Date: March 20, 2001
To: Board of Supervisors
Subject: MOVING FORWARD TO IMPROVE SAN DIEGO'S HEALTH CARE INFRASTRUCTURE

Summary:
Over the past five years, the County of San Diego has taken great strides to improve health care services throughout this region. However, because of State and federal funding inequities, there is much more to be done. In an unprecedented move, the business community, via the San Diego Regional Chamber of Commerce, is helping to bring this issue to the forefront and is willing to work with the County of San Diego's ongoing efforts to help fix some of these inequities.

RECOMMENDATIONS:
SUPERVISORS DIANNE JACOB AND RON ROBERTS

1) Receive the San Diego Regional Chamber of Commerce's report, San Diego's Health Care Infrastructure... In Jeopardy: And What It Means to Business and the Community of San Diego.

2) Direct the Chief Administrative Officer to include in the County's Legislative Program the action items presented in this report and identify opportunities to work together with the health care community and the San Diego Chamber of Commerce to secure increased state and federal funding for health care in this region.

Fiscal Impact:

There is no fiscal impact as a result of this request.

Background:

Over the past five years, the County of San Diego has taken great strides to improve health care services throughout this region. In 1997, the Regional Healthcare Advisory Committee (RHAC) was formed in an effort to create a "Road Map" for San Diego's health care future. Some of the accomplishments from this process include; $4.9 million in tobacco settlement funds has been dedicated to increase the reimbursement to private hospitals for CMS patient care, bringing CMS funding up to $22.9 million for existing eligible patients and services; $1.5 million in tobacco settlement funds has been dedicated to North County hospitals that participate in the CMS program; County Medical Services eligibility levels have been expanded to 100 percent of the Federal Poverty Level, resulting in approximately 2,600 people receiving health care throughout this region; continuing efforts to pursue federal approval of a 1115 demonstration waiver to expand health coverage to the uninsured in San Diego County; in conjunction with the Project Management Committee (PMC), which is comprised of representatives of business, health care providers, community health advocates, consumers and labor, the County is working with the State Legislature for approval of a Business Health Access Resource Center; the County of San Diego was the first jurisdiction to dedicate 100 percent of the tobacco settlement dollars to health based programs; and, the County is currently advocating for state law change to allow one person businesses to be eligible for small business group health insurance rates.

However, there is much more to be done. The 1998 Partners in Health report documented that nearly one in four San Diegans under 65 are without health care coverage, and yet most of these are in households that have someone in the labor force. It went on to state that the single biggest reason for the lack of insurance is that many of these employees simply do not earn enough to afford insurance.

The County has actively advocated for years for the State and federal governments to increase unfair Medi-Cal reimbursement rates for local physicians and hospitals. From 1996 to 1999, residents of San Diego County were shorted a total of $55.06 million dollars in state health realignment funds because of an inequitable funding formula. That money could go far to improve healthcare services in this region and decrease the numbers of uninsured. The County is now working with other counties to try to get a portion of these realignment funds returned to San Diego County.

Yet another area that San Diego residents are short changed is through CHIP - the California Healthcare for Indigents Program. It is funded out of Prop. 99 tobacco tax funds and provides money for health care to our region's indigent population. Over the past five years, our funding from CHIP has dropped by more than half * from $9.1 million per year in 1995 to only $4.2 million in 1999. This is money that goes to pay physicians and hospitals in our County who care for the indigent poor. The County has worked hard to get this money back, but unfortunately, the state has refused to help. The State owes this County at least $23 million annually for badly needed health care.

Today's presentation shows some of the results of this massive under funding. In an unprecedented move, the business community, via the San Diego Regional Chamber, is helping to bring this issue to the forefront and is willing to work with the County of San Diego to fix some of these inequities. The health of the San Diego workforce and economy depends on it. We urge your support.

Respectfully submitted,

DIANNE JACOB
Supervisor, Second District

RON ROBERTS
Supervisor, Fourth District