SINGLE PAYER FINALLY GETS ITS DAY IN COURT AND LOOKS GREAT!

Although the final results of the Health Care Options Project (HCOP) won't be out for another week, preliminary analysis by the Lewin Group is showing that a single payer health care system in California could provide every resident with comprehensive, high quality health care from cradle to grave. All this without spending more than what is currently being spent on health care!

The HCOP study analyzed and compared 9 different models to achieve universal health care coverage in California. Each of the nine options is posted online at www.healthcareoptions.ca.gov/doclib.asp. The HCOP proposals include three single payer plans, expansion of Medi-Cal/Healthy Families, individual and employer tax credits, subsidies for workers and/or employers, and combination approaches. The 3 single payer models submitted are all proving to be the most cost-effective and comprehensive. Cal-Care, the single payer model submitted by Health Care for All-California (Vote Health is an HCA affiliate), has been well-received. The results of the study will be given to the California Legislature by March of this year.

There will be a public symposium to present the study results and discuss the options with the authors at a day-long conference on February 7th at the Oakland Hilton. HCA local affiliates have been quite successful organizing people to attend. Registration may be full, but if you would like to attend call 1-800-858-7743, then press 0 for registration, prior to January 18th. Margot Smith will organize carpools; call 510-486-8010.

Vote Health is organizing a press conference on February 7th. For further information call Sue Bergman at 540-7085. This is a terrific step on the road to single payer!

ACMC Trustees To Tackle Budget Deficit at January 28 Meeting

The ACMC Finance Committee reported that the Medical Center's operating deficit will reach $15 - 17 million for fiscal year 2001-02. They hope to locate $10 - 11 million in revenues, leaving a $5 - 6 million deficit in the best scenario. In CEO Ken Cohen's December report to the ACMC Board of Trustees, he outlined several proposed changes in services the center provides. These include closing the C-1 Obstetrics/gynecology and Pediatric Clinics on the Highland Campus, to capture the 70% higher reimbursement rates enjoyed by the system's outlying clinics.

Vote Health believes the reduction of clinic services on the Highland Campus is a financially risky proposal. We remember a similar scheme in 1995 when Highland tried to refer patients out to the clinics and many refused to go:

• Some either went without care or to outside providers and were lost to the Med Center.
• Labor and delivery referrals for Highland dropped. This in addition to the new choices Medi-Cal patients had in using private medical facilities imperiled the existence of county labor and delivery services.
• It took three years to rebuild utilization rates of labor and delivery.

The Critical Care Building was specifically designed and constructed to enhance the ACMC's ability to provide quality care to our county residents by being able to compete with the private sector for Medi-Cal patients. We know that Santa Clara, San Francisco and Contra Costa counties all have hospital-based clinics that get the Federally Qualified Health Care rates. Highland's clinics have not previously qualified for this funding, but an effort is being made to send in an application with as much strength and as quickly as possible. If the Bush Administration gives it the green light (not a done deal, as you might imagine), ACMC CEO Cohen has said the clinics can remain open on the Highland Campus because of the increased reimbursement this would bring. The fate of the pediatric clinic is still uncertain.

At the January 28 meeting, the Board of Trustees may consider a number of proposals to address the budget deficits, including closure of Ob/gyn and Peds Clinics on the Highland Campus, Central and Alameda clinics, and possibly Fairmont's skilled nursing facility. Speak up to preserve these critical services on Jan. 28, at 5:00 PM (before the Vote Health meeting), Eastmont Wellness Center, top floor of 6955 Foothill Blvd., Oakland.

Safe Staffing Delayed

The state has failed to meet its January 1st deadline for implementation of AB 394. This is the Safe Staffing Bill that would mandate nurse-to-patient ratios, the first in the nation. We expect the state to issue emergency regulations within the next couple of months. The delay is because "it is very complicated to determine what the ratios should be." See the article below for the governor's contact numbers if you'd like to ask him why he's delaying these important regulations. Lives are at stake!

Governor Davis Announces Budget Cuts; We Say No Cuts to Health Care

Vote Health joins with other health advocates to oppose the following proposed cuts:

• The elimination of the child Health and disability Prevention Program ($69.5 million savings);
• The imposition of co-payments on Medi-Cal recipients, creating a barrier to care for the poorest Californians and directly reducing provider reimbursement; ($61.2 million savings);
• The cuts in provider reimbursements, especially to safety-net hospitals, which are already suffering from massive federal buts and are overburdened ($85 million savings);
• The continued delay in the expansion of the state Healthy Families' program to cover low-income working parents ($215 million savings total for this year and next).

To contact Governor Davis and tell him people need more access to health care, not less: Governor Gray Davis, State Capitol Building, Sacramento, CA 95814, Phone: 916-445-2841, Fax: 916-445-4633, governor@governor.ca.gov.

We welcome new Organizer/Administrative Assistant Beatriz Quezada!

