Measure H: It Mightve Been Great

Photo by Jack GouldA 67-year-old woman—we'll call her Beatriz —goes to her community health clinic in Anaheim, where the doctor discovers she's suffering from congestive heart disease. In layman's terms, Beatriz's arteries are choking, and she runs the risk—a very high risk —of heart attack.

Beatriz has no health insurance. So Dr. Don Garcia sends Beatriz to UC Irvine Medical Center (UCIMC) in Orange. There, she is treated and released—with a bill for several thousand dollars. Beatriz is well beyond her working days, and her children are themselves mostly poor; in short, she cannot pay UCIMC's bill. Meanwhile, despite treatment, Beatriz's condition has worsened.

What would Measure H have done for Beatriz?

In a word: nothing.

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Measure H is advertised as the compassionate cure to what ails the county's poor. In fact, the hospitals and doctors backing the measure have cynically leveraged public concern about low-income health care into support for an initiative that will do almost nothing to improve the overall health of the poor. But it will do wonders for health professionals. Measure H will send $9 million of tobacco settlement money per year to hospitals and doctors who provide emergency-room services to the county's poor, along with another $6 million per year to a select group of community health clinics that, not surprisingly, are among the measure's most ardent backers.

The best that can be said for H is that these hospitals and doctors are required by law to provide emergency care for the county's poorest citizens; as much as anyone, they deserve a share of the tobacco-settlement money. The worst is that H is virtually identical to Measure G in several respects—it provides virtually the same amounts of money to the Sheriff's Department, anti-tobacco campaigns, senior care and hospitals. While H provides more money to emergency-room doctors than G ($6.9 million vs. $1.8 million), it does nothing to make sure that Orange County's poor don't require emergency care to begin with. No matter which measure wins, not a cent of the money that comes from the tobacco settlement will reach primary-care physicians such as Garcia, doctors who see uninsured low-income patients daily. Who will get paid? Only hospitals, emergency-room doctors, a vaguely described collection of senior-health providers and the 18 community clinics specifically listed in Measure H.

"Measure H leaves out physicians like me who keep people from having to go to the hospital in the first place," Garcia complained. "Instead, the institutions will get the money—but it won't trickle down. That's why nobody has stepped forward to say Measure H is the best thing for the consumer. They are looking at what is good for the big institutions that have emergency rooms. They are taking care of themselves.

"Who's suffering? The poor," Garcia concluded. "Who's being bailed out by Measure H? The corporate senior executives" who run the county's big hospitals.

Garcia says the current crisis in low-income health care has its roots in the 1976 decision to transfer ownership of the county hospital to UC Irvine. As a result of the sale, UCIMC—the county's largest hospital—is no longer required to provide free care to the public beyond emergency-room service, for which the hospital receives state funding each year.

A handful of state and federal programs reimburse the hospital when it treats certain low-income residents, children or the elderly. Unfortunately, numerous cases have arisen in which Orange County residents whose hospital stays should have been covered under Medicare or other programs were never alerted to that fact by UCIMC staff or county eligibility workers. As a result, many low-income residents who end up in emergency rooms are forced to pay for the treatment out of their own pockets.

The Weekly first examined this problem in a story about one of Garcia's other patients, 19-year-old Anaheim resident Karla Ceja ("Preventing Care," May 19). Ceja, who visited UCIMC last year for the delivery of her baby, was eligible for MediCal. But because she is not a U.S. citizen, Ceja told a county eligibility worker that she didn't think she would qualify. Though most noncitizens are in fact covered by the program, nobody corrected her. There were complications with the pregnancy, and what should have been a routine delivery quickly went bad. Ceja's baby died shortly after birth. In addition to her misery, Ceja was left with more than $10,000 in unpayable bills and at least one telephone call per day from the hospital's collection agency. Additional health problems have boosted that bill to more than $24,000.

Even after the Weekly publicized her story, UCIMC and county health workers insisted that Ceja could not receive retroactive coverage; she would have to pay her bills. Garcia intervened, and the hospital agreed in October to pay the massive bill with money from the university's medical scholarship fund.

If Measure H wins, UCIMC could apply for reimbursement from tobacco funds when it treats patients such as Ceja who can't pay their bills. But what Ceja—and thousands of other low-income residents—really need is insurance for relatively cheap primary care that would help them avoid the expensive emergency room altogether.

"Ninety-nine percent of the people who go to UCIMC for emergency care are not insured," Garcia explained. "They are indigent or poor working people that have no access to health insurance. Let them participate in the system—give them an insurance card."

Postscript: on Nov. 7, Don Garcia says, he'll hold his nose and vote for Measure H anyway.

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