Much of the $8.3 million in tobacco settlement funding that Ventura County expects for the coming year should be used to shore up cash-strapped public health-care programs, government chief Johnny Johnston said.
Johnston is recommending big reductions in funding for private doctors and hospitals, as well as smaller cuts to community health programs run by private nonprofit groups.
Money saved from those reductions could then be funneled to the county's public hospital and mental health clinics to blunt the effects of expected cuts in state funding for the 2003-04 budget cycle, the county executive officer said.
"The financial reality is the safety net of the county is being reduced by the state, and I have no place else to go to try to make that up," Johnston said.
His recommendations, set to go before the county Board of Supervisors on Tuesday, drew strong criticism from the chairman of a citizens' committee that advises the county on how to spend the tobacco dollars.
Johnston's proposals would give $7 million of the $8.3 million to county programs, far more than the citizens' group had recommended, Camarillo businessman David Maron said.
The advisory committee, which would lose most of its administrative funding under Johnston's proposal, also wanted more dollars to flow to community-based nonprofit groups that provide a variety of new health services, from stop-smoking campaigns to dental clinics, he said.
The substantial changes suggested by Johnston represent an "abandonment of the public review process" that supervisors promised in 2000, Maron said.
"This proposal transfers most of the money to county departments, with no oversight, no strings attached, no accountability and no involvement by the public in how the funds are used," Maron said.
Private-practice doctors and hospitals are also expected to protest Johnston's suggestion because it would slash into two funds that reimburse them for unpaid health-care services.
Under the proposal, the doctors' fund would receive $250,000 for the budget year that begins July 1, a 44% reduction from the previous year.
For two years the reimbursement fund has had unclaimed dollars by year's end, Johnston said.
A reimbursement fund established for private and nonprofit hospitals, meanwhile, would be cut 72%.
Dollars for most hospitals would be eliminated altogether. The exception is Ojai Valley Community and Santa Paula Memorial hospitals, which would split $250,000.
Ojai Valley and Santa Paula, both small facilities serving semirural communities, have struggled to maintain services in recent years, Johnston states in a report to supervisors.
In contrast, state data show the county's other four private hospitals had positive operating margins and can afford to cover the cost of uninsured care on their own, the county chief said.
A physicians' spokeswoman said she would protest Johnston's recommendations at Tuesday's meeting.
Ventura County doctors rely on the fund to pay for services that are otherwise not reimbursed by public or private health insurance, said Mary Carr, head of the Ventura County Medical Assn.
Doctors are reimbursed at half rate after they have tried to collect for at least 90 days, she said.
"They still have to treat patients. So this will just be another reduction of physicians' fees when they are already categorically discounted on every health plan," Carr said.
If supervisors approve Johnston's recommendations, Maron said, they will be backing off from a pledge to allow community oversight of the tobacco dollars, the result of the settlement of a lawsuit by the states against major tobacco companies.
Maron contends that promise was crucial in crushing a ballot initiative, sponsored by Community Memorial Hospital in Ventura, that would have given all the money to private hospitals.
But Johnston said he has little choice. The county is already facing a $15-million budget gap for the coming year.
More cuts are anticipated when the state adopts its own fiscal plan. California is wrestling with an unprecedented $35-billion budget shortfall.
"[The citizens' advisory group] has their role and I have my role," Johnston said. "It's the same old story -- there ain't enough money."