would be below $30,120 for a single person).
Among the eye-opening results: More than six in 10 respondents (63%) said they had skipped or delayed medical care because of the cost in the past year, a figure well above the already alarming statewide average of 52%. Nearly half said that waiting had made their condition worse.
Additionally, nearly half those in the Central Valley (48%) said they had medical debt, compared with 36% statewide. Among those with low incomes, the close survey found, the debt figure soared to 56%.
More than a third said it was somewhat or very difficult to access quality, affordable care. More than half said their community doesn’t have enough providers, including mental health care providers. And perhaps most ominously, 23% of Central Valley residents said a hospital had closed in their community in the last year — more than four times the state average.
That last finding relates to so many others. “Health care workforce shortages are negatively impacting access to care in the region,” the California Health Care Foundation’s Stremikis said. “Unfortunately, cost problems and workforce [issues] are now affecting the health care decisions of hundreds of thousands of Central Valley residents every year.”
The 2023 closure of Madera Community Hospital, the only acute care facility for Madera County’s 160,000 residents, was a graphic example of the challenges Central Valley residents can face in finding care. When the hospital folded, so did its three clinics, and a year and a half later the facilities all remain shuttered. A Modesto-based company is in the process of buying the bankrupt hospital, though it’s unclear how long that process will take.
In some ways, the results of the Central Valley survey can be be viewed as a harbinger of the future of many rural areas in the state. One recent study, by a group advocating for health care payment reform, found that 40% of California’s rural hospitals are at risk of closing — nearly two dozen hospitals in all.
The state’s 60-plus rural community hospitals “are facing their gravest challenge in decades,” the California Hospital Association wrote in an issue brief. The association said the percentage of rural hospitals that lose money caring for patients has risen from 40% to 56% in the past five years alone.
Some of them will close; others will simply reduce services. The hospital association found that over a recent 10-year period, 20% of rural hospitals stopped offering services for pregnant and delivering women. Some 40% stopped offering chemotherapy.
In a state constantly grinding for health care reform, the ripples of emergency are being felt in markets small and large. It’s worth noting that the Madera Community Hospital’s potential comeback is being made possible in part by a $57 million loan through the state’s Distressed Hospital Loan Program.
Nearly $300 million in no-interest loans has been disbursed through that program, and there almost certainly will be more. As the Central Valley’s experience shows, the need is acute.
