Lawmaker Pushes for Expansion of Health Care for Poor Patients

The chairman of the Assembly Health Committee, painting a dismal picture of health care for the poor in California, called Wednesday for the consolidation and expansion of a variety of health-care programs that serve low-income mothers and children.

Assemblyman Bruce Bronzan (D-Fresno) proposed that $123 million in tobacco taxes raised under Proposition 99 be used to pay for the expansion of seven state programs that provide services ranging from perinatal health care to childhood immunization.

During a wide-ranging breakfast session with The Times Sacramento Bureau, Bronzan also blasted California’s health-care system, saying it provides inadequate treatment for low-income pregnant women, children, the mentally ill and those who cannot afford health insurance.

The state’s already beleaguered health-care system is facing a cutback of $1 billion under Gov. George Deukmejian’s budget plan, Bronzan said. Even now, he said, county hospitals are often unable to care for the number of poor patients who come through their doors.

Many private medical providers do their best to avoid treating patients on Medi-Cal, Bronzan said. He also said that many mentally ill, seldom institutionalized under government policy in the 1980s, roam the streets with little public assistance.

“There’s a lot of sadness and true tragedy,” he said. “To me, the worst part of anything we do is the mental health system. There are some desperately ill people out there who can’t get in (institutions) under any circumstances, and where they end up is on the streets with no care, no nothing.”

Furthermore, Bronzan said, far too many California infants are born with low birth weights, need extensive medical care and possibly face a lifetime of physical and mental disabilities. After years of decline, the infant mortality rate went up slightly in California in 1985 and again in 1987, he said.

The assemblyman pointed out that low birth weight babies and infant health complications are often the result of preventable causes: inadequate prenatal care and the mother’s use of tobacco, drugs or alcohol during pregnancy. Low-income, minority and teen-age mothers also are the most likely to deliver children with low birth weights.

As a result, taxpayers are paying more in Medi-Cal costs to care for these ailing babies than it would require to provide proper prenatal care and educational programs in the first place, Bronzan said.

“It’s directly because of the lack of access to care,” he said. “And that is a direct result of government policy: the reductions in Medi-Cal. It’s very typical for a (low-income) woman to have her first prenatal visit at the beginning of her third trimester. No wonder we have low birth weight babies and all the problems we’re having.”

Bronzan said his proposal to expand and consolidate the seven health-care programs is designed to improve care for pregnant women, mothers and their children.

But he said his idea is likely to face opposition from some lower-level state and local bureaucrats who run the existing health-care programs and do not want to see them absorbed into a larger operation.

Top officials at the state Health and Welfare Agency said they have taken no position on Bronzan’s proposal but noted that elements of the plan are “not incompatible” with the Administration’s goals.

Introduced in skeletal legislative form earlier this year, Bronzan’s measure--now with more details--would create a single nutritional and health program for women and children that would be run by the 58 counties under plans they develop locally.

Some Programs Would Go

In the process, Bronzan would abolish the following programs: Maternal and Child Health, Child Health and Disability Prevention, Immunization Against Communicable Diseases, California Children’s Service, Prenatal Health Care, Dental Disease Program for Children and California Special Supplemental Food Program for Women, Infants and Children.

Deukmejian’s proposed budget for the 1989-90 fiscal year would provide $429 million for these programs. Bronzan proposes to spend all of that money, plus the $123 million in Proposition 99 funds, for a total of $552 million.

The Democratic legislator’s plan to use Proposition 99 money would eat up the entire $123-million fund earmarked for educating the public about the danger of tobacco, even though other legislators and public health advocates have proposed a variety of other ways to spend the money.

Bronzan acknowledged that it might be “stretching” the definition of anti-smoking education to spend the money on health-care programs for mothers and children. But he pointed out that smoking is one of the major causes of low birth weight babies and said he hoped to convince Proposition 99 supporters and the Legislature that his proposal would be an appropriate use for the money.

“We will be expanding services and reforming the system at the same time,” he said.