After depending on the local hospital for more than a century, Fort Scott residents now are trying to cope with life without it.

This article was first published on Tuesday, May 14, 2019 in Kaiser Health News.

By Sarah Jane Tribble

FORT SCOTT, Kan. — A slight drizzle had begun in the gray December sky outside Community Christian Church as Reta Baker, president of the local hospital, stepped through the doors to join a weekly morning coffee organized by Fort Scott's chamber of commerce.

The town manager was there, along with the franchisee of the local McDonald's, an insurance agency owner and the receptionist from the big auto sales lot. Baker, who grew up on a farm south of town, knew them all.

Still, she paused in the doorway with her chin up to take in the scene. Then, lowering her voice, she admitted: "Nobody talked to me after the announcement."

Just a few months before, Baker — joining with the hospital's owner, St. Louis-based Mercy — announced the 132-year-old hospital would close. Baker carefully orchestrated face-to-face meetings with doctors, nurses, city leaders and staff members in the final days of September and on Oct. 1. Afterward, she sent written notices to the staff and local newspaper.

For the 7,800 people of Fort Scott, about 90 miles south of Kansas City, the hospital's closure was a loss they never imagined possible, sparking anger and fear.

"Babies are going to be dying," said longtime resident Darlene Doherty, who was at the coffee. "This is a disaster."

Bourbon County Sheriff Bill Martin stopped before leaving the gathering to say the closure has "a dark side." And Dusty Drake, the lead minister at Community Christian Church, diplomatically said people have "lots of questions," adding that members of his congregation will lose their jobs.

Yet, even as this town deals with the trauma of losing a beloved institution, deeper national questions underlie the struggle: Do small communities like this one need a traditional hospital at all? And, if not, what health care do they need?

Sisters of Mercy nuns first opened Fort Scott's 10-bed frontier hospital in 1886 — a time when traveling 30 miles to see a doctor was unfathomable and when most medical treatments were so primitive they could be dispensed almost anywhere.

Now, driving the four-lane highway north to Kansas City or crossing the state line to Joplin, Mo., is a day trip that includes shopping and a stop at your favorite restaurant. The bigger hospitals there offer the latest sophisticated treatments and equipment.

And when patients here get sick, many simply go elsewhere. An average of nine patients stayed in Mercy Hospital Fort Scott's more than 40 beds each day from July 2017 through June 2018. And these numbers are not uncommon: Forty-five Kansas hospitals report an average daily census of fewer than two patients.

James Cosgrove, who directed a recent U.S. Government Accountability Office study about rural hospital closures, said the nation needs a better understanding of what the closures mean to the health of people in rural America, where the burden of disease — from diabetes to cancer — is often greater than in urban areas.

What happens when a 70-year-old grandfather falls on ice and must choose between staying home and driving to the closest emergency department, 30 miles away? Where does the sheriff's deputy who picks up an injured suspect take his charge for medical clearance before going to jail? And how does a young mother whose toddler fell against the coffee table and now has a gaping head wound cope?

There is also the economic question of how the hospital closure will affect the town's demographic makeup since, as is often the case in rural America, Fort Scott's hospital is a primary source of well-paying jobs and attracts professionals to the community.

The GAO plans to complete a follow-up study later this year on the fallout from rural hospital closures. "We want to know more," Cosgrove said. The report was originally requested in 2017 by then-Sen. Claire McCaskill (D-Mo.) and then-Rep. Tim Walz (D-Minn.), and has been picked up by Sen. Gary Peters (D-Mich.). Here in Fort Scott, the questions are being answered — painfully — in real time.

At the end of December, Mercy closed Fort Scott's hospital but decided to keep the building open to lease portions to house an emergency department, outpatient clinic and other services.

Mercy Hospital Fort Scott joined a growing list of more than 100 rural hospitals that have closed nationwide since 2010, according to data from the University of North Carolina's Cecil G. Sheps Center for Health Services Research. How the town copes is a window into what comes next.

