IMPATIENT PATIENTS: Beware of skinny envelopes in your mailbox. They’re worse than rattlesnakes. I got one a couple of months ago from my life insurance company. My premiums, it notified me, would be going from $235 a month to $7,000. That sort of math I can’t do in my head. It was signed by a guy named Phil Fields. When I called him to make sure this couldn’t possibly be correct, I would learn that Phil Fields is a strategic figment of the company’s imagination. The voice I got instead — I stopped asking his name after the fourth try — assured me my eyes were just fine and my reading comprehension spot-on.
Compared to all the skinny envelopes now being opened by untold thousands of county residents — courtesy of Donald J. Trump’s Big Bad Beautiful Bill and his “Show Me Your Papers” fatwa — my problems are a walk in the park. Theirs is a walk down the gangplank. Ascribing a solid number to those straining that gangplank is challenging, but the way I read the tea leaves in what’s loosely called the Central Coast, the number is north of 42,000.
If anything, I suspect, that’s an undercount.
As the county supervisors and county health officials are learning, there’s really no good way to deliver really bad news. Last Tuesday, they heard how 7,500 county public health clinic patients — covered by Medi-Cal through CenCal insurance — would have to be transferred to other providers because their immigration papers are deemed unsatisfactory. That number, by the way, has now shrunk to 7,000.
Immigrant rights activists packed the house, demanding: Why didn’t you tell us sooner? Why are you caving in now? There’s a legal injunction blocking Trump and protecting these patients and the county. Does Santa Barbara really want to be the first county in the state to throw its immigrant patients overboard? Words like “betrayal” got tossed around. A lot.
I get it. These are people who’ve spent the past eight months in perpetual fight-or-flight mode, triggered by Trump’s roving ICE bands of masked marauders. Even though the State of California — not the federal government — is paying for these 7,000 patients, their care is part of a broader federal program, Federally Qualified Health Centers, created to effectively bribe medical providers to care for poor patients.
Santa Barbara, by the way, is one of only five counties in the state with clinics like this. Noncompliance with Trump’s orders, the supervisors were repeatedly told, comes with a perilous price.
County Public Health officials are dealing with their own brand of fight or flight. And no, they are not throwing anyone overboard, they bristled. They’re making sure these patients get transferred safely to medical facilities. In fact, 31 health care providers — offices, not individuals — have agreed to take all 7,000 patients. And no one will have to drive more than 15 minutes to get there.
Yes, there is an injunction in place, but injunctions tend to fail before the wrath of Trump. And they are not acting “prematurely,” they say, because successful transfers take months, not days.
Public health officials are in a full freak-out mode of their own. The county could risk losing all its federal health funding for all its clinics and all its patients — not just the 25 percent who are without documents.
But the more you dig, the worse it gets. The aforementioned CenCal solution — administratively heroic as it is — does not cover all the county clinic patients who are documented but uninsured. How many are there? If the county sheds these patients, who will be forced to pick them up? And at what cost? At some point, emergency rooms will feel the pinch.
And what about the 10,000 or so residents who are likely to lose the insurance they have, such as the Affordable Care Act? Trump and the Republican Congress are insisting on yanking the tax credits and subsidies that make such insurance actually affordable. For those tuning in late, those subsidies expire at year’s end unless renewed; that’s what the whole government shutdown is purportedly about.
Then there’s the other 25,000 people who will be kicked off the Medi-Cal insurance rolls because they happen to be single adults and not the widows and orphans insisted upon by the Trump administration. About half these people are likely to fall off because the new federal rules require that they reapply every six months. Who does that?
Or because they will be required to get jobs or do volunteer work. Sounds reasonable enough, but when other states, such as Georgia, tried enforcing these requirements, they only succeeded in pushing people off the rolls while failing utterly to increase the number of working people.
And what happens when the same new citizenship requirements are attached to programs for homeless people? Or those with mental illnesses? Or people who need medical attention while in county jail?
Little wonder tempers are flaring among many partners in Santa Barbara’s sprawling health care universe. It didn’t help when county Public Health Department’s medical partners found out that public health clinics would soon discontinue specialty care treatments. These are not legally mandated, it turns out. But they’ve been provided a very long time.
Getting back to my skinny letter, it came postmarked from an address in Huntsville, Alabama. Huntsville is where we designed a new generation of rockets and missiles right after World War II. To help out, we hired some of the best rocket scientists Nazi Germany had to offer. No war crimes charges got filed. And I’m guessing we gave them some new names. I wonder if Phil Fields was one.
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