The most prominent candidates to fill seats this fall on the
One is an
A third is a former legislator who battled unsuccessfully for single-payer health insurance. A fourth is an activist who raised millions to fight HIV in Africa.
But whoever emerges from the field of 11 candidates competing in two districts will have to take a big-picture approach when they assume office in December if they hope to help the county navigate federal healthcare reforms.
In separate interviews, District 1 candidate
Solis, a former Labor secretary who is heavily favored to fill termed-out Supervisor
Duran, Kuehl and Shriver, all vying to replace Supervisor
"I don't think we always have to think about adding more county workers but rather using existing [private contractor] systems that are there and providing them with additional funding," said Duran, a West Hollywood city councilman who is HIV-positive.
Duran, a critic of the county's response to AIDS during the 1980s, in recent months has complained that the public health department has been too slow to respond to meningitis outbreaks.
Investing in partnerships with clinics and nonprofits is a vision that marries well with
Historically, its patients — many so poor they had to be subsidized by taxpayers—had few other places to turn. Today, thanks to health reform, more than 600,000 formerly uninsured county residents have policies through the Covered California exchange and Medi-Cal. They can now seek care at private hospitals — taking their insurance dollars with them.
The threat of losing patients just as they gain the ability to pay represents a major financial uncertainty for the county. Officials worry that without significant improvements to the quality of county health operations, delays and other problems could eventually drive insured patients away, drying up dollars that could keep the public healthcare system afloat.
To prevent such an outcome, Solis said the health services department would need to "step up" to make it easier to access care and to "bring up the level of expertise and training" among staff. She also said she wanted the county to renew efforts to use parcel tax revenue to establish a trauma center in the eastern San Gabriel Valley.
But Solis said she would not necessarily make a similar call for money to ease sometimes severe crowding in the emergency department at
Though she would like to see the hospital have more beds, Solis suggested it might make more sense to ease crowding by redirecting patients to nearby facilities with more space.
"Whatever is flexible, whatever the budget could handle," she said.
Shriver cited his healthcare experience working with entrepreneurs to launch the RED campaign, which provided HIV medications for millions in Africa.
"Competition is good," he said. "Questioning is very good for the system, because it causes old practices to change."
He said using technology to streamline county systems — an effort that is already underway — is key for improving the customer experience.
Longtime healthcare reformer Kuehl, a former lawmaker, expects Obamacare to deliver more, not fewer, patients to the county, and said she thought it would ultimately alleviate emergency room overcrowding by improving preventive care.
The four leading candidates called for closer oversight over the new
As for the roughly 1 million residents in Los Angeles County who are expected to remain uninsured, some of the 11 candidates suggested there should be limits on provided services, especially when patients lack coverage because they are in the United States illegally.
In the District 3 race, candidates Douglas Fay and Rudy Melendez endorsed restricting some medical services to residents who lack legal papers; opponent Yuval Kremer also called for limits. Pamela Conley-Ulich, also running for that seat, said immigrants without papers should be asked to repay their medical debts.
Kuehl, who says she still dreams of a day when California will have universal coverage, said she also thought undocumented patients might be asked to pay for care when they could.
But she endorsed the call for expanded care for the uninsured, saying she hoped the county would provide something that would "look very much like what Medi-Cal looks like," with an array of benefits including extensive primary care.
The county's health services department is working with community clinics to launch a managed care-like offering that would provide medical services for about 100,000 uninsured county residents later this year.
Duran and Solis said they back the effort. Shriver said he supported preventive care for county residents, with insurance or without, but campaign manager Sarah Dusseault said the candidate was "trying to figure out" if the proposed program was the best approach.
The leading candidates declined to offer specifics on how the county would pay for indigent care.
All said they would look for ways to cut costs in the existing system. Kuehl said she supported a bill proposed by state Sen.
"More money should be going to [all] healthcare, but it doesn't have to be county money," Kuehl said.
She promised to use her contacts in Sacramento to make sure the county gets all the state funding it could to beef up its health system.