'We Were Naive'

Over time, Mercy became so much a part of the community that parents expected to see the hospital's ambulance standing guard at the high school's Friday night football games.

Mercy's name was seemingly everywhere, actively promoting population health initiatives by working with the school district to lower children's obesity rates as well as local employers on diabetes prevention and healthy eating programs — worthy but, often, not revenue generators for the hospital.

"You cannot take for granted that your hospital is as committed to your community as you are," said Fort Scott City Manager Dave Martin. "We were naive."

Indeed, in 2002 when Mercy decided to build the then-69-bed hospital, residents raised $1 million out of their own pockets for construction. Another million was given by residents to the hospital's foundation for upgrading and replacing the hospital's equipment.

"Nobody donated to Mercy just for it to be Mercy's," said Bill Brittain, a former city and county commissioner. The point was to have a hospital for Fort Scott.

Today Mercy is a major health care conglomerate, with more than 40 acute care and specialty hospitals, as well as 900 physician practices and outpatient facilities. Fort Scott is the second Kansas hospital Mercy has closed.

Tom Mathews, vice president of finance for Mercy's southwestern Missouri and Kansas region, said Fort Scott's steady decline in patients, combined with lack of reimbursement — as well as the increasing cost of expenses such as drugs and salaries — "created an unsustainable situation for the ministry."

But Fort Scott is a place that needs health care: One out of every four children in Bourbon County live in poverty. People die much younger here than the rest of the state and rates for teen births, adult smoking, unemployment and violent crime are all higher in Bourbon County than the state average, according to data collected by the Kansas Health Institute and the Robert Wood Johnson Foundation. Ten percent of Bourbon County's more than 14,000 residents, about half of whom live in Fort Scott, lack health insurance. Kansas is one of 14 states that have not expanded Medicaid under the Affordable Care Act and, while many factors cause a rural closing, the GAO report found states that had expanded Medicaid had fewer closures.

The GAO report also found that residents of rural areas generally have lower household incomes than their counterparts in bigger cities, and are more likely to have limitations because of chronic health conditions, like high blood pressure, diabetes or obesity, that affect their daily activities.

The county's premature birth rate is also higher than the 9.9% nationwide, a number that worries Dr. Katrina Burke, a local family care doctor who also delivers babies. "Some of my patients don't have cars," she said, "or they have one car and their husband or boyfriend is out working with the car."

By nearly any social and economic measure, southeastern Kansas is "arguably the most troubled part of the entire state," said Dr. Gianfranco Pezzino, senior fellow at the Kansas Health Institute. While the health needs are great, it's not clear how to pay for them.

Health Care's 'Very Startling' Evolution

Reta Baker describes the farm she grew up on, south of town, as "a little wide place in the road." She applied to the Mercy school of nursing in 1974, left after getting married and came back in 1981 to take a job as staff nurse at the hospital. She has "been here ever since," 37 years — the past decade as the hospital president.

It has been "very startling" to watch the way health care has evolved, Baker said. Patients once stayed in the hospital for weeks after surgery and now, she said, "they come in and they have their gallbladder out and go home the same day."

With that, payments and reimbursement practices from government and health insurers changed too, valuing procedures rather than time spent in the hospital. Rural hospitals nationwide have struggled under that formula, the GAO report found.

Acknowledging the challenge, the federal government established some programs to help hospitals that serve poorer populations survive: Through a program called 340B, some hospitals get reduced prices on expensive drugs. Rural hospitals that qualified for a "critical access" designation because of their remote locations got higher payments for some long stays. About 3,000 hospitals nationwide get federal "disproportionate share payments" to reflect the fact that their patients tend to have poor or no insurance.

Fort Scott took part in the 340B discount drug program as well as the disproportionate share payments. But, though Baker tried, it could not gain critical access status.

When Medicare reimbursement dropped 2% because of sequestration after the Budget Control Act of 2011, it proved traumatic, since the federal insurer was a major source of income and, for many rural hospitals, the best payer.

