Los Angeles Times on restoring slashed Medi-Cal benefits:
When the last recession plunged the state government into a multibillion-dollar hole, California lawmakers were forced to cut deeply into numerous valuable programs just to make ends meet. Many of those cuts were penny-wise and pound-foolish, however, especially the ones in safety-net programs like subsidized child-care that helped low-income families stay in the workforce. So as the economy improved, lawmakers and former Gov. Jerry Brown slowly pieced the state's safety net back together again.
But some important benefits have yet to be restored, a full decade after the recession ended. A good example is the subsidy Medi-Cal eliminated for eyeglasses. The program will pay when poor Californians visit an optometrist to find out how bad their vision is, but won't help cover the cost of the glasses or contact lenses they may need to drive a car, operate a machine or read a manual — in other words, things they may need to do in order to hold a job.
Similarly, Medi-Cal no longer covers speech therapy, audiology, podiatry or incontinence supplies — the sort of treatments and supplies that can enable people living at or below the poverty line to be more productive and, potentially, start climbing up the income ladder.
In the big scheme of the state budget, these are not expensive programs. Plus, if they were added back, the federal government would cover roughly two-thirds of the tab. Restoring vision coverage would cost the state about $22 million a year, and restoring all of the lost benefits would be about $34 million.
On the other hand, those are annual expenses, not one-time costs. And the state has other, expensive health care needs and wants. Two of the biggest are proposals aimed at achieving universal coverage in California by making health insurance more affordable for moderate-income Californians and extending Medi-Cal to immigrants living in the state illegally.
Make no mistake — universal coverage would be good for all Californians, including those who already have insurance. Beyond the strong moral argument for providing treatment to everyone who needs it, there are good economic and public health reasons for bringing every resident under the insurance umbrella and providing timely, efficient care.
The steps required to make coverage available and affordable to all Californians, however, would cost the state $6 billion or more per year. And while Sacramento has been riding a wave of budget surpluses, the state can't afford to have its obligations grow faster than its economy. That's a recipe for disaster in the next downturn. As Gov. Gavin Newsom warned on Wednesday about the current extended economic expansion: "What we're experiencing right now is simply without precedent in modern American history and it is not a new normal. Any time people talk about the new normal, that's when things collapse."
So it makes sense for the state to continue to advance cautiously on the health care front, restoring cuts before offering new benefits and looking for ways to pay for expanded coverage. One good idea on the revenue front is Newsom's proposal to impose new state tax penalties on adult Americans who don't sign up for health coverage, replacing the federal penalties that Congress eliminated in 2017.
That's a twofer: The penalties would encourage younger, healthier Californians not to go uninsured, and they would raise money to help pay for premium subsidies to moderate-income families who would otherwise have to spend too high a percentage of their monthly income on insurance. It's not clear, however, that Newsom's proposal would generate enough money to cover the full cost of the subsidies.
One possible answer is to renew the tax on managed-care organizations that is set to expire at the start of the next fiscal year, July 1. The tax, which generates money for Medi-Cal that the federal government then matches, raises about $1.5 billion a year. When combined with the state funds Newsom has proposed to spend, that would be more than enough to cover the subsidies' cost and help extend Medi-Cal to more Californians. The Trump administration had pushed back on such taxes, and Newsom didn't seek to renew the state's version for fear of jeopardizing other health care-related assistance the state is seeking from the feds. But with the administration approving Michigan's proposal for a tax similar to California's, the door seems open for the state to continue the levy, as it should.
The Fresno Bee on deaths in the Fresno County Jail:
The Fresno County Jail has a troubling distinction. As a story by reporters Jason Pohl of The Sacramento Bee and Ryan Gabrielson of ProPublica shows, no county jail in California has had a sharper increase in custody deaths since 2011 than the one in downtown Fresno at 1225 M St.
From 2011 through 2018, 47 deaths occurred inside the jail. That contrasts with the seven years before 2011, when the jail had 23 inmates die while in custody.
Of those 47, four were murders that occurred despite corrections staff being in charge of making sure such crimes did not occur. The remaining deaths resulted from medical conditions, issues with drug or alcohol withdrawal, and suicides.
