In medical school, doctors learn how to treat sick patients. But to heal, the patients who come into my office in a Sacramento community clinic need more than medicine — they need the food, shelter and other necessities their family incomes provide. California’s Paid Family Leave and State Disability Insurance programs are sadly failing families by not providing a realistic amount of income. Gov. Gavin Newsom and lawmakers have a chance to change that by adopting Senate Bill 951, which would enable low-wage workers — the majority women and people of color — to access benefits that truly support them when they need it most.
I provide care to patients who are on Medi-Cal (the state’s low-cost health insurance program) or are uninsured, often working jobs with low wages that they can’t afford to give up when they become ill or need to care for a family member. Paid Family Leave and State Disability Insurance are supposed to prevent these Californians from falling into poverty or homelessness when they need to take time off. But the program is largely an empty promise for these patients because the benefits replace only 60 percent of income. Two of my patients are among the many Californians caught in this trap.
The first is a middle-aged man who was a front-line worker; he started coughing up blood and was found to have a mass in his lung. We tried to get this mass evaluated quickly because of our concern for malignancy. However, the patient felt he couldn’t miss work to get an evaluation because the wage replacement he would receive through State Disability Insurance was too low for him to be able to support his family. As a result, his diagnosis of lung cancer was delayed to the point that it was more difficult to treat, resulting in him requiring more intensive care and ultimately dying earlier than expected. In addition to the individual tragedy, his wife and children were now left without a husband and father.
The next patient is an elderly woman with multiple, severe medical problems who was lovingly cared for by her adult children. Due to her medical condition and early dementia, she required full-time care. However, her children made the difficult decision to leave their mother home alone for long periods during the day because, once again, the Paid Family Leave wage replacement rate was too low and they had to go to work to pay rent and other bills. One day, while the woman was alone, she developed shortness of breath due to an asthma exacerbation requiring emergency evaluation. Fortunately, she was able to call 911, and the paramedics transported her to the emergency department for a 16-hour visit. If her son had been home, he could have given her medication to prevent her breathing from getting worse. If her children were able to take leave to care for her, her emergency department visit might not have been needed, thereby preventing a dangerous medical situation and saving the medical system a significant amount of money.
SB 951 authored by Sen. Maria Elena Durazo would address this problem by increasing wage replacement rates for Paid Family Leave and State Disability Insurance to 90 percent for California workers earning lower wages.
My work with patients who need these benefits shows that the rates are currently too low and disproportionately disadvantage low-income workers and communities of color. Too many of my patients are forced to sacrifice their health in order to pay for housing, food and childcare. This tradeoff can have long-term health implications for patients like those I’ve described. SB 951 will help us move toward health equity and ensure that all people who live in California can make decisions that optimize their health.
Sharad Jain is a general internist physician who is on the faculty of the UC Davis School of Medicine and is a primary-care provider at a federally qualified health center in Sacramento.