Then, in 2013, when the federal government began financially penalizing most hospitals for having too many patients returning within 30 days, hospitals like Fort Scott's lost thousands of dollars in one year. It contributed to Fort Scott's "financial fall," Baker said.

Baker did her best to set things right. To reduce the number of bounce-back admissions, patients would get a call from the physician's office within 72 hours of their hospital stay to schedule an office visit within two weeks. "We worked really, really hard," Baker said. Five years ago, the number of patients returning to Fort Scott's hospital was 21%; in 2018 it was 5.5%.

Meanwhile, patients were also "out-migrating" and choosing to go to Ascension Via Christi in Pittsburg — which is two times larger than Fort Scott — because it offered cardiology and orthopedic services, Baker said. Patients also frequently drove 90 miles north to the Kansas City area for specialty care and the children's hospital.

"Anybody who is having a big surgery done, a bowel resection or a mastectomy, they want to go where people do it all the time," Baker said. Mercy's Fort Scott hospital had no cardiologists and only two surgeons doing less complicated procedures, such as hernia repair or removing an appendix.

Last year, only 13% of the people in Bourbon County and the surrounding area who needed hospital care chose to stay in Fort Scott, according to industry data shared by Baker.

There were no patients in the hospital's beds during one weekend in December, Baker said, adding: "I look at the report every day. It bounces between zero and seven." The hospital employed 500 to 600 people a decade ago, but by the time the closure was announced fewer than 300 were left.

That logic — the financial need — for the closing didn't sit well with residents, and Mercy executives knew it. They knew in June they would be closing Fort Scott but waited until October to announce it to the staff and the city. City Manager Martin responded by quickly assembling a health task force, insisting it was "critical" to send the right message about the closure.

Relations between Mercy and the city grew so tense that attorneys were needed just to talk to Mercy. In all, Fort Scott had spent more than $7,500 on Mercy Closure Project legal fees by the end of 2018, according to city records.

Will Fort Scott Sink With No Mercy?

When Darlene Doherty graduated from Fort Scott High School in 1962, there were two things to do in town: "Work at Mercy or work at Western Insurance." The insurance company, though, was sold in the 1980s, and the employer disappeared, along with nearly a thousand jobs.

Yet, even as the community's population slowly declined, Martin and other community leaders have kept Fort Scott vibrant. There's the new Smallville CrossFit studio, which Martin attends; a new microbrewery; two new gas stations; a Sleep Inn hotel, an assisted living center; and a Dairy Queen franchise. And the McDonald's that opened in 2012 just completed renovation.

The town's largest employer, Peerless Architectural Windows and Doors, which provides about 400 jobs, bought 25 more acres and plans to expand. There's state money promised to expand local highways, and Fort Scott has applied for federal grants to expand its airport.

Baker and some of the physicians on Mercy's staff have been busy trying to ensure that essential health care services survive, too.

Baker found buyers for the hospital's hospice, home health services and primary care clinics so they could continue operating.

Burke, the family care doctor, signed on to be part of the Community Health Center of Southeast Kansas, a federally qualified nonprofit that is taking over four health clinics operated by Mercy Hospital Fort Scott. She will have to deliver babies in Pittsburg, which is nearly 30 miles away on a mostly two-lane highway that has construction workers slowing traffic as they work to expand it to four lanes.

Burke said her practice is full, and she wants her patients to be taken care of: "If we don't do it, who's going to?"

Mercy donated its ambulances and transferred emergency medical staff to the county and city.

And, in a tense, last-minute save, Baker negotiated a two-year deal with Ascension Via Christi hospital in Pittsburg to operate the emergency department — which was closed for two weeks in February before reopening under the new management.

But she knows that too may be just a patch. If no buyer is found, Mercy will close the building by 2021.

This is the first installment in KHN's year-long series, No Mercy, which follows how the closure of one beloved rural hospital disrupts a community's health care, economy and equilibrium.

Sarah Jane Tribble: sjtribble@kff.org, @SJTribble

 

Establishing identity helps avoid the treatment risks that come with not knowing a patient's medical history.