When it comes to county jails in California, 2011 was a significant year. That is when state prison officials began diverting inmates from their facilities because of a U.S. Supreme Court order spurred by overcrowding. California corrections stopped accepting certain inmates and instead directed them back to county jails. The process is known as "realignment."
For Fresno, that meant housing a new kind of inmate — a man serving out years of a prison sentence. Up to then, inmates typically were in the county jail no more than two years while their cases went through court.
Add in other key factors — a jail chronically full, lawsuits over whether inmates are getting proper medical and mental health care, understaffing in the ranks of correctional officers, inmates whose behaviors have been impacted by long-term drug use or gang affiliation — and the deaths-in-custody statistic takes on a complicated perspective.
Some recent developments will help Sheriff Margaret Mims lower the death total. For one thing, a new jail is under construction downtown. It will replace an antiquated annex built in 1947. Also, hiring for correctional staff is much improved, and the jail is getting closer to full staffing.
One thing likely won't change, though: the type of inmate going into the jail. With Fresno County's long history of gang crime and rampant methamphetamine abuse by those addicted to that destructive drug, many of the inmates being locked up are tough, hardened individuals.
"What happens in the community happens in the jail," Mims says.
There are few things as complex as running a jail. That said, Mims is responsible for every person inside it, and deaths in custody are a stain on her leadership as sheriff. Mims and her corrections team need to do all they can to reverse the trend. That could mean reviewing current plans, procedures and practices in the quest for improvements.
The ultimate goal is saving lives under her care.
LAWSUITS AND ORDERS
Overcrowding has long been a challenge in the Fresno County Jail. In 1993, lawyers representing some inmates sued the county over conditions they said amounted to cruel and unusual punishment. The result was a federal "consent decree" capping the jail's population.
Today the daily population hovers around 3,000 inmates, making Fresno County the seventh-largest jail in the state. Los Angeles County is tops with 16,000 inmates. In the Central Valley, Sacramento County is first with 3,700 inmates.
If Fresno County gets too full, under the consent decree Mims has to release inmates and limit arrivals to bring the population down.
In 2015, the Prison Law Office in Berkeley reached a consent decree with Fresno County over medical and mental health services not being properly provided to inmates. The decree required hiring more corrections staff and making sure services were available and medical needs were met.
PHYSICAL LAYOUT A CHALLENGE
Like many local jails, Fresno County's main jail is a "tower," meaning it is multiple-story facility. Cpl. Larry Gomez, a 28-year correctional officer, said tensions can arise when crowded inmates cannot get physical space from others.
That is particularly true for an inmate serving out a long sentence, Gomez said. "You spend 10 years in a constricted area, people might act out. They get tired of being confined in a small space."
Gomez is asked if the Fresno County Jail a dangerous place. "Jails have always been dangerous. Prisons are dangerous. Overall, it's more dangerous. We have had officers stabbed in the neck and back. Recently we had an officer slashed very seriously in the face.
"The county jail is not meant to be a state prison."
The new jail annex will have a modern design so staff can better see inmates at all times. Offices for medical staff and probation officers will be built in. Of the $110 million for the new annex, $80 million is from the state.
STAFFING GETTING BETTER
The county has ramped up recruitment efforts. Of the 580 correctional officer positions in the budget, only 15 were vacant as of April 25. Gomez said full staffing helps lower mandatory overtime use, which in turn improves morale.
A new medical provider has been hired, which Mims said will improve services for the inmates.
Most people don't give a second thought about their county jail unless someone escapes. But one budget number points to how important the jail is: $100 million. That is the jail budget for one year; it is half of the Sheriff's Office overall budget.
No price can be put on the death of a person, even a jail inmate. One of those who died last year was Andre Erkins. The father of two young children with his girlfriend, he was arrested on Jan. 18 for a probation violation. A judge ordered him to serve a month in jail. On Feb. 17 he complained of not feeling well. The official report saysErkins was sent to the infirmary, and was talking to staff when he collapsed from a seizure-like incident. He was pronounced dead at 8:37 p.m. The coroner ruled it a natural death from heart disease.
Erkins' cellmate told Pohl and Gabrielson that he tried to get help for more than 10 hours before correctional staff acted.
"There was no reason that boy should have died," said the cellmate's mother.
Those children will never know their father. And for the county, the death was yet another since realignment that gives Fresno County its dishonorable distinction.