Republicans Criticize Wilson Over Care Cuts

Gov. Pete Wilson’s proposal for massive cuts in state health programs is drawing fire from lawmakers in his own party who complain that some short-term reductions will impose long-term costs on government while others may deny essential medical care to the needy.

The dissension within Republican ranks surfaced this week when two Assembly committees held hearings to invite public comment on the governor’s proposals for $2.2 billion in health and welfare cuts that he says are necessary to balance the state budget without raising taxes.

As the plan came up for review before the committees, it was three Republicans--not Democrats--who delivered the severest criticism on the proposed cuts in health services.

“It’s a cockamamie plan,” said Assemblyman William J. Filante (R-Greenbrae), a surgeon who is the only doctor to be a member of the Legislature.

Filante, joined by Assemblyman Gerald Felando (R-San Pedro) and Assemblywoman Tricia Hunter (R-Bonita), zeroed in on several of the governor’s proposals. Among them are limiting inspections of hospitals, eliminating chiropractic care and reducing payments to doctors under such Medi-Cal services for the needy as surgery, psychiatry and anesthesia.

“What are we going to do? Give them (surgery patients) a bullet to bite on?” asked Felando, referring to the proposal to cut rates for anesthesia services.

The criticism from within his own party comes as Wilson has been taking Democrats to task for their opposition to his proposed cuts. With Republicans joining in, it makes it harder for the governor to portray the Democrats’ resistance to his plan as purely partisan.

All three Republicans who attacked elements of the governor’s cuts have ties to the health care industry--Hunter is a registered nurse and Felando is a dentist--and are the Republican leaders in the Legislature on health care issues.

A bemused Assemblyman Tom Bates (D-Oakland), watching as the Republican committee members grilled state health officials on the proposals, said it reminded him of the days when Democrats used to attack various proposals of former Democratic Gov. Edmund G. (Jerry) Brown Jr.

“Don’t let me interrupt,” he quipped.

John Rodriguez, deputy director for programs for the Department of Health Services, attempted to deflect the criticism by explaining that the Administration had tried to tailor health care cuts so that fewer poor people would lose eligibility for services. To do that, he said, state officials had to find other savings and cut non-essential services.

“These are some bad choices in a bad year,” he acknowledged.

Hunter was the first to draw blood at a hearing Monday, saying she was concerned that the proposal to eliminate periodic state licensure inspections of hospitals would eventually mean that “no government agency at all will be going into hospitals” for inspections. She said the Wilson proposal comes at a time when the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO), which also inspects hospitals to determine if they meet national standards, is considering reductions in on-site inspections.

Administration officials assured her that even with the elimination of periodic inspections, they would still examine hospitals whenever there was a patient complaint. They said that in the past most enforcement actions taken against hospitals had been generated by complaints and not routine inspections.

“But I would suggest to you,” Hunter said, “that many people don’t know to complain to a government department.”

Felando argued that the plan to eliminate Medi-Cal coverage of chiropractic services would force patients with back ailments that a chiropractor could treat to seek more expensive medical services. “Tell me how that will save money?” he asked.

Rodriguez said that health officials assumed there would be some “switch over” to medical services but that the state would save money because most chiropractic patients would not switch.

All three Republicans objected to a proposed 10% cut in Medi-Cal reimbursement rates for surgery, psychiatry and anesthesia services. With Medi-Cal already paying significantly less than the standard rates for these services, they said, additional cuts would only prompt surgeons, psychiatrists and anesthesiologists to stop offering care to the poor.

“If they leave the market like many doctors and dentists already have, then poor patients are not going to receive care,” Filante said in an interview Tuesday.

Filante noted that he endorsed several aspects of Wilson’s health care plan, such as his proposal to expand Medi-Cal patient enrollments in managed care programs such as health maintenance organizations--but, as a physician, he said, he felt it was important to point out elements he considered unworkable.