The Los Angeles County Board of Supervisors has yet to figure out how to deal with the 2.7 million county residents who do not have health insurance--the largest uninsured county population in the United States--and time is running out.
In 1995, President Clinton came to the rescue of the county's ailing health system, which is the last resort for non-elderly citizens without insurance, when L.A. County faced a shortfall of several hundred million dollars.
Later, the federal Health Care Financing Administration provided some funds over a five-year period to allow the county to develop solutions to the chronic under-funding of its health care system.
A year ago, arguing that five years was not long enough to reconstruct the system, the county won an extension of the waiver and the continuation of the additional funding.
But federal authorities warned that the county system will have to be financed through its own means starting in 2005.
What has happened since last year to prepare for this? Not much. A "blue ribbon committee" made a series of recommendations, but the supervisors did not act on them. Among the recommendations was that the Department of Health Services be placed under an independent board in order to provide the stimulus for change.
So far, the Board of Supervisors has rejected this idea.
If nothing changes, what can we expect to happen in two years, when the waiver falls off sharply? Crisis. Cutbacks. Closures.
The Venice Family Clinic, the largest free clinic in the U.S., received $3 million of the waiver funding when the supervisors asked it to take over two county ambulatory care sites.
The clinic is now the only safety net for 17,000 uninsured Westside residents who make 88,000 visits a year. One hundred new patients are turned away each week.
What will happen without the waiver funds?
The board does face the problem of inadequate funding, but so did New York State.
New York, however, will soon launch a program to use $1.1 billion in state, federal and county funds over 31/2 years to reduce the state's uninsured population by about 619,000.
The program will provide free health insurance for those families earning up to 150% of the poverty level--too much to qualify for Medicaid (the same as Medi-Cal here)--and for single adults who earn up to 100% of that level.
This program--the first time a state has extended such a government insurance to adults without children--marks a shift in Republican Gov. George E. Pataki's thinking about the role of government in covering the uninsured.
It is a step that California Gov. Gray Davis, a Democrat, should find easier--if he would focus on it.
New York State may not have solved the whole problem, but it is improving it one step at a time.
In L.A. County, each step will require imagination and hard work. To date, the Board of Supervisors has shown none of these qualities.
We need results before time runs out, when the only way out of the mess will be to close clinics and impose severe cutbacks.
Failure to act now before the waiver and its subsidies run out is unconscionable.
Eighty-five percent of the county's uninsured population works.
Many of these people are on the front lines of child care and elder care or have jobs in the food service business. It is in everyone's best interest that they stay healthy.