Both Candidates Focus on Health Care Crisis

By 10 a.m., both waiting rooms at the South Central Family Health Center are filled with people waiting for one of four doctors to treat severe abdominal pains, fevers, diabetic episodes.

Few of the factory workers, nannies or deliverymen who sit elbow to elbow in the low-cost clinic are insured. Neither are the housewives whose husbands hold other low-wage jobs that do not offer benefits.

Because of the crushing demand for affordable health care among the uninsured, many will have to wait hours to see a doctor.

This, in a nutshell, is Los Angeles’ health care crisis. According to UCLA researchers, 41% of the city’s adults and 33% of its children are uninsured. That’s much worse than in the rest of the county, where 26% of adults and 20% of children don’t have health insurance.

While the city is ground zero for the problem, it has no legal responsibility to meet its residents’ health needs. That job falls to the county. But if Mayor Richard Riordan’s work in education has proven one thing, it is that the office’s influence can be pushed beyond its official limits.

Using the Power of the Office

Both men hoping to succeed Riordan, City Atty. James K. Hahn and former state Assembly Speaker Antonio Villaraigosa, say they would use the power of the office to lessen the ranks of the uninsured. Both also are adamant that no city tax dollars ought to be used to solve the problem.

They focus on the need to encourage more businesses to offer their employees health insurance and to help the poor access government-sponsored health programs. The liberal Democrats differ mainly in their strategies.

Villaraigosa is proposing specific measures involving schools and subsidies to small business, while Hahn speaks in general terms of outreach and using the bully pulpit to cajole business owners into providing health insurance.

Villaraigosa, who is more likely to raise the health care issue on campaign stops, touts his work in the Assembly in launching the state’s Healthy Families program, a low-cost insurance plan for the working poor.

If elected, Villaraigosa said, he would support a bill by Assemblyman Gil Cedillo (D-Los Angeles) that would bring down the exorbitant cost of health insurance for small businesses through group purchasing and subsidize premiums for their low-wage workers who do not qualify for other government programs.

Villaraigosa said he would like to spend an unspecified portion of the $15 million of tobacco settlement money the city collects every year to further subsidize premiums.

“Rather than by executive fiat require small businesses to provide health care, I think we need to provide incentives,” he said. “And one incentive is to address the high cost of health insurance in Los Angeles.”

Cedillo’s bill proposing the $499-million program died last year in the Senate, and some worry that the prospects are dim this year. Confronted by a softening economy and worsening energy crisis, Gov. Gray Davis last week announced he was dipping into the state’s emergency reserve fund to finance a pared-down budget for the fiscal year that begins in July.

“This year, anything that has a ticket price of that size is in danger because of the energy crisis,” said Beth Osthimer, an attorney with San Fernando Valley Neighborhood Legal Services who specializes in health care issues.

Los Angeles’ staggering rate of uninsured residents has long been thought to arise from its high number of small businesses and service industry and garment factory jobs.

Unlike large corporations, these employers typically do not offer health insurance. Many say they cannot afford it. Some observers believe an abundance of undocumented immigrants, willing to work for small salaries, also depresses wages and makes benefits a luxury.

Hahn agrees that business owners are a big part of the solution to the problem of the uninsured. If elected mayor, Hahn said, he would speak out about the issue to persuade business owners to offer the benefits voluntarily.

“I think health care is a basic right, and we ought to push employers, and the city needs to have the courage to take a moral stand that we believe that if somebody [has] a full-time job that they ought to have health care,” Hahn said.

Federal laws prohibit local governments from requiring businesses to offer health insurance. Some advocates for the poor have been searching for ways to increase coverage through the “living wage” laws that many cities have adopted in recent years. Those laws require businesses that contract with government to pay their employees salaries above the minimum wage.

“Since the living wage passed in 1997, we’ve been trying to solve the health care issue,” said Madeline Janis-Aparicio, a leader of the Living Wage Coalition and an active union organizer. “It’s like moving through sludge. We have not been able to get leadership of any top city officials or staff. We’re hoping that with a new mayor we’ll see some leadership.”

Good Timing for Leadership

There’s never been a better time for it.

Next year, the federal government will begin phasing out a $247-million-a-year bailout of the county health department.

The department still has no solid plan for how it will make up the difference, and it now is essentially rudderless. Its director resigned, and his second-in-command will fill the job until the county finds a replacement. The medical director was ousted last year and has not been permanently replaced.

