By Rob Waters
June 7, 2013
Read the original blog post at Forbes.com
A battle has broken out between California counties and Governor Jerry Brown, who is proposing to take an estimated $2.5 billion over the next three years from local health and prevention programs.
These funds, which have flowed from the state to counties since 1991, support community clinics in Los Angeles and other cities that serve poor people who don’t have insurance. They help pay for public health programs, like one in Alameda County that provides preventive services to children with asthma, reducing hospitalizations.
The Brown administration says the money will no longer be needed by the counties because the Affordable Care Act—Obamacare—will enable low-income people to obtain health coverage, either through the Medicaid program or from federal subsidies for private health insurance. Brown proposes to take $300 million from the counties this fiscal year, $900 million next year and $1.3 billion in 2015-2016.
Counties and health advocates contend that many uninsured people who rely on safety-net clinics for treatment will remain uninsured and need community care even after Obamacare is implemented. And they say expanded health insurance coverage, while important, won’t fund the critical prevention work that can keep people from needing treatment in the first place.
Alameda County may lose more than half of the $56 million it gets from the state for healthcare and public health programs, says Alex Briscoe, the county’s director of health care services.
“Our safety net programs are already bursting at the seams,” Briscoe says. “This proposal is divorced from the reality of what’s going on locally. We think the state has hugely underestimated the number and the burden of the residual uninsured.”
California has moved as fast as any state to carry out the Affordable Care Act. The state is moving quickly to expand Medicaid and to set up healthcare exchanges where people will be able to buy insurance. But even after the act is implemented, 3 million to 4 million people in California are expected to remain uninsured, including about 800,000 undocumented immigrants, says Anthony Wright, executive director of Health Access, a California advocacy group.
The cuts are likely to weaken an infrastructure of clinics and programs that counties have created to serve the uninsured, Wright said. The impact may be intensified because the cuts would come at the moment counties are trying to gear up to enroll people in MediCal, he said.
“We need all the capacity we can get during this transition,” Wright says. “This would take money out of the safety net at exactly the time we need it most. That doesn’t make any sense.”
The cuts to public health and prevention programs may have “disastrous results,” says Cynthia Harding, deputy director of the Los Angeles Department of Public Health. Her department gets $69 million from the state and uses it to investigate disease outbreaks, provide flu vaccines in the community and run campaigns to prevent injuries and violence.
When an outbreak of hepatitis A related to frozen berries began to emerge in April, her department quickly put together emergency clinics and vaccinated people who may have eaten the tainted fruit. “We could have had a huge outbreak,” she says.
Even without the proposed cuts, counties are struggling to fund prevention efforts that have been shown to make a difference. An Alameda County program called Asthma Start has had great success helping children with asthma keep their symptoms under control. It should be serving about 2500 children—but the county only has enough money to serve 400, Briscoe says.
“We come to your home, vacuum, get rid of asthma triggers and make sure you have primary care,” Briscoe says. “About 90 percent of these kids don’t need to go back to the emergency room.”
For these children, access to health insurance won’t solve their problems—unless it comes with effective prevention.
“People aren’t going to get healthier just because they have health insurance,” says Briscoe. “The things that cause poor health are violence, poverty, dirty air. Those are the things we need to address.”