Initiative Launch: Health Would Get Tobacco Money

Saying Orange County shirks its legal duty to provide medical services to the poor, a coalition of county health advocates Thursday launched a campaign for a ballot initiative that would steer most of the county’s $900 million in tobacco settlement money to health care.

The group--which includes all hospitals, community clinics and major physician organizations in the county--also received the backing of Msgr. Jaime Soto, vicar for Hispanic affairs for the Diocese of Orange, and former county Supervisor and state Sen. Marian Bergeson.

“It is the duty and statutory obligation of the Board of Supervisors to provide these health care services,” Bergeson said Thursday at a news conference kicking off the effort to qualify the measure for the November ballot. “[For the county] to deny that responsibility is not fulfilling its obligation.”

On Thursday, CHARTS, or Citizens Health Alliance to Reinvest the Tobacco Settlement, filed a copy of the proposed initiative with the county registrar of voters. In mid-March, coalition members can begin gathering valid signatures from 71,206 registered Orange County voters to secure a spot on the November ballot.

The initiative would allocate 80% of tobacco funds each year to health care programs and 20% to the Sheriff’s Department. The money would go for such things as senior health care and transportation, emergency rooms, community clinics, mental health facilities and anti-smoking and drug rehabilitation efforts.

The coalition launched the initiative after what members called stalemated negotiations with the supervisors over how to spend the tobacco settlement money.

Supervisors have voted over the past six months to spend the vast majority of the $900 million--expected in annual settlement payments of $30 million to $38 million over 25 years--on jail projects and reducing the county’s bankruptcy debt. Health care would get about $8 million annually over the next 10 years, with more possible in subsequent years, under one county plan.

Supervisors have said in recent weeks that they would oppose such a ballot measure and don’t plan to change their position on allocating tobacco cash.

“Good luck to them, but I don’t support it and won’t change my priorities,” Supervisor Jim Silva said.

He took issue with Bergeson’s statements that the supervisors are making a mistake, saying: “She is not on the board. She resigned. I am on the board, and it is my responsibility.”

Supervisor Cynthia Coad said the county must reduce its debt and remains under a 1978 court order to expand its severely crowded jail facilities.

“Their heart is in the right place, but I am just asking the public to look at all the needs the county has,” Coad said.

Health Care Agency Director Michael Schumacher pointed out that the county will spend $32.6 million this year from its general fund for health care, an amount that has increased by $4.3 million since the bankruptcy.

He also said combined federal, state and county funding for medical services to the indigent has grown 26.5% since fiscal 1996, to $42.3 million.

But coalition members maintain that county support was inadequate even before the bankruptcy, when the county spent $40 million on health care. The county cut its share of the health care budget by $12 million in the months after the 1994 bankruptcy.

The result, coalition members say, is that physicians, clinics and hospitals are forced to provide the equivalent of hundreds of millions of dollars in unreimbursed care to the poor, the uninsured and others. An estimated 425,000 Orange County residents lack health insurance, and hospitals cannot legally turn away patients in need who cannot pay.

“The emergency medical system is on the brink of collapse,” said Dr. Daniel Abbott, president of the California branch of the American College of Emergency Physicians.

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Coalition members say the annual shortfall in payments for medical care in Orange County includes:

* $160 million in uncompensated care [bad debt and charity] for people who could not pay hospitals;

* $14.6 million in uncompensated care provided by community clinics;

* $16 million in reduced payments to physicians caring for the 18,000 people in the county’s program of medical services to indigents. The amount is the difference between the $10 million the county actually paid physicians and the $26 million in allowed charges;

* $99.2 million in similar unpaid charges to hospitals under the indigents program.

Coalition members vowed to raise $1 million to win passage of the ballot measure. Each of the 31 hospitals in the county has agreed to raise at least $10,000 for the drive, said Peter Bastone, CEO of Mission Hospital Regional Medical Center and a board member of the Healthcare Assn. of Southern California, a hospital trade group.

Doctor groups and others are expected to provide additional contributions. Others involved may include the heart, lung and cancer associations. Also endorsing the initiative were the American Assn. of Retired Persons and a group of 14 churches in central Orange County called the Orange County Congregation Community Organizations.

“We have negotiated for a year,” Bastone said. “The only way to move them is an initiative.”

Coalition members said there would be no going back or negotiating a compromise.

“We are taking this to a vote in November,” said state Sen. Joe Dunn (D-Garden Grove).

It was unclear who might mount opposition to the CHARTS group. None of the supervisors said they would lead such a fight.

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The CHARTS initiative would give 19% of the annual allotment to health care and transportation programs for seniors and the disabled; 20% to community and hospital clinics; 23% to physicians and on-call doctors who treat nonpaying patients at emergency rooms; 12% to anti-smoking, addiction and mental health programs; 6% to hospitals for uncompensated emergency room care, and 20% to the Sheriff’s Department for public safety programs, which the initiative suggests could include expansion of mental health, alcohol and drug abuse treatment programs and facilities for inmates.

The initiative has an escape clause that would allow supervisors to reallocate tobacco settlement funds for one year during a fiscal emergency, defined as a predicted decline of 10% or more in the county’s general fund.