Health Under Gann

The chill effect of the Gann amendment on the state is starkly visible in Gov. George Deukmejian’s budget proposals for health services--including AIDS, Medi-Cal, programs for the medically indigent, and other poverty health services.

The only major qualitative improvement proposed--improving the long-neglected prenatal care of Medi-Cal mothers--would be funded by cutting the fees of other doctors, thus risking a worsening of the already dismal access to care for the poor.

Major urban counties, including Los Angeles, that bear the brunt of the cost of serving medically indigent adults would receive no increase in regular state funds next year--a proposal that risks further cutbacks in basic services to an estimated 5 million Californians.

The state’s AIDS program would be increased by $5.3 million to a total of $70.2 million, the largest in the nation, according to Deukmejian, but even this has drawn criticism. Dr. Lauren White, incoming president of the California Medical Assn., called it “unrealistic,” and so it would seem, measured against caseload projections. On this score, however, the governor has promised additional money if it proves necessary.

The only substantial input of new money for basic services will come from federal funds to ease the effect of the new immigration amnesty program. California is scheduled to receive $1.7 billion over the next four years, and Los Angeles County, a center of undocumented immigrants, will be the major beneficiary. Some of that will help emergency and obstetric services to those seeking amnesty and to other undocumented aliens.

Medi-Cal, the joint federal-state program for low-income persons, will be increased more than 8%, to $6.2 billion. The increase is accounted for almost entirely by projected increases in the utilization of services, in increased caseloads and in increased costs. The only significant improvement in fees is in the prenatal program, in which the compensation of obstetricians would go from $659 to $765, with an additional $150 to doctors providing comprehensive prenatal services. Even with that 16% increase, however, the total fee is so far below the average compensation in the state that it remains doubtful that it will attract intothe program enough obstetricians to ensure access to this highly cost-effective service for all the eligible women. Additional 10% increases are proposed for other services to children under Medi-Cal. The fee increases are to be financed by 10% cuts of other doctors’ fees--a serious mistake, we think.

Once again the governor has refused any funding for trauma centers, and any additional funding for treating those without health insurance--the population segment in major urban areas that has created the crisis in trauma networks.

Deukmejian makes much of what he calls “keeping faith with Proposition 4,” the ill-conceived Gann amendment adopted by the voters. We think he is wrong. Flaws in that formula to limit public spending are more and more evident, and this prosperous state finds itself unable to respond adequately with cost-effective public services and forced to postpone services that will only be costlier because of the postponement. That is particularly evident in health care. But even within the constraints of the Gann initiative there are opportunities for improved services, including health services. If the governor does not understand that, perhaps the Legislature does.