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Politics in Action:

In Los Angeles, California, the nation’s second-largest public health system is in dire financial trouble. In recent years, the Clinton administration helped with funding when necessary – but that aid will run out. LA. County will be facing an estimated $800 million deficit by 2005. The Bush administration has so far been unwilling to address the situation.

In the absence of any state or federal bailout, and an increase in the number of uninsured (to an estimated 2.5 million uninsured) the L.A. County Department of Health plan to shutter one or more of the county’s six public hospitals, and 15 of its 18 clinics, despite the fact that these are heavily utilized facilities.

The County’s Board of Supervisors approved that decision at a packed public meeting on June 26, 2002, and were greeted with shouts and boos from those in attendance.  A period of public testimony, required by law, followed that decision.  CIR members and their patients provided powerful testimony, about the impact these cuts would have on the area’s most vulnerable. “Who is going to take care of all these patients?” asked Dr. Dan Schaefer, a CIR Southern California vice president, who is a PGY 3 in Family Medicine at Harbor/UCLA, which may lose its trauma center, emergency room, or face possible closure. “The other public hospitals are already overwhelmed. Private hospitals don’t have the capacity or the interest to do so.”

An overtaxed system

“I have been rallying, talking with reporters and getting out the word about what these cuts will mean to people who think they may not be affected by it. They believe, ‘I have health insurance, this won’t affect me,’” said CIR leader Dr. Naeemah Ghafur, a PGY 3 in Family Medicine at Imperial Heights Clinic of King/Drew Hospital, whose clinic is slated to close in October. “If these cuts go through, the chronically ill patients we see will end up coming in later, and sicker, to hospital emergency rooms. That means when you go with your sick child to the emergency room, or you’re on the freeway and your SUV rolls over in traffic, …you’re going to have to wait many more hours than you already do.  That’s why it doesn’t matter if you’re insured or not.  This is not an issue for the uninsured, or the working poor, this is everyone’s issue.  It’s vital to everyone. Our system is already overtaxed to the point of breaking. I foresee a disaster if these cuts go through,” Dr. Ghafur said.

Unintended consequences

In public testimony, the Board of Supervisors heard from people who would have died had these cuts been in effect, because their proximity to now-targeted trauma centers and ERs literally saved their lives. CIR leader Dr. Christine Dauphine, a PGY 2 in General Surgery at Harbor/UCLA Medical Center, said that she expects more deaths, as, “patients will present to ER later and sicker,” and that the cuts could also spark a public health crisis due to “increases in the spread of infectious diseases such as TB and meningitis.”

Another unintended consequence of the proposed cuts would be to disrupt the residencies of doctors at the affected hospitals. “I try to put it in the far back of my mind,” Dr. Melanie Midget, CIR department representative and PGY 3 in Psychiatry at King/Drew told the L.A. Times. “You’re trying to finish your residency, your education, and then there’s the thought that my program may close.”

In what may be an early response to the looming crisis, UC Irvine Medical Center announced that it would no longer provide indigent services to those who live far away from its facilities, the L.A. Times reported in early August. Health care experts expect to see other private hospitals limiting their services if public hospitals close, as a way to avoid patient overload and debt from uninsured patients.

Despite the public outcry, the Board of Supervisors came back on August 20th and confirmed these first round of cuts – 15 clinics and the conversion of one hospital to an outpatient clinic - to go into effect October 1, 2002. “We are on our last leg, unfortunately, in this whole area,” Supervisor Gloria Molina said at the start of the meeting. “This is one of the most unfortunate votes I will ever make on this Board.”

Creative financing for public health

In the past the federal government has bailed out L.A.’s public health system. In 1995, the Department of Health received a $1.2 billion federal package, which was extended in 2000 and expires in 2005. Currently, neither the state nor federal government has offered further financial assistance, although the Board of Supervisors indicated they are still hoping for more federal assistance to avert future cuts to already overwhelmed county hospitals. On September The Board of Supervisors announced it will ask voters to approve a $75 million homeowners tax in a November initiative to help offset the deficit.  At 3 cents per square foot per month, the new tax would cost $46.22 annually for a 1,500 square-foot home. The Board has also proposed a pilot project to fund one of the hospitals slated to close.  In another development, the state’s legislature passed a bill to increase traffic violations and use the money to help fund trauma care.

Health care security

In response to the growing number of working families who are uninsured, SEIU, which CIR is affiliated with, has launched a Health Security Campaign. It focuses on legislative efforts aimed at controlling insurance and drug costs, expanding coverage for the uninsured, and making sure that health care is a central issue in the 2004 presidential elections.