County Looking for $1.6 Million of Cuts in Health Care for Poor

Faced with inadequate state funding for medical care for the indigent, county supervisors began the painful task Tuesday of searching for more than $1.6 million in possible service reductions. But some health officials warned that the cutbacks could, as one put it, “make the frailest and the neediest . . . sicker.”

With the sometimes emotional testimony of needy patients who qualify for treatment under the County Medical Services (CMS) program serving as a backdrop, Tuesday’s hearing was dominated by requests from health contractors and others that the county not reduce spending on what Supervisor Brian Bilbray described as a “medical safety net.”

Money Over Sentiment

Though supervisors sympathized with the speakers and lavishly praised the program’s merits, they argued that fiscal constraints might force the board, in Supervisor Susan Golding’s words, “to do some things we don’t want to do” by reducing the CMS program and other vital county services.

Recognizing those unpleasant financial realities, the board unanimously moved tentatively toward possible reductions in the CMS program by directing county administrators to recommend possible spending cuts, tighter eligibility requirements or other money-saving methods. Those recommendations are expected to be reviewed by the board next month.

“Every member of this board feels that CMS is valuable and would like to continue it,” Golding said. “But you can’t get blood out of a turnip, and the turnip in this case is the county.”

On one level, Tuesday’s hearing marked another chapter in a story line that has become familiar at the county in recent years--the county’s continuing chagrin over the state’s failure to fully finance programs that it orders counties to operate. This fiscal year, San Diego County received $41 million from the state for the CMS program, $2 million less than anticipated--a budgetary woe worsened by the fact that the number of patients in the program increased 16% last year.

“This is a prime example of the state’s failure to understand its relation with counties,” Assistant Chief Administrative Officer David Janssen said. “We do not question the need for additional resources for this program. But the answer is in Sacramento.”

Indigent patients and their advocates, however, argued that at least a temporary answer to the problem could be found in San Diego County itself. Noting that the county received $6.2 million in emergency state funds last year to help offset reductions in funding for health and welfare programs, they urged the supervisors to maintain the CMS program at its current level by spending some of those dollars.

The Legislature, however, did not specifically restrict the use of those dollars, which county officials placed in the county’s contingency reserve fund with an eye toward spending them on various programs as needs arise.

Some CMS patients, however, painted a poignant portrait of why they believe that some of the emergency funds ought to be spent on the health care program; many described life-threatening operations and treatments that they otherwise could not afford.

“Without this help, I’d probably be at Greenwood Mausoleum,” said Robert Fisher, who received a quadruple heart bypass operation under the program.

County in Tight Spot

Under CMS, the county contracts with four medical groups for health services: UC San Diego Medical Center, Grossmont District Hospital, the North-East San Diego Health Plan and the Community Health Group. Hospitals already absorb a portion of the cost for treating CMS patients, receiving $560 per daily admission while costs average $650, according to Dewey Baggett, president of the San Diego-Imperial Counties Hospital Council. Therefore, reductions in CMS funding could lead to larger deficits for hospitals and create the potential for so-called “patient dumping” to avoid the losses, hospital administrators warned.

Though acknowledging the merits of those and other arguments, the supervisors repeatedly argued that insufficient state funding has put the county in an untenable financial position, forcing the board to weigh the CMS program against other needed services.

“I don’t know morally if I can say whether children who are (abused) should take second to those who are sick,” Bilbray said. “The problem is that Big Brother in Sacramento is not sending down the dollars to fight the battles . . . (he) says we should be fighting.”