Health on the Line

Over the next seven days in Sacramento, legislators will determine the funding of basic health services in California. The outcome has broad implications for the life of every citizen because the trauma and emergency-room programs are included.

The most important package of bills covers the reform of prenatal, perinatal and child-health services, merging many of them into the so-called Baby-Cal program (AB 3595 and 3747) and expanding Medi-Cal physician fees in perinatal services (AB 3646) in ways not only to improve service but also to ensure more participation by doctors.

Another package would provide an additional $25 million in state and $25 million in federal funds for the medically indigent, for hospitals with emergency services and outpatient services that are generating disproportionate numbers of non-paying patients. The amount of money is small, but it goes to the heart of remedying the financial crisis that has brought serious deterioration in the trauma network and emergency-room services of Los Angeles County.

In long-term-care programs of Medi-Cal, a budget increase has been proposed to ensure compensation for nursing homes at least for the increased cost of implementing California’s new minimum wage and the ripple effect that it inevitably will have on pay scales of other workers. Without that relief, the nursing facilities will face a deterioration of services that already are severely pinched by budget constraints.

Two other health areas have urgent demands on the budget. For AIDS, it has been proposed to make a further increase of $42 million beyond the funding proposed by Gov. George Deukmejian. Even that would only begin to cover the escalating cost that extends beyond care to the area of education, the only defense against the epidemic’s spread. And in the mental-health program a call for $25 million has been sounded in the Assembly--hardly an adequate response to escalating needs, including the growing need for services to AIDS patients suffering dementia, but at least a start.

These proposals would drain the state’s reserves. But that is what the reserves are for. This is a year of fiscal crisis. But it is also a year that is marked by a continuation of a crisis in the basic healthcare system. To ignore that crisis, to postpone the responses that are now before the Legislature, would invite grave consequences.