Health Cuts Would Eliminate Crucial Services, Opponents Say

For Gigi Welch, a Riverside mother of two boys afflicted with a severe form of muscular dystrophy, the outcome of the budget battle in Sacramento is agonizingly personal.

Her sons, Dakota, 5, and Gavilan, 6, have been able to live at home and attend local schools because of two state health programs, Medi-Cal and California Children’s Services, which pay for thousands of dollars in life-sustaining medical supplies, including ventilators to assist breathing, tube-feeding apparatus and customized wheelchairs.

But proposed cuts to state health care programs would eliminate the services for Dakota and Gavilan and may force them into institutional care.

“It is not the place they should live,” a horrified Gigi Welch said this week. “They go to school. They lead normal lives every day here. But I can’t let them get sick. And there’s no way I can come up with the money to pay for their machines.”

The Welch family is one of thousands throughout California whose future hangs on the resolution of a state budget. With lawmakers’ refusal Tuesday to cut public school spending to the level Gov. Pete Wilson sought, health care and other social programs appear more certain than ever to be sharply curtailed.

Behind the numbers that frame the debate in Sacramento are tragic and unacceptable human consequences, advocates for the poor contend.

“They’re literally killing people,” said Robert Leonard of Campaign for Fair Share, a coalition of more than 150 community assistance agencies, health care organizations and clergy that has held rallies in several cities over the last week to dramatize the impact of proposed health and welfare cuts.

“We don’t have a budget deficit up in Sacramento, we have a moral deficit,” said coalition member John Beauchamp of Health Access at a rally Wednesday outside the Ronald Reagan office building in downtown Los Angeles. “They have ways to cut that don’t hurt people. They just aren’t scrutinizing them.”

About 316,000 families and individuals who fall into Medi-Cal’s medically needy category would lose health care coverage under the Wilson Administration’s proposal to cut state health and welfare spending by 15%. These generally are working people who make too much money to qualify for welfare--which automatically entitles recipients to Medi-Cal benefits--but are too poor to afford private health insurance.

Others who fall into this category include 56,000 adults who are severely disabled by mental or physical handicaps, and 67,000 nursing home residents who have no other means to pay for their care.

These long-term nursing home residents would be eligible for only 240 days of care per year, under the Administration’s proposal to limit Medi-Cal expenses. What would happen to them for the remaining four months of the year is a question that stunned nursing home administrators don’t even want to think about.

“It’s the dumbest thing I ever heard of!” said Kitty Creeth, administrator of Alamitos West Convalescent Hospital in Los Alamitos. “What am I supposed to do, just sit everyone out on the curb and hope for the best?”

Creeth said 108 of the facility’s residents depend on Medi-Cal, no longer having the assets and savings to stay above the poverty line. More than half of them have been at Los Alamitos more than 240 days. Twenty have no living family members, and many others lack relatives who are capable of caring for them. Most of the residents are confused or demented and cannot care for themselves. Many have additional medical problems that require professional care.

“Ninety percent of these people have worked all of their lives, they struggled through the Depression, they saved and paid into Social Security so they would be taken care of in their old age,” Creeth said. “To put them out on the street now is just absolutely wrong.”

Realistically, the street is not an option. It would amount to patient abandonment and expose the nursing homes to legal consequences, experts say.

Kathy Daigle, spokeswoman for the California Assn. of Health Facilities, representing the state’s 1,200 nursing homes, said her group most likely would call on county hospitals--by current state law, the health care provider of last resort--to take these infirm elderly on the 241st day.

But another Wilson Administration proposal would eliminate that law--known as Section 17000--to relieve counties of costly health care obligations. The combination of the proposed cutbacks in health programs and repeal of Section 17000 is a doomsday scenario to many advocates for the poor. Several said they would immediately seek court intervention to block such an effort, even if legislative leaders acquiesce.

“We would litigate the heck out of it,” said Melinda Bird, a leading health care attorney at the Western Center on Law and Poverty. “Quite simply there are too many people’s lives at stake.”

Repeal of 17000 would permit counties to close all public hospitals and clinics, eliminating the sole source of health care for hundreds of thousands of indigent and uninsured patients. “We are talking about a Calcutta proposal,” said Nancy Mintie, an attorney with the Inner-City Law Center in Los Angeles. “People will be dying in the streets, and there will be no place we can take them for help.”

Even without repeal of Section 17000, the consequences of a 15% reduction in state health and welfare spending are dire for county-run health systems. Los Angeles County potentially could lose $593 million, or 26% of its health care budget, necessitating the closure of several of the county’s already overcrowded public hospitals, according to Irving Cohen, the county Department of Health Services’ finance chief.

“It wouldn’t be total liquidation, but total deterioration of the public health system,” Cohen said, leading to more critically ill poor choking the emergency rooms of private hospitals because they were unable to get care when their conditions were easier--and less expensive--to treat.

Cohen said the department’s priority will be to safeguard public health, meaning that immunizations for children, tuberculosis control, AIDS and sexually transmitted disease programs are likely to be spared. In line with Wilson’s priorities, county health officials also would strive to protect existing children’s medical services.

Of low priority would be those Cohen calls the “walking sick,” people who might get better over time or might get critically ill, such as adults with chronic heart disease, diabetes and asthma.

“You can’t make cuts like this painlessly,” Cohen said. “Someone’s got to get hurt.”