Keep Puffing

If you're a smoker and live in California, keep puffing. Thanks to the sorry state of health care in Orange County, your deadly habit may soon be all that's left to pay the medical bills of Orange County's poorest residents.

With California's economy in the toilet, Sacramento is planning major cuts in funding for health care. Although it's unclear exactly how big those cuts will be, the Orange County Board of Supervisors recently said it plans to slash health care, too. Last year, the county cut $23 million from the budget for the Health Care Agency (HCA). This year, the county plans to bleed HCA by another $8.4 million.

In fact, the county has just one secure source of cash: the state's tobacco settlement fund. Last year, the fund provided $26.44 million to the OC Coalition of Community Clinics. This year, it is projected to provide $29.5 million. But that amount is likely to decrease in future years as less people smoke and more smokers die. “This will be an incredibly difficult time for health care in Orange County,” said Pat Markley, a spokeswoman for HCA. “We're very concerned these cuts will reduce services for Orange County's poorest population.”

According to an HCA nurse who asked to remain anonymous, service has already been reduced for poor people. In fact, she said, it has steadily dwindled as the agency's budget has gone down in recent years. “Our budgets have been so absurd for so long that we've been told by higher-ups to send people to LA for real coverage,” she said, calling it HCA's “unofficial-official policy.”

The most recent proposed cuts mean HCA will have to reduce funding for its network of programs that provide disease control, mental-health services, and drug- and alcohol-abuse treatment throughout Orange County. Unlike Los Angeles County, which funds medical care for poor and indigent people through the USC Medical Center, Orange County has no public hospitals.

HCA operates only five public health clinics, in Santa Ana, Westminster, Buena Park, Costa Mesa and San Juan Capistrano. The agency also contracts with seven clinics that provide HIV testing and treatment, seven mental-health outpatient clinics as well as seven child-abuse-treatment centers. But that number could soon go down.

“We're fairly certain that some of our small, outlying clinics will have to close and we'll have to consolidate those services to a central location,” Markley said. “That means the people who need these services will have to use public transportation. In some cases, people may opt to just forget about health services because it's too big an inconvenience.”

HCA also provides some money to more than 20 clinics operated by organizations that belong to the OC Coalition of Community Clinics. Those clinics depend mostly on private contributions and grants and are the primary source of medical care for millions of poor people in Orange County. But because of the poor state of the economy, corporate donations are becoming scarcer, and grants are becoming more competitive.

“The clinics are definitely going to be impacted by the cuts,” Markley said. “They are bracing to see what will happen. I know they will be feeling the pinch.”

“The worse the economy gets, the less people are covered through their employers,” said Mary Moyer, clinic services manager for the Share Our Selves (SOS) Free Clinic in Costa Mesa. The clinic provides free medical and dental care to working families who aren't poor enough to qualify for Medicare but who have no health insurance and can't afford to pay for medical treatment. “Those people have no option but to come to us. For the working poor earning the minimum wage in Orange County, there is just no money left over after living expenses for medical care.”

“Orange County has a long Republican history that didn't favor building a particularly strong infrastructure,” Moyer added. “So the county is dependent on community clinics to provide medical care to low-income people.”

Last year, thanks to a major drop in private funding, Moyer said SOS had to rely on the fund to pay for its dental-care program. “This year's settlement money will be used to staff that program, but there's only enough to pay for a dentist to be there one day per week,” Moyer said. “We are fortunate because Hoag Hospital helps us out, but if the donors dry up, we are going to have to cut back on what we do. Things will definitely get worse before they get better.”