Poor and Sick? Cure May Be Tobacco Cash

It’s only noon on Friday but the “Clinic Closed” sign has just been hung on the door at the Share Our Selves medical clinic in Costa Mesa. Patients would have to return Monday to use the clinic’s free services.

For Jean Forbath, founder of the 29-year-old nonprofit agency, closing the doors early is unavoidable because Share Our Selves just doesn’t have enough money to handle the crushing need.

“We can be open every day, seven days a week and still wouldn’t be able to handle all the patients. We can’t afford it,” she said.

For five years, health and social services for the poor have taken a back seat in Orange County as officials used all available funds to pay down the massive debts stemming from its historic 1994 bankruptcy.

Now, Forbath and dozens of other health care leaders want a piece of the county’s $912-million windfall from the nationwide tobacco settlement to make up for cutbacks and bare-bones budgeting at such long-neglected programs as Share Our Selves.

Last week, health care advocates confronted county supervisors to demand that settlement funds, to arrive over the next 25 years in $30 million to $38 million annual increments, be earmarked for local health care--not more jail beds or early debt payments as other county officials propose.

The money is needed, they say, to make sure every newborn has medical care, to shore up financially stressed community clinics, to pay for more of the care provided to the poor and uninsured and to bulk up meager amounts paid to hospitals that are required to care for indigents because no county hospital exists.

“The tobacco money is really needed because it can supplement any form of health care,” said Terry Fowler, nursing director for UCI’s medical clinics in Anaheim and Santa Ana. “It could support anything: family planning, immunization outreach, expanded hours, patient education, emergency care services.”

At Share Our Selves, caring for patients with chronic health problems like diabetes, hypertension and high blood pressure has caused costs to go through the roof, Forbath said. Diabetic patients, for instance, need expensive insulin and sometimes special treatments like laser eye surgery, she said.

“It’s expensive care and it’s forced our clinic to have a cap on the number of chronic care patients we can help,” she said. “It’s not only [us] but every clinic has a cap, and it’s really sad to turn these people away because they have no place to go.”

County officials have proposed using the windfall from the tobacco industry to lower the county’s debt, pay for jail expansion and, through a financing scheme, free up more money in the general fund. County finance officials hope to make recommendations to the board at a Nov. 9 meeting.

But leaders of a newly formed health care coalition want supervisors to hold off on any decisions until their group and the county Health Care Agency can develop spending priorities.

Besides, “the earliest we would see any [tobacco] money coming in would be next summer,” said Jon Gilwee, a member of the coalition, called Health Alliance to Reinvest the Tobacco Settlement (HARTS).

Health care advocates are upset that supervisors have cut as much as $12 million from the annual health care budget since the bankruptcy. The $40-million pre-bankruptcy budget dropped to $28.3 million and has risen slowly to this year’s $32 million in funding.

Among the hardest hit areas were mental health and alcohol and drug abuse services and hospital indigent health care.

“Most of these programs were restored either in costs or revenues,” maintains David L. Riley, a county health agency spokesman. “The county may have restored the money or found a more efficient way to provide the service.”

The gains, though, are minor, advocates say. The county health agency still closed its Westminster Avenue clinic, which served 3,700 patients a year and provided screening of women for ovarian cancer.

The HARTS group plans to meet early this week to discuss strategy.

Members will be working largely from the Orange County Needs Assessment, a 400-page blueprint of health care needs in the county. The report, released in April, is based on telephone surveys of 5,000 county residents. It identifies who gets sick and who receives care.

Among its key findings are: 425,000 residents lack health care, including 90,000 children; 52% of those without insurance are Latino or Vietnamese; 13% of county residents are eligible for Medi-Cal yet only 8% participate.

It found, for instance, a significant number of people with asthma, diabetes and dietary deficiencies and many who didn’t get check-ups regularly.

The authors of the report agreed that the county’s top priority for health care “should be to find a medical home for every child born in the county,” said Felix Schwarz, executive director of the Health Care Council of Orange County.

To make sure newborns get the medical attention they need, advocates want to educate poor and uninsured mothers while they are still in the hospital about the free and subsidized insurance programs available for children. In some cases, the county would only fund the education process; in other cases, it might subsidize the cost of the insurance, Schwarz said.

The tobacco money also should be used to help financially stressed community clinic programs like Share Our Selves, health care advocates say.

The closing of a Santa Ana clinic that ran out of funds earlier this year shows that there is “no excess capacity” among free and low-cost clinics, said Sam Roth, a HART spokesman who works for the Orange County Medical Assn.

Advocates suggest tobacco money could be used to expand clinic service either by building new facilities or funding an expansion of hours.

The health care community also agrees that the county should steer more money into its Medical Services for the Indigent program. The program pays for the poor who show up at emergency rooms and clinics in dire need of medical treatment. By law, hospitals must treat everyone.

Hospitals, especially the major ones like Children’s Hospital of Orange County and UCI Medical Center, have long complained about meager reimbursements for such mandatory care.

The program has suffered since the bankruptcy partly because the county has tightened eligibility. The number of people served has dropped from 29,000 in 1995 to 20,000 last year.

Without a county hospital--it was sold to UCI nearly 25 years ago--doctors, those who have medical insurance and hospitals that serve the poor essentially subsidize all indigent care, Gilwee said.

“We know there is a desperate need here because we have cut the number treated and we still have 425,000 without insurance,” Schwarz said.

Among other areas being considered for funding by HARTS are: the visiting nurses program, which was reduced after the bankruptcy; senior transportation for medical care; cultural and bilingual outreach programs promoting preventive health care and immunization; expansion of community mental health services; anti-drug, anti-alcohol and anti-smoking programs for youths; increased health services at the county jails; and anti-addiction programs for all ages.

Supervisors acknowledge the need to spend more money on health care but also want to reduce the county’s debt and build a much-needed jail.

While much of the tobacco money will go toward those projects, said Supervisor Todd Spitzer, “we can scrape off about $8 million [a year] for other strategic needs, which include health care.”