Court balks at limit on indigent healthcare

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Times Staff Writer

A state appeals court has struck down a San Diego County program that offers free healthcare to those who make $1,078 a month or less but provides no subsidies for those who make more.

The decision Wednesday by a three-judge panel of the 4th District Court of Appeal reversed a trial court’s decision in favor of the county’s all-or-nothing plan.

Attorneys for the plaintiffs said Wednesday’s decision could bring lifesaving care for thousands.


“This opinion will save lives and prevent a good deal of needless suffering,” said Richard Rothschild, an attorney with the Western Center on Law and Poverty in Los Angeles.

The San Diego County Board of Supervisors will meet in closed session June 12 to decide whether to appeal the decision to the state Supreme Court.

More than 21,000 people a year in the county receive care under the program for indigents.

At issue is the county’s rule that denies free or subsidized care to anyone who makes more than the $1,078 cap. Many other counties apply a sliding scale, providing partial payment for care for those making slightly over an income limit.

San Diego’s position, which swayed the trial court, is that nothing in state law requires a sliding scale.

“Our position is that while we do owe indigents care, we have full discretion over defining who is indigent and thus eligible,” said Deputy County Counsel C. Ellen Pilsecker.

The three-judge panel said that under the county’s rule, many working poor have little choice but to quit their jobs in order to get healthcare. The panel cited one case in which a woman’s cancer was inoperable by the time she had quit her low-paying job to become eligible for free care under the county program.


The class-action lawsuit challenging the county’s eligibility rules was filed in 2005. After losing an initial round in court, the Board of Supervisors increased the eligibility limit from $802 a month to $1,078. But the supervisors declined to change their policy to subsidize care for those earning above the limit.

The $1,078-per-month figure represented 135% of the national poverty income level. By comparison, Orange County sets its eligibility limit at 200%.

Plaintiffs’ lawyers argued that the county set the income limit unrealistically low based on a flawed study of the cost of living in San Diego.