Clinics on a Tightrope

Venice Family Clinic looks just like a private facility, and its patients are regular folks, trying to keep their families healthy enough to go to work or stay in school despite their lack of health insurance. The clinic runs with a professionalism and efficiency that public hospitals can’t match: a telephone wait of only two or three minutes to get a clinic appointment, which usually comes within three days of the call. In the process, the clinic, with its 86,135 patient visits a year, takes considerable pressure off local hospitals.

This and 170 facilities like it are what Los Angeles County and state and federal governments have put at risk in their eleventh-hour foot-dragging in the matter of whether a five-year federal rules waiver worth $1 billion to county health facilities will be renewed.

County and state officials are supposed to head to Washington today, having finally found enough common ground to present a plan to save the county’s outpatient public health system. There was an odd atmosphere of calm among the officials, as if the county wasn’t one week away from the expiration of the $250-million-a-year federal waiver that rescued its health system from bankruptcy in 1995. The calm doesn’t extend to the nonprofit clinics around Los Angeles County as they scramble to prepare for the worst, a sudden reduction of county funds that would leave many of the county’s 3 million uninsured residents in the lurch.

The board of directors of the Venice clinic will meet this weekend to figure out whether to raise $166,000 per month to keep it and two other facilities operating at full capacity or to try to cut expenditures further. That $166,000 is what’s left after clinic officials proposed a way to pare $600,000 out of their annual spending. “We have no reserves for this,” said Elizabeth Benson Forer, executive director of the clinic.

Other clinics are in similar situations. The federal extension might be granted for just one year; it might be for an amount less generous than the 1995 bailout. Whether either of those comes about, it’s time to seal the deal.