Clarifying Health Care for Poor

Controversy has been growing over Los Angeles County’s admission and fee policies for health services to indigents, all of which seems unnecessary to us--the more regrettable because it tends to distract officials and the public from bigger issues associated with caring for the poor.

The remedy proposed in a suit brought against the county by three public- and poverty-law centers is a simple one--so simple, indeed, that we can only marvel that matters have reached the point of litigation.

“The county need only consistently affirmatively disclose correct information to all its patients,” the plaintiffs assert. The county has not yet responded in court, but officials have said that they already are complying with state law on the disclosure of information.

In a legal sense it may be true. In a practical sense it does not seem to be the case. A new study by the UCLA School of Public Health turned up evidence of what we would interpret as incomplete information, and our own reporters have confirmed the problem.

At the heart of the dispute is the fee structure imposed by Los Angeles County after the state, three years ago, imposed indigent health care on the counties but failed to provide adequate funding for the program. Under rules in Los Angeles County, free care or reduced fees are available for those who qualify under what is called the Ability to Pay Plan. Under revised standards of that plan, anyone with a monthly income under $700, and a family of four with a monthly income under $1,100, is eligible for free care.

Under pressure from poverty groups, the county has recently completed the installation of signs in English and Spanish informing clinic and hospital patrons that they may qualify for “reduced payments,” and that they can inquire about that option. That notification may meet state standards, but it seems to us to fall short of full and complete information. Preferable, clearly, is a notice already in use in some of the clinics that advises qualified persons, in both English and Spanish: “The Ability to Pay Plan-Revised will help pay for some or all of your bill.”

County officials have done an effective job in providing indigent health care, given the inadequate level of funding. The state made a significant step for the fiscal year that began July 1 in providing a substantial increase, but it is still far short of the levels of funding promised when the program was turned over to the counties. That inadequate state funding should be the focus of public concern.

The fee structure in Los Angeles County generates about $11 million for a budget that totals $1.2 billion. The UCLA study indicates that the Ability to Pay Plan is cumbersome--often requiring a second office visit, usually at a separate location, and in some cases requiring a six-week wait. Both the fee structure and the Ability to Pay Plan need to be reexamined to be sure that they are not working as unnecessary and counterproductive barriers to health care for the needy. Health care denied raises the risk of more serious illnesses, and thus raises the ultimate cost of care while also creating, in the case of infectious disease, public health problems.

A reexamination of the fee program, and the income-analysis procedure, will take time. There is no need to await the outcome of the study to address the clear and present need for better information. Signs at clinics should include reference to the Ability to Pay Plan and the possibility that free care or reduced fees are available to most poor people. That should be reinforced with written literature that patients can carry away with them, and by staffs trained for inform all callers of the options.