The 2010 federal healthcare law will make health coverage available to millions of the uninsured, but it won't reach all of them. In California, county health officials and the Brown administration are now tussling over how much to spend on the remaining uninsured, and on county health programs in general. Gov. Jerry Brown wants to reclaim some of the state tax dollars that counties have been spending because there will be fewer uninsured to care for, and that's not unreasonable. But the state should be careful not to undermine the counties' efforts to protect public health, nor should it deny them the ability to care for more people in a more cost-effective way, if they choose.
Since 1991, the state has been sending a portion of the sales taxes and vehicle license fees it collects to the counties for health-related spending. Of the roughly $1.5 billion they receive today, about half is spent on public health programs — for example, food safety inspections, flu vaccinations and anti-smoking campaigns — and half is spent on caring for indigent residents without insurance.
Thanks to the 2010 law, more than half a million of those Californians are expected to gain coverage through Medi-Cal, largely at the federal government's expense. Most counties rely on contractors to provide care, so it shouldn't be too hard to calculate how much the Medi-Cal expansion cuts the counties' expenses. But for counties that operate their own hospitals and clinics, including Los Angeles, the math is considerably more complex.