Commentary: Yolo County Needs To Avoid Cuts in YCHIP

On Tuesday, the Yolo County Board of Supervisors will discuss cutting an already-underfunded YCHIP program budget by 36 percent.  There is no doubt these are tough times for local government and of all governments counties are suffering the most and yet also relied upon the most for vital services.  Yolo County is no exception.  They are being forced to cut one-third of their general fund budget.

Two weeks ago Sheriff Ed Prieto made a vigorous defense of his department arguing that law enforcement would be hamstrung by the proposed cuts.

In Dr. Seuss’s classic that pits innovation and progress against the perils and fragility of the environment, we were introduced to the Lorax, the spokesperson and defender of trees:

“I am the Lorax, I speak for the trees, for the trees have no tongues.”

In many ways, those most vulnerable in this county and this state face a similar problem.  They have no voice and few advocates like the Sheriff who can muster the political will to rescue them.  We have learned that even lifelong health advocate Supervisor Helen Thomson, was on the committee that recommended these cuts.

Still those who read the editorial section of the Davis Enterprise may have read the poor, indigent, and undocumented’s version of the Lorax, Dr. Lisa Baumeister.

She is a Woodland-based family physician who serves many YCHIP patients.

“I believe it has been wise public health policy to provide safety net health care to poor, undocumented immigrants, and Yolo County should continue to do so, despite current economic challenges.”

She cites Pew Research Center data that estimates roughly 95 percent of undocumented immigrants are employed and contributed to the local economy through low-skilled positions in agriculture, construction, food service or maintenance. Yolo County’s agricultural economy, in particular, depends on the inexpensive labor of undocumented farm workers.

She continues:

“Nearly half of undocumented immigrants (47 percent) are married, and many have children who are U.S. citizens.  Children growing up with parents who are medically or mentally impaired are at higher risk for abuse, and stressful home environments. Children from such unstable homes would be more likely to drop out of school, use drugs, develop mental illness and engage in crime.”

She cites a key example of an adverse consequence of such a policy shift:

“One of my patients is a 34-year-old poor, undocumented woman, a mother of two children, who works as a house cleaner and whose husband works in construction. She has been diagnosed with a benign brain tumor.

Owing to the relatively inexpensive specialty care financed by the YCHIP program, her condition is well-controlled by medication, and her prognosis is excellent. As long as she has access to this medication, she is able to continue working. If her eligibility for YCHIP ceases, she will lose access to specialty care and will be unlikely to afford her medication, putting her at serious risk for permanent loss of vision.”

For me one of the key points that I tried to make in my Saturday column is that cutting back coverage may not save money.

“From a strictly fiscal standpoint, one might argue that Yolo County cannot afford to pay for this patient’s chronic medical care, regardless of her contribution to the local economy. But denying her coverage won’t necessarily save money. Studies show that when access to primary care is reduced there is a predictable increase in emergency care and hospitalizations for a range of conditions.

In my patient’s case, without medication, enlargement of her brain tumor eventually could lead to the need for emergency neurosurgery. As with care for all uninsured, we would all bear the costs of this expensive care, because the costs of emergency care for uninsured patients eventually are passed on to insured patients in the form of high premiums.”

There are also as cited on Saturday, broader health implications beyond that community.

“I am also concerned about the broader public health implications of using immigration status to allocate medical care. Immigrants have legitimate, deep-seeded fears of immigration authorities. Many immigrants may avoid clinics if they know they will be asked for their legal status because of fears that this could endanger themselves or an undocumented family member.

When Proposition 187 was passed by California voters in 1994, it had a prolonged chilling effect on health care use within immigrant communities. Yolo County’s decision to check immigration status may similarly deter health care use among both documented and undocumented immigrants.

Delays in or avoidance of care could lead to the spread of infectious diseases like tuberculosis or swine flu. Indeed, a California survey of tuberculosis patients showed that fear of deportation was associated with delays in treatment of tuberculosis, which has a high prevalence rate in immigrant communities.”

I understand the implications of the budget crisis.  We will need to cut back on vital and needed services.  But we also have a lot of decisions make about what services are most important.  People have suggested well what would you cut instead.  I have often been a critic of the Yolo County Criminal Justice system that I think is a bit too quick to charge people and prosecute relatively minor crimes.  This is a real opportunity to look at what we prosecute and see if there are better ways to do it.  If we just make cuts to make cuts, then the vulnerable will get harmed.  If we take a bit longer and make cuts where we should make them anyway, we can all benefit in the long run.  There is little doubt that we would still have to cut important programs, but we also have to be careful that budget cuts today do not mean greater expenditures in the future.

