Community Editorial: Debating Health Care Funding at the Local Level

Dr. Edward C. Kravits, an ear, nose and throat specialist, administers to a patient at the Lestonnac Free Clinic in Orange. (Photo by: Violeta Vaqueiro)

Dr. Edward C. Kravits, an ear, nose and throat specialist, administers to a patient at the Lestonnac Free Clinic in Orange. (Photo by: Violeta Vaqueiro)

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Nearly 275,000 Orange County residents depend on as many as two dozen organizations operating a network of 65 local community health care clinics that address primary care needs.

By 2014, another 140,000 residents potentially will swell clinic client lists with the advent of a new national health care law that expands eligibility.

Next to CalOptima, which is the county’s managed care health plan for the elderly and poor, and Kaiser Permanente, the clinics are one of the main service providers for the poor and uninsured across Orange County.

“We are the safety net,” said Isabel Becerra, who is the executive director of the Coalition of Orange County Community Health Centers and visited with the Voice of OC Community Editorial Board last week.

The advent of a new national health care law has really focused attention on finding the most cost-effective and healthful way to provide basic medical care for the poor.

Yet it has also triggered a political firestorm, evidenced by the current debate in the U.S. Supreme Court.

Orange County supervisors have rejected more than $20 million in health care grants from the Obama administration in recent years, arguing that the grant strategy is duplicative and part of a questionable federal strategy to expand long-term debt to service current social service needs.

Becerra said she respectfully disagrees with county supervisors, saying that the health care grants do lower long-term costs for taxpayers.

“Prevention saves money down the road,” Becerra said.

Yet regardless of the local funding stalemate over what critics call “Obamacare,” community health care leaders like Becerra say supervisors can still do a lot to expand health care opportunities for Orange County’s most threatened residents.

She wants county supervisors to increase the federal designations for qualified, one-stop health centers serving medically underserved populations.

Orange County new has five centers with that designation. Becerra said it should be 10.

While county supervisors have been reluctant to do that in the past, Becerra said it’s critical that resources to pay for doctors at small clinics be expanded.

Becerra said county supervisors have led in this area before.

She specifically credited Supervisor Bill Campbell and former Supervisor Lou Correa for supporting expansion of federal designations for community clinics that ultimately allow them to serve more clients.

Becerra credited Campbell as a leading force in getting the designation for a Huntington Beach-based clinic several years ago.

She also believes its time that supervisors continue that trend by doubling the amount of clinics with the federal designation.

Last week, community clinic supporters fanned out in Sacramento and spoke with legislators about the advantages of the network created in Orange County.

Becerra said there’s good capacity in terms of patient rooms at clinics. But those exam rooms are often empty and need doctors to serve poor residents.

“If we don’t increase the capacity in terms of providers, we’ll be tapped out, and that’s why an increase in federal resources is really important to us,” Becerra said.

“The doctors are working at their capacity,” she said.

A federal designation is worth $650,000 for five years for each clinic, Becerra said.

When asked about county supervisors and the rejection of Obama health care programs, Becerra says Orange County faces a stark shortage on dollars.

The central issue, she sees, is that “everybody loses money on MediCal. It’s no secret. The only ones that make money are the federally designated clinics because their reimbursement rates are much higher.”

Community Editorial Board member Jennifer Muir asked why some smaller clinics are reluctant to seek the federal designation.

“The No. 1 reason is governance,” said Becerra, noting that a federal designation means the clinic must have a board of directors composed of users.

Community Editorial Board member Anne Olin wondered aloud about the business model for small clinics that can’t get the federal designation.

“Those that are able to achieve the designation can subcontract with those that don’t,” Becerra explains. For example, the clinic “Healthy Smiles” that only does dental care can’t get the designation, but they can subcontract to clinics that don’t offer that service. And they can subcontract at a higher rate.

Community Editorial Board member Rusty Kennedy asked the toughest question: whether the undocumented can receive care.

“Yes,” Becerra said, acknowledging it’s the No. 1 question she gets from elected leaders about the clinics’ work.

“The reason is that until federal law changes, we don’t ask for that at the front end.”

“Our mission,” Becerra said, “is to make sure everyone has access to health care.”

— NORBERTO SANTANA JR.

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