A decrease in services would mean even longer lines at county clinics and hospitals, where patients already languish for hours--sometimes days--before they are treated. More than 2.5 million uninsured residents rely on the county’s public health facilities.

And although getting employees of small businesses insured would help ease the strain on overcrowded public facilities, it would not make a difference for tens of thousands of day laborers, gardeners and housekeepers who work in the city’s underground economy.

These are people who earn so little they qualify for government assistance, but the fear of deportation, the lack of information about government programs and mistrust of government keeps them from applying for the aid.

The fears are unfounded, according to the county’s Department of Public and Social Services, because being an illegal immigrant does not disqualify someone from Medi-Cal or Healthy Families, nor will it affect a person’s immigration status.

Carmen Chavez, a garment factory worker, has lived here since emigrating from Mexico in 1972. Despite her low wages--currently $240 a week--the single mother of five spent decades without health insurance because she didn’t know she qualified for government aid.

She developed recurring severe abdominal pain more than a year ago, but said doctors at a county clinic and hospital only checked her vital signs and sent her home, telling her to return if she began to bleed or became feverish.

Chavez could not afford a private doctor, so she put up with the pain until finally deciding to cross the border and see an affordable doctor in Tijuana. “I had to know what I had,” Chavez said. An ultrasound revealed a two-pound tumor.

She said county hospital workers had done one thing for her: A clerk told her she and her children probably qualified for Medi-Cal, California’s version of the federal Medicaid program for the poor. She applied and was accepted into the program, which three months ago paid for surgery to remove the tumor.

But the pain in her right side persists, and a weary Chavez returned to the South Central clinic last week. Worried doctors ordered a CT scan.

Ways to Get More People Signed Up

Both Hahn and Villaraigosa said they will work to get people like Chavez and her children signed up for government-sponsored health programs. As with many other issues, there are only subtle differences in how the candidates say they plan to do that.

Villaraigosa said he will press the Los Angeles Unified School District to get more involved in enrolling children in government health programs. His efforts are in line with another Cedillo bill, which proposes to cut red tape by assuming that families who qualify for reduced-fee school lunches probably qualify for help with health insurance.

Hahn said he wants to use schools, libraries, Internet sites and private, nonprofit community groups to get the word out to residents that these programs exist and where and how they can apply.

Both cited paramedic services as one area of health care where the mayor does have some responsibility and can make a significant impact, noting the city’s low ratio of paramedics to residents.

Riordan’s budget, unveiled last month, calls for the addition of 80 paramedics to the Fire Department, but it is only a fraction of the 500 the department hopes to add in five years to meet the increasing need for emergency services.

“That’s one big area where the city is involved in health care,” Hahn said. Displaying familiarity with the subject, he said he did not think that past solutions, which stretched resources by splitting up two-paramedic crews and teaming them up instead with lesser-qualified emergency medical technicians, are the answer.

“I think it works best when both individuals are able to provide the same level of service,” he said. “I think we should be expanding that to have more paramedics.”

Villaraigosa said he wanted to ensure that the gains of this year are permanent, but stopped short of calling for expansion. “I want to look at whether or not we need to build on this,” he said.

Both mayoral candidates say they will lobby the state and federal government to increase their share of health care dollars, which finance 80% of the local public health system, according to the county health department. They agreed that money won in a settlement with tobacco companies should be spent on health care.

“Since I was the guy who won the money, I have a little proprietary interest in how it’s spent,” the city attorney said, referring to his role in joining the lawsuits filed by local governments against the tobacco companies. Los Angeles’ $312-million share, spread throughout 20 years, should pay for “whatever we can do to keep children from smoking . . . or improve the health of city residents.”

He defines that broadly to include the expansion of meal programs for seniors, elder care and day care.

Villaraigosa said that, aside from the money he proposes to spend on a small business health care subsidy pool, the remainder should be spent on smoking-prevention programs.

Although health care is an important issue for the mayor to take on, both men draw the line at spending city tax dollars to help solve the problem.

“I’m not suggesting by any stretch that we need to take on the role of the county or somehow tackle that issue directly,” Villaraigosa said.

Hahn agreed: “The city obviously has a finite budget, and if we try to take on a whole new responsibility, other services will have to be cut, and we can’t do that.”