Letters to the Editor

Viewpoint: Health care reform begins at home

San Luis Obispo County residents have been fortunate to have a health care system that includes four community hospitals, a network of federally qualified Community Health Centers, private physicians willing to accept Medicare and Medi-Cal patients and a century-old commitment by San Luis Obispo County to maintain a health care “safety-net” for the poor and uninsured.

Because of the strength of this system, San Luis Obispo County has been able to avoid the health care crisis affecting other communities.

This collaborative of private and public health care providers has ensured that the residents have access to affordable and quality health care, regardless of their ability to pay.

However, this may all be changing as the health care community deals with a number of issues: ever-growing numbers of uninsured patients, fewer private doctors willing to accept new patients or to accept Medicare or Medi-Cal patients, increased charity care at local nonprofit and private hospitals and decreased support for the health care safety net by San Luis Obispo County.

Since closing the county-run General Hospital and outsourcing the operation of their four family care centers in 2004, San Luis Obispo County’s support for the health care safety net has decreased from a high of $5.4 million (inflation adjusted) to the current $3.65 million, a decline of more than 32 percent. County officials have announced another cut of $1 to 1.5 million to safety net funding in 2010-2011.

Cuts at the local level are being driven by reductions in state funding. If federal funds are not forthcoming, the governor’s budget includes extensive cuts in essential programs that benefit low-income patients such as Family PACT, cancer detection and treatment, children’s health and Expanded Access to Primary Care (EAPC).

These developments at both the state and federal level are shaping up for a health care crisis that the county may not be able to avoid. This crisis will likely impact all county residents, not just poor or uninsured people.

Dwindling numbers of private doctors and reduced capacity by safety net providers such as Community Health Centers mean that hospital emergency rooms will need to take up the slack in providing primary care services.

This crisis is likely to trickle down to privately insured patients in the form of longer waiting times to make routine appointments and added expense throughout the system to make up for the cost of uncompensated care.

It’s imperative that a local plan be formed to help mitigate the access to health care.

To do this, I strongly recommend that the County of San Luis Obispo Board of Supervisors reconvene the Future Vision Task Force to address the future of the health care safety net in San Luis Obispo County.

In 2003, the Board of Supervisors formed the original task force to appraise the status of the county’s health care safety net. After several months of study and public hearings, this group of stakeholders made their recommendations to the Board of Supervisors.

In order to increase access to care for county residents while reducing county expenditures, their proposal included the closing of General Hospital and the outsourcing of their Family Care Centers to Community Health Centers.

The proposed 2010 Future Vision Task Force should be charged with revisiting and updating their findings from 2003 and recommending new actions regarding the county health care safety net. The committee will allow stakeholders and the public to understand the challenges residents face in accessing health care.

This task force should also address improving coordination of health care services between primary care physicians, specialists, hospitals, Community Health Centers, San Luis Obispo County and other safety net providers.

In closing, I hope that my prediction for a health care crisis does not occur and that the County of San Luis Obispo can continue to ensure access to affordable, quality health care services for our low income and uninsured residents.

In view of the many troubling signs, it is prudent that county policy makers and stakeholders re-examine the counsel of the original 2003 report.

While it is hoped that national health care reform will help address some of the problems noted above, it is clear that any meaningful help will not occur for several years. If no state programs are available, what is San Luis Obispo County’s responsibility to the uninsured and underserved?

What would county patients do without a health care safety net, which provides life-saving services on a daily basis?

Ronald Castle is the CEO of the Community Health Centers of the Central Coast, Inc.