Flap grows over prenatal care for illegal immigrants; Wilson scored over plan to eliminate program funds.

Wilson scored over plan to eliminate program funds

A major feature of Gov. Pete Wilson's election-year budget is the elimination of state funding for illegal immigrants' prenatal care. And if that state funding is indeed withheld, Los Angeles-area health care facilities' revenues would likely drop dramatically, industry sources said.

Los Angeles County health officials and hospital administrators have been particularly critical of Wilson's call for eliminating state-funded prenatal care for illegals, given that L.A. and other Southern California counties are where the vast majority of the state's illegals reside.

Officials at both public and private medical institutions in L.A. stated that they hope to continue to administer prenatal care for illegal immigrants because it makes economic sense.

Women who do not receive prenatal care, they said, are much more likely to deliver their babies in intensive care units, which could increase delivery costs three- or fourfold, they said.

County facilities will continue to provide prenatal care even if Wilson succeeds in wiping out state funding, said Don Petite, chief financial officer for the L.A. County Department of Health Services. That means funding for prenatal care programs will have to come from other sources, including dipping into county funds to cover any shortfalls.

"What will happen is that we will not be reimbursed by the state, and that will leave a hole in the county budget," Petite said.

Likewise, hospital administrators claimed that much of the burden of paying for the care will fall on hospitals.

"Hospitals throughout their tenure have had to shoulder much of the responsibility of paying for care," said Hal Wurtzel, vice president of Valley Presbyterian Hospital in Van Nuys. "It is a financial burden that probably will only become more extensive."

Reimbursement under Medi-Cal has been declining in recent years, Wurtzel explained. Currently, hospitals can expect to be reimbursed from the state Medi-Cal budget for only 25 cents on each dollar of medical services provided, he said.

Unfortunately, neither the county government nor local hospitals are in financial shape to take on the extra burden. Since 1991, at least 30 Southern California hospitals have reduced their staffs through attrition and layoffs. In the past 10 years, 33 hospitals in Los Angeles County have closed their doors. And the worst does not appear to be over for L.A. hospitals, according to the Hospital Council of Southern California. Hospital-bed occupancy rates remain low, and there is apparently no end in sight for that trend as health care delivery shifts from acute care to preventive care.

Wilson's proposal could not come at a worse time for California hospitals, said David Langness, spokesman for the Hospital Council of Southern California. "More than half the hospitals in California operated in the red last year," he said. "This will only drive more of them into financial losses."

Another significant issue, according to Langness, is that state funding for prenatal care has been needed to boost the number of private physicians and hospitals providing such care to illegal immigrants. That increase in service providers has been crucial because county facilities at one time did not have the capacity to service the skyrocketing number of pregnant illegal immigrants pouring into the system.

Another reason public health officials are critical of Wilson's proposal to cut state funding is that significant improvement has been made in reducing L.A. infant mortality rates in recent years. Many sources attributed that to state funding for prenatal care.

In 1986, the California Legislature added prenatal care to benefits provided to illegal immigrants in the state. Since then, L.A.'s infant mortality rate, defined as the number of infants who die in their first year of life, has been reduced dramatically.

Latest statistics, which were compiled in 1991, peg Los Angeles County's infant mortality rate at 7.8 deaths per 1,000 children born. In 1988, that ratio was 9.3 per 1,000 births.

Many health care experts said that trend could reverse if state funding for prenatal care is cut off. According to Susanna Molnar, paranatal coordinator at the National Health Foundation, a direct relationship exists between prenatal care and infant mortality rates. "We have seen that the increase in programs for prenatal care has helped to decrease the infant mortality rates," she said. According to the Wilson administration's calculations, elimination of prenatal care funding would save the State of California at least $82 million per year. Also of consequence, the Wilson proposal is likely to appease the growing number of anti-immigration activists in California during this election year.

Wilson claimed that in the four years since state-funded prenatal care for illegal immigrants was adopted, state spending in that area has increased from $17.7 million a year to $82 million a year.

However, some health care sources argued that one reason for the dramatic spending increase was that the state, and specifically Wilson, had actively supported the program until recently. National Health Foundation's Molnar said she is perplexed by Wilson's reversal on the program. "Actually, the state has spent quite a lot of money (on outreach) for women to get the prenatal care," she said.

Likewise, Langness of the hospital council said Wilson's turnaround on this issue is upsetting to the hospital community. "The governor himself pushed these programs in the past," he said. "We do not understand this sudden reversal." In addition, Langness said Wilson's reversal is politically motivated: "All it is, as far as we understand, is an election-year gambit by a politician whose ratings are low."

Beyond its possible political attractiveness, Wilson's proposal to eliminate prenatal care funding is likely to backfire as a cost-saving measure, according to several health care sources.

Prenatal care, which includes clinical care and education to pregnant women, is geared toward early detection of problems associated with pregnancy. Health care sources stated that prenatal care reduces the risk of children being born at low birth weights, with disabilities, drug addictions and other life-threatening complications. Treating such problems is almost always more costly than administering prenatal care, sources said.

In fact, numerous studies have concluded that, for every dollar spent on prenatal care, between $5 and $13 are saved on treating early childhood health problems.

One factor further complicating the issue is that California can legally eliminate prenatal care funding. Under federal law, however, it cannot do away with providing emergency services, including child birth services, to illegal immigrants.

Wilson's proposal is being widely criticized by health care professionals, who insist the plan is not likely to reduce Medi-Cal costs. Under state and federal law, hospitals are required to administer emergency care to any individual in need.

Women in labor will continue to show up at L.A. hospital emergency rooms to deliver babies whether they receive prenatal care or not. And if those women have not received prenatal care, chances are much higher that their children will require state-funded emergency care in their early years.