Little Hoover Commission Report Says HHS System Could ‘Collapse’ Without Reform
The state's "$60-billion-a-year" health and human services system is "in danger of collapse," and Gov. Arnold Schwarzenegger (R) and policymakers must make "fundamental reform" their "highest priority," according to a report by the Little Hoover Commission, an independent state oversight committee, the Los Angeles Times reports. The report, the result of a yearlong investigation of 13 state departments under the umbrella of the Health and Human Services Agency, said that "[a]s organized, managed and funded, the system is simply unsustainable," noting that the health of the most "vulnerable" Californians has suffered as a result. The report found that California ranks 43rd in the nation in health coverage for children, with one out of six children uninsured, and 48th in ensuring that all residents have health insurance -- six million children and adults are on Medi-Cal and another six million have no insurance at all. According to the report, drafted by a 13-member panel, such rankings are the result of "years" of problems that have not been addressed, "patchwork repairs" that have not been effective and failure to track the efficacy of programs, the Times reports.
The panel said that a growing number of eligible residents are being denied care while less-qualified beneficiaries have access to the same programs because of "overly complex" organizational structures, "perverse" funding incentives and "weak" oversight. At the same time, "[d]uplicative" state government functions -- such as 10 teenage-pregnancy programs operated independently by four departments -- are not using state funds effectively, according to the Times. The panel also criticized past attempts to address problems within the agency, noting that the "lack of focused and persistent leadership has resulted in piecemeal reforms that only made matters worse." The panel urged Schwarzenegger to "take the lead in rescuing threatened services from an expensive, inefficient and duplicative bureaucracy and to make the responsible departments perform better at less cost," according to the Times.
The commission offered a number of advisory recommendations for reform that "would produce millions of dollars in immediate savings and billions in years ahead," according to the Times. It stated as its top priority increasing cooperation among the state and local governments and shifting control of programs and funding to the counties, where most of the services examined in the report are delivered. Counties, in turn, should be held accountable for programs' performances. The panel also suggested that the state "more aggressive[ly] ... pursu[e] federal funding and obtai[n] waivers" from the federal government for "innovations that might deliver services at lower costs," the Times reports. The commission estimated that the state could save about $5.5 billion by increasing efficiency in local programs by 10%. According to the Times, if the governor and state lawmakers commit to making fundamental reform of the agency "their highest priority, a more economical and efficient system could emerge that would help the state both 'live within its means' and deliver essential services to the needy," the report said (Ingram, Los Angeles Times, 5/6).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.