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Wilson Budget Plan Cuts Counties' Care Obligations : Aid: Proposal would lift required welfare and health services. Needy would be left without help, critics say.


SACRAMENTO — Gov. Pete Wilson, a former mayor, has said throughout his 18 months in office that the state should not force added burdens onto local governments without also giving them the money to pay for the programs.

Now, in a bold move to help him balance the state budget, Wilson has proposed a dramatic extension of that doctrine of local control. He wants to take money from counties and in turn relieve them of a huge responsibility: their historical obligation as the caretaker of last resort for the sick and poor.

Wilson proposed Friday to repeal two legal pillars that undergird the counties' commitment to the needy, freeing these 58 arms of the state to decide for themselves what level of care and protection to provide their less fortunate residents.

If they get that freedom, many counties are expected to limit general assistance--the welfare program for those who qualify for no other aid--and to restrict access to medical care by capping health budgets, eliminating some services and charging low-income patients a fee for every visit to the doctor.

"The governor believes that local governments need to have the ability to set priorities and decide for themselves how best to spend their available resources," said Kassy Perry, Wilson's deputy communications director.

Wilson's call for repeal of the mandates goes further than the requests of county supervisors, who have asked that these laws be suspended or modified to give them maximum flexibility. The governor's stand, though supported by many lawmakers, may be a negotiating position from which he will retreat to middle ground.

But for now, advocates for the disadvantaged are warning that Wilson's move could leave the poor and the infirm with nowhere to turn. Even without the state's blessing, they say, the beleaguered counties have allowed gaping holes to appear in the "safety net." They note that the state will not make the needs of the homeless and sick disappear by removing the responsibility of government to care for them.

Without a minimum obligation, said Democratic Assemblyman Sam Farr of Carmel, some counties might resort to the equivalent of a "Greyhound bus ticket out of town."

And the anticipated reduction in county health services, others say, could produce a ripple effect, inundating private hospitals with non-paying patients, which would force these facilities to shift the cost to those who do pay or close their emergency rooms.

"People need to remember that the county safety net protects everyone, even those of us who have insurance," said Maryann O'Sullivan, executive director of Health Access, a coalition of religious, labor and consumer groups.

Wilson's plan would shift $1 billion of local property tax revenue to the schools and cut 15% from the state health and welfare budget. He has not said how he would make that 15% cut but is reviewing options that include the removal from Medi-Cal rolls of thousands of working poor people whose care under current law would become the responsibility of the counties.

Without relief from state mandates, county officials say, they will lack the flexibility to implement the budget cuts humanely.

"If they end up cutting hundreds of millions out of the county property tax and hundreds of millions out of Medi-Cal, there's no way to put a reasonable or compassionate spin on it--people will die," said Karen Coker, a lobbyist for the California State Assn. of Counties.

John Sweeten, director of legislative affairs for San Diego County, said the counties' primary objective is to make sure they are able to "manage whatever we have left" when the budget deal is done.

"We have to have the ability to move funds from one program to another, to reduce services if necessary, to not only address whatever priorities are most pressing locally but to live with whatever resources are available," Sweeten said.

The Wilson Administration, with less than two weeks before the start of the fiscal year, is considering dozens of proposals to loosen the state's grip on the affairs of city and county governments. But Wilson said Friday that he has decided to push for repeal of two fundamental laws that guide every county action on health and welfare issues.

One, known as Section 17000 for its spot in the state Welfare and Institutions Code, makes counties the caretaker of last resort. It requires every county to "relieve and support all incompetent, poor, indigent persons, and those incapacitated by age, disease, or accident," when these people are "not supported and relieved by their relatives or friends, by their own means, or by state hospitals or other state or private institutions."

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