—David M. Greenwald reporting

About The Author

David Greenwald is the founder, editor, and executive director of the Davis Vanguard. He founded the Vanguard in 2006. David Greenwald moved to Davis in 1996 to attend Graduate School at UC Davis in Political Science. He lives in South Davis with his wife Cecilia Escamilla Greenwald and three children.

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8 thoughts on “Commentary: Yolo County Needs To Avoid Cuts in YCHIP”

  1. martin

    I don’t know whether I support giving away government funds to non-US citizens, but I do know that there aren’t any funds available for that purpose. If you want to give away our money, you should first investigate ways of acquiring the money. Others are doing this. San Diego has a program to develop clean energy jobs, why doesn’t Yolo County have any program other than taxing us to give our money away to people who aren’t US citizens?

    What are the City and County planning staffs doing? If this is an important decision, where is the research presenting the alternatives and investigating why there are so many people in Yolo County that we have to sacrifice for and pay? Are these new County employees that we are responsible for? How long do you anticipate supporting them? For the rest of their lives?

    SAN DIEGO, CA–(MARKET WIRE)–May 4, 2009 — To help accelerate the development of clean energy and green jobs in Imperial County, SDG&E today announced plans to open the Renewable Energy Resource Center in El Centro this week.

    The new center, opening tomorrow, will assist renewable energy developers in launching their projects in Imperial County. It will evolve into a facility where schools, businesses and anyone interested in a cleaner energy future can tap a wide range of resources to learn more about renewable energy.

    http://finance.yahoo.com/news/SDGampE-Seeks-to-Stimulate-iw-15118250.html

  2. Rich Rifkin

    It is situations like this why it is so important for our elected officials to be wise in their ordinary budgeting, especially when it comes to labor contracts. How many millions of dollars would the county have saved in the last 10 years, money it would now have available to protect public health and provide care for the very poor, if the supervisors had not changed the pension formula for correctional officers to 3% @ 55 and deputy sheriffs to 3% @ 50, neither of which (just as with Davis) can be sustained? The board of supervisors spent $2.4 million in lawyer bills trying to take over Conaway Ranch (for no rational reason). The settlement got them some of that back, but the whole quixotic pursuit suggests to me the supervisors were not thinking about the people (like the lady with the benign brain tumor) when they were hiring lawyers at $500 per hour to pursue a fruitless misadventure.

    The county would have tens of millions of dollars more now (same as Davis) had they not shifted up to 2.5% @ 55 pensions for all desk workers, including the elected members of the Board of Supervisors. The other county benefits (holiday policies, sick leave, etc.) are actually a bit less generous than those given by the City of Davis. However, the county has this provision — “Each employee receives a benefit package of $19,606 annually to purchase health, dental and vision insurance. Any
    remaining balance of the benefit package will be paid to the employee as taxable earnings.” — in many of its contracts. That’s a nice thing to have if you will never have financial setbacks and you have no poor people in need of services. However, provisions like that are part of the reason why, when times are tough, very poor people get run over by the budget cuts.

  3. David M. Greenwald

    “It is situations like this why it is so important for our elected officials to be wise in their ordinary budgeting, especially when it comes to labor contracts.”

    I think you are exactly right which is why I because some such a budget hawk, with limited resources you have to prioritize.

  4. My View

    “”It is situations like this why it is so important for our elected officials to be wise in their ordinary budgeting, especially when it comes to labor contracts.”
    I think you are exactly right which is why I because some such a budget hawk, with limited resources you have to prioritize.”

    It is far easier to nickle and dime the fiscal problem to death, than it is to attack the basic structural deficits we have and the reasons why. I am not particularly in favor of spending tax dollars on illegal aliens, but the cost of that program is a drop in the bucket compared to the real problem, which is overly generous employee salaries and benefits, particularly to management. Those salaries and benefits cannot be sustained indefinitely…

  5. Rich Rifkin

    [b]”I am not particularly in favor of spending tax dollars on illegal aliens”[/b]

    I have mixed feelings about “illegal aliens.” On the one hand, they broke our laws to enter the U.S. and or to work here, in a sense jumping the line ahead of those who lawfully wait. If I did the same, entering some other country to work there illegally, I would not be surprised in the least that the officials in that country would kick me out. I don’t think illegals in the U.S. should be surprised at all to be treated as outlaws.

