Board Funds Medical Care for Indigent

SANTA ANA —  The Board of Supervisors on Tuesday pledged $7.5 million for indigent medical care, giving up their long-held insistence that the state bear the cost of the entire program.

Without comment, supervisors agreed to provide county general funds to Indigent Medical Services, an 8-year-old, county-run program that reimburses doctors and hospitals for treating uninsured patients. The action came even as the board faced a $60-million deficit for the next fiscal year.

The move, along with a decision last week to spend $740,000 for a preventive medicine and basic care program for the county’s poor, signals greater recognition by the supervisors of the crisis in health care and a new commitment to ease it. These funds are the first provided by the county for the indigent that were not required by the state.

“We are taking a step toward making health care--and health care access--a priority,” said Supervisor Harriett M. Wieder, chairwoman of the county’s Health Care Task Force. “ . . .My colleagues are recognizing that health care needs to be a priority along with the monies we budget for crime.”

Doctors, hospital officials and health care advocates applauded the board’s new interest in subsidizing health care. “This is a major change,” said Russ Inglish, vice president of the Hospital Council of Southern California. He said the IMS program was still under-funded--but less so now.

“I think this is real movement,” Inglish said. “It’s a showing from the Board of Supervisors that they are concerned about indigent health care.”

Board Chairman Gaddi H. Vasquez said that Tuesday’s vote showed “that the board considers health care a priority. And we are doing as much as we can . . . hopefully to maintain a system that provides essential services.”

Each month more than 24,000 Orange County residents seek emergency treatment under the Indigent Medical Services program. Many of these, usually white males, are employed but lack private health insurance and do not qualify for the state Medi-Cal program, county officials have said.

The decision to add county money to the IMS program came under duress--out of concern that doctors and hospitals might quit the program if new money was not added, said Health Care Agency director Tom Uram, who negotiated the agreement with doctors and hospitals.

“I was convinced unless the county came up with some money we would not have a system” of indigent care, Uram said. “The rate of payment was getting to the breaking point. I suspect hospitals or doctors would have bailed out” if supervisors had not found new money for the program.

The board’s action must be ratified by 30 local hospitals, probably by late July, Uram said. Overall, the agreement would boost the IMS reimbursement pool to $38 million for the fiscal year beginning July 1. (The rest of the money comes from state, federal or required matching funds designated for health care from Orange County.)

Uram said the $7.5-million addition will probably help hospitals and doctors regain some of the funds they lost when Gov. George Deukmejian last July slashed the budget for medical indigent programs statewide. In that cut, Orange County lost $11.5 million of state money for medically indigent adults, receiving only $13.2 million from the state.

At that time, many counties including San Diego and Los Angeles used local funds to restore funds that were cut. But Orange County supervisors testily declined to do so and accused doctors of doing too little to aid the indigent.

On Tuesday, Uram said he expected Orange County to receive about the same amount in state funds for the 1991-92. So “an additional $7.5 million practically makes up for the $11.5 million cut” last year, he said. He added, “I’m optimistic that health care has a higher priority with this board than it did five years ago.”