Delay Sought in Health Care Cuts

A coalition of labor, clergy and political leaders Tuesday accused Los Angeles County supervisors of preparing to cut health care to the uninsured as a ploy to get more money from the state and federal governments.

“You can’t say, ‘OK, we’re going to let poor people die and this will wake up the state and [federal government],’ ” said former Los Angeles Mayor Richard Riordan, who was among those urging supervisors to postpone the service reductions they are slated to make today.

Supervisors will consider a plan to cut $150 million from their sprawling health system, reducing hospital beds by 29% and outpatient care by 26% and eliminating 5,000 positions. The county has enough money on hand to keep the department at full strength through next year, but declining federal funds leave it with a projected $800-million deficit by 2005, and county officials say they need to move now or face worse shortfalls in the future.

In interviews Tuesday, supervisors were cool to the requests for delay. “The feds expected us to do this five years ago,” Supervisor Yvonne Brathwaite Burke said. “Where we made our mistake is letting people like Mr. Riordan make us delay so we have no credibility in Washington.”

The last time the county was in such dire financial straits was the mid-1990s, when a $1-billion bailout from the Clinton administration staved off hospital closures. The money, in the form of a waiver of Medicaid rules, came with strings attached: The county had five years to make its system more efficient before the money expired.

Supervisors did not make all the reforms they had promised, and in 2000 asked the administration for an extension. They got another five years, but the amount of money dwindles each year until running out in 2005. Declining federal money means that deficits will begin in the next fiscal year.

Although the supervisors have enough cash on hand to close that gap for now, they have argued that using spare cash to keep the health system going without future funding would create more severe problems. “Just to sit on our hands and say, ‘The money’s coming, the money’s coming,’ is foolish,” Supervisor Don Knabe said.

But the officials who spoke Tuesday, calling themselves the Coalition for Healthy Communities, said it is dangerous to cut health services.

Cuts should only be made, said Dr. Brian Johnston of the Los Angeles Medical Assn., “when it’s demonstrated it can be done safely, without putting people at risk.”

Riordan pointed out that the county system not only cares for the uninsured, but also provides emergency services to all classes. “Whether you’re rich or poor, if you’re in an automobile accident, or the bus you’re on is hit, if you’re brought to an ER, the chances are 50-50 you’re going to be brought to a county ER,” Riordan said. His successor, Mayor James K. Hahn, released a statement also urging the supervisors to delay cuts.

Robin Smiler is a nurse at the busiest of those emergency rooms, at County-USC Medical Center in Boyle Heights, where patients in gurneys line the hallways, waiting for a free hospital bed. Supervisors will consider reducing that hospital’s size from about 700 beds to 600 by 2005.

“You don’t know what it’s like to tell a mother you can’t medicate her child because you’re too busy trying to intubate a gunshot wound victim,” Smiler said. “I just want to urge the board, please don’t move so fast that things will spiral out of control.”

Speakers did not identify new sources of money the county could find to pay for the system. Riordan said the county should sit down with state and federal officials and hammer out a solution.

Supervisors, who meet annually with health officials in Sacramento and Washington, scoffed at that. Burke said she had spoken with President Bush when he came to Los Angeles in April but that she does not see an easy answer.

“We have a choice. We can do this and try to start to cut down on our system of delivery,” Burke said. “If we don’t, we run out of money and we have nowhere to go.”