    However, I try to think of all individuals as individuals. Once a person is here, what should it matter to me his passport status? When I see and meet Mexican-born workers (who, I have found in my personal experience, without exception are great and dilligent and reliable workers) I appreciate them as fellow human beings, trying to do their best. In a moral sense, is a poor woman born in Tijuana who lives and works in Davis or Woodland with a brain tumor any less worthy of receiving proper medical care than one born in San Ysidro?

    I fully understand the arguments that we need to greatly improve our border security*, so it is not so easy for workers to “break-in” to our country. I’m all for taking whatever measures we need to do that. I also don’t have a problem (in most cases**) with deporting illegal workers and punishing those who employ them. But on a human level, I don’t see the wisdom (or morality) in not helping a poor person in need of medical care, simply because that individual came here to work without documentation. That person is every bit as much a human being as legal aliens or the native born and deserves to be cared for just the same.

    It’s worth noting that all advanced foreign countries (that I’m aware of) treat foreigners in need of medical care the same as they treat citizens. If you are visiting France, for example, French hospitals will treat you for free, even if your passport has expired. The same is true in Canada, England, Germany, etc.

    ———–
    * While there never may be a full solution to our problem of illegal aliens — it’s a problem for them, too, having to live and work without full protection of the law — I think part of the answer, after we upgrade border security, is to allow more migrant workers to legally come here. If we increased the supply of legal workers, fewer would be compelled to come illegally. Those who come with papers could then be discriminated against more efficiently. The ones who don’t abide by our laws or don’t help our economy could be deported. The vast majority who behave lawfully and provide needed labor could legally be integrated as Americans, much the same as most immigrants always have been.

    ** I don’t know where I would draw the line, but an “illegal alien” who has been in the United States for a substantial amount of time, who has worked and paid taxes and not been violent or committed property crimes deserves amnesty. To me, that kind of a person has proven his or her worth to become a citizen of the U.S.

  6. wu ming

    to deny medical treatment to any significant population in a society facing the possibility of an influenza pandemic is incredibly dumb. people can think what they want about the immigration system (although it’s worth pointing out tangentially that very few of most of our ancestors had to jump through anywhere near the number of hoops, quotas, laws and fees as we currently ask of current immigrants or migrant workers. it was just “sign your name and don’t have infectious diseases at time of entry” for europeans until the 1920s), but diseases spread across all of our man-made social and legal divisions with ease. to deliberately place barriers to anyone getting medical care in that context would be cutting off our heads to spite our faces.

  7. Rich Rifkin

    [b]it was just “sign your name and don’t have infectious diseases at time of entry” for europeans until the 1920s[/b]

    That’s largely, but not entirely true. It really depended on what was going on in the U.S. at the time. When immigrants (mostly Irish and Germans) came in the period leading up to and including the Civil War, they were forcibly conscripted into our military with the threat of deportation. The same was true with later wars. My grandfather, who came from Poland to the U.S. (arriving in 1915 in San Francisco), was threatened with deportation in 1917 (as were all of his fellow garment workers) if he did not join the U.S. Army in 1917.

    Also, just who was “sick” and who was healthy was often capricious. I have a lot of family in the Montreal area, because some of their ancestors were denied entry into the U.S. 110 years ago due to “illnesses” that were either harmless or non-existant. None of them had tuberculosis and all lived long lives. Yet some bureaucrat at Ellis Island denied them entry.

    Even though Canada admitted those relatives of mine, who came from Romania, our neighbors to the north back in those days were more prejudiced than America was against Jewish immigration, and often denied Jews entry for made up reasons.

  8. Anon

    “to deny medical treatment to any significant population in a society facing the possibility of an influenza pandemic is incredibly dumb. people can think what they want about the immigration system (although it’s worth pointing out tangentially that very few of most of our ancestors had to jump through anywhere near the number of hoops, quotas, laws and fees as we currently ask of current immigrants or migrant workers. it was just “sign your name and don’t have infectious diseases at time of entry” for europeans until the 1920s), but diseases spread across all of our man-made social and legal divisions with ease. to deliberately place barriers to anyone getting medical care in that context would be cutting off our heads to spite our faces.”

    There will always be justifications for keeping programs, such as health care to illegal aliens. But there is only so much money to go around. If we don’t cut health care to illegals, where do we cut? Be specific…

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