LOS ANGELES COUNTY: Waiver Negotiations Stall as Deadline Looms
The battle over a $1-billion federal bailout of Los Angeles County's health system has turned into a "poker game," with spectators wondering which player -- the local, state or federal government -- will "blink first," the Los Angeles Times reports. In 1995, the federal government waived Medicaid regulations that would have prevented the county from receiving full reimbursement for care given at outpatient clinics rather than at hospitals, and many expected that the waiver would be extended past its upcoming June 30 expiration date. However, the Times reports that "battles over money and questions of whether the county has truly fixed its Department of Health Services" are stalling negotiations on the matter. In the wake of recent congressional allegations that HCFA "violated its own rules in forgiving Medicaid debts of public health agencies in Los Angeles County and New York City," the agency wants the county to "wean itself off federal dollars." HCFA officials also argue that the federal government should not have to shoulder the financial burden of a bailout alone, especially because California boasts a hefty budget surplus this year. HCFA officials also have questioned why the county did not save "nearly as much money as it had projected" in 1995 or move more patients into community clinics. Meanwhile, Gov. Gray Davis (D) is "wary" of spending too much of the state's $13 billion surplus on "an ongoing cost like a health care bailout." For its part, the county has offered to pay $60 million annually toward the proposed bailout. Alejandro Stephens, president of Service Employees International Union Local 660, said that each level of government is waiting "to see what the other side is going to do first." If they wait too long, county officials say they may have to shut down dozens of clinics and scale back services at others. A meeting involving representatives from Los Angeles County and the state and the federal government was scheduled for Monday in Washington, D.C. (Riccardi, 6/4).
Adding Fuel to the Fire
Upping the stakes in the negotiations, the Los Angeles Board of Supervisors yesterday voted to move forward with an environmental impact report for a new, smaller County-USC Medical Center to replace the earthquake-damaged Boyle Heights hospitals. The vote comes one week after Assembly Speaker Bob Hertzberg (D-Sherman) wrote a letter to the board urging them to stall approval of the report until "we put aside our differences and come together in support of one plan" to fix the county's looming health care crisis. Hertzberg added that he had created a special Assembly committee to investigate the potential problems if the waiver is not extended. Assemblywoman Gloria Romero (D-Los Angeles), who heads the new committee, attended yesterday's meeting to persuade supervisors to delay the report. Some county officials and medical experts argue that a smaller facility will not be able to handle the medical needs of the community. Noting that the County-USC issue has "soured relations" between the supervisors and the Legislature, Supervisor Gloria Molina, who has fought for a larger facility, said, "I'm sure the governor and the speaker are not going to allow dollars to come into L.A. County ... and shortchange East Los Angeles" (Riccardi, Los Angeles Times, 6/7).
The Blame Game
"Blame for this unnecessary drama can be laid not only on the county, but also on the state and the feds," a Times editorial asserts. Admitting that the "county acted badly from the beginning" by failing to meet its stated goals of reducing costs and neglecting to make plans for the eventual loss of the waiver, the editorial argue that the federal waiver must, nonetheless, be extended "because too much misery will result if it isn't." But, they add, HCFA is right to demand that the county and the state share in the cost of the bailout. The editorial concedes, "If the federal brinkmanship can be set aside, and if the county and state quickly come to terms on shouldering a fair portion of the cost, Los Angeles County's huge uninsured population can retain the publicly provided care it needs. Washington, Sacramento and Los Angeles officials would do well to remember that the bureaucratic lines that separate them don't matter to uninsured sick people" (6/4).