Future in doubt for two Highland clinics
By Matthew Leising
STAFF WRITER, Contra Costa Times

January 4, 2002

The Alameda County Medical Center is considering a highly controversial plan that would reduce certain prenatal and pediatric services now offered at Highland Hospital. The plan, though, is being hotly debated by Highland Hospital staff and health-care advocates.

According to hospital officials, the plan calls for a "shifting of services" to off-site clinics at the Eastmont Wellness Center and the Central Clinic in Oakland in order to help the hospital save money. Critics, though, insist the proposal effectively amounts to the closure of the existing clinics -- which could ultimately endanger Oakland residents.

The closure could be a short-term measure, lasting 18 months or so, if new facilities at Highland are certified at the same level as the Eastmont and Central facilities. This certification, though, is not guaranteed -- meaning that the shift might then become part of a longer term solution to the hospital's financial woes.

The reason for the anticipated moves is purely financial, according to ACMC chief executive Kenneth Cohen, and is due to changes in the level of reimbursement the federal government provides to public hospitals for Medicare patients. As it stands right now, Cohen said, Highland is already running a $10 million deficit this fiscal year.

"I can guarantee you that if we do not (shift the clinics), we will incur a $1 million loss," Cohen said. "Without some changes, we're looking at cutting some services."

The plan to shift services to Eastmont and Central should generate $1 million, Cohen said, because those clinics receive higher levels of reimbursement from the federal government than the clinics at Highland.

But some staff of the off-site clinics and health-care advocates are crying foul over the plan, insisting that the shift is likely to harm patients and could actually cause the hospital to lose money.

"It's not shifting services -- it's closing (the clinics)," said Gina Shepard, a registered nurse at the Highland Hospital pediatric clinic. "I do understand they are between a rock and a hard place, but this is not the solution," Shepard said.

Shepard worries that the roughly 25 patients she sees a day in the pediatric clinic will not be able to be absorbed by the clinics at Eastmont and Central. And, she said, the continuity of care between the clinics at Highland and the hospital itself would be broken, ultimately to the patient's detriment.

Critics also question the financial soundness of the proposal. "We really don't understand the thinking of closing those clinics down. We think financially that would be a disaster," said Nancy Friedman, chairperson of Vote Health, a non-profit health care advocacy group in Oakland.

Friedman said that shifting women away from the prenatal clinic at Highland would reduce the number of women that actually give birth at the hospital, which provides a significant source of revenue.

She is also concerned that a reduction in the number of women delivering babies at Highland could jeopardize the hospital's care of women with high-risk pregnancies. "That puts women's lives at risk," Friedman said.

Yet Cohen said there is no plan to shift high-risk pregnancy services from Highland, and that under the Medicare contract the hospital is required by law to provide delivery services.

Also at issue is the new building Highland Hospital is set to move into within 18 months, which includes new pediatric and prenatal clinic facilities. The new clinics cost $200,000 to build, and there are fears that they will never be used.

Cohen, however, says that the ACMC is attempting to get the new Highland clinics to meet the same federal standards as the Eastmont and Central clinics, whereby they would bring in the same level of revenue.

Underlying all these changes is a shift in the way the federal government pays public hospitals that treat indigent or low-income patients under Medicare. The Bush Administration recently lowered the level of reimbursement paid to hospitals that care for Medicare patients from 150 percent to 100 percent of the cost. The change came after it was discovered that some states, though not California, were using federal Medicare money for non health-care uses -- such as road construction. The decrease in Medicare payments is costing California's public hospitals $250 million a year.

Under that tightening, Cohen said "safety net" hospitals such as Highland, which treat a large percentage of patients without insurance, are scrambling to stay afloat. "There are not many options you can have to generate $1 million dollars," Cohen said.

Yet the proposed change to the Highland clinics is not the best way to handle the budget crunch, said Bradley Cleveland, the communications coordinator for the SEIU local union 616. While the union has worked closely with Highland, Cleveland said "This is the only area where we think they strongly need to rethink this." The union would rather see a more proactive plan where Highland increases the number of women that deliver babies at the hospital.

If the hospital could deliver 150 babies a month, up from the current 120, it might generate $1.5 million more a year, Cleveland said. And this plan would add to the health-care network now in place at Highland (between the clinic and the hospital), rather than disband it, he added.

Cohen said the ACMC is receptive to such ideas and has been working with the union to assess the feasibility of the plan. "I don't think this is a hard-and-fast process," Cohen said of the possible clinic shift. "If there are alternatives that make sense, we'll take a look at them."

The ACMC board of trustees is set to decide the fate of the pediatric and prenatal clinic either this month or next, Cohen said.

Whether the outcome will satisfy all involved is still up in the air, though.

"For facilities like us -- and San Francisco General, Children's Hospital and others that depend on Medical payments, I don't see a way to offset the risks," Cohen said.

Matthew Leising can be reached at mleising@cctimes.com

Newsletter committee:
Nancy M. Friedman, Dan Hodges, Margot Smith, Kevin Reilly, Terry Hill