This article was first published on Monday, May 13, 2019 in Kaiser Health News.

By Susan Abram and Heidi de Marco

The 50-something man with a shaved head and brown eyes was unresponsive when the paramedics wheeled him into the emergency room. His pockets were empty: no wallet, no cellphone, not a single scrap of paper that might reveal his identity to the nurses and doctors working to save his life. His body lacked any distinguishing scars or tattoos.

Almost two years after he was hit by a car on busy Santa Monica Boulevard in January 2017 and transported to Los Angeles County+USC Medical Center with a devastating brain injury, no one had come looking for him or reported him missing. The man died in the hospital, still a John Doe.

Hospital staffs sometimes must play detective when an unidentified patient arrives for care. Establishing identity helps avoid the treatment risks that come with not knowing a patient's medical history. And they strive to find next of kin to help make medical decisions.

"We're looking for a surrogate decision-maker, a person who can help us," said Jan Crary, supervising clinical social worker at L.A. County+USC, whose team is frequently called on to identify unidentified patients.

The hospital also needs a name to collect payment from private insurance or government health programs such as Medicaid or Medicare.

But federal privacy laws can make uncovering a patient's identity challenging for staff members at hospitals nationwide.

At L.A. County+USC, social workers pick through personal bags and clothing, scroll through cellphones that are not password-protected for names and numbers of family or friends, and scour receipts or crumpled pieces of paper for any trace of a patient's identity. They quiz the paramedics who brought in the patient or the dispatchers who took the call.

They also make note of any tattoos and piercings, and even try to track down dental records. It's more difficult to check fingerprints, because that's done through law enforcement, which will get involved only if the case has a criminal aspect, Crary said.

Unidentified patients are often pedestrians or cyclists who left their IDs at home and were struck by vehicles, said Crary. They might also be people with severe cognitive impairment, such as Alzheimer's, patients in a psychotic state or drug users who have overdosed. The hardest patients to identify are ones who are socially isolated, including homeless people — whose admissions to hospitals have grown sharply in recent years.

In the past three years, the number of patients who arrived unidentified at L.A. County+USC ticked up from 1,131 in 2016 to 1,176 in 2018, according to data provided by the hospital.

If a patient remains unidentified for too long, the staff at the hospital will make up an ID, usually beginning with the letter "M" or "F" for gender, followed by a number and a random name, Crary said.

Other hospitals resort to similar tactics to ease billing and treatment. In Nevada, hospitals have an electronic system that assigns unidentified patients a "trauma alias," said Christopher Lake, executive director of community resilience at the Nevada Hospital Association.

The deadly mass shooting at a Las Vegas concert in October 2017 presented a challenge for local hospitals who sought to identify the victims. Most concertgoers were wearing wristbands with scannable chips that contained their names and credit card numbers so they could buy beer and souvenirs. On the night of the shooting, the final day of a three-day event, many patrons were so comfortable with the wristbands that they carried no wallets or purses.

More than 800 people were injured that night and rushed to numerous hospitals, none of which were equipped with the devices to scan the wristbands. Staff at the hospitals worked to identify patients by their tattoos, scars or other distinguishing features, as well as photographs on social media, said Lake. But it was a struggle, especially for smaller hospitals, he said.

The Health Insurance Portability and Accountability Act, a federal law intended to ensure the privacy of personal medical data, can sometimes make an identification more arduous because a hospital may not want to release information on unidentified patients to people inquiring about missing persons.

In 2016, a man with Alzheimer's disease was admitted to a New York hospital through the emergency department as an unidentified patient and assigned the name "Trauma XXX."

Police and family members inquired about him at the hospital several times but were told he was not there. After a week — during which hundreds of friends, family members and law enforcement officials searched for the man — a doctor who worked at the hospital saw a news story about him on television and realized he was the unidentified patient.

Hospital officials later told the man's son that because he had not explicitly asked for "Trauma XXX," they could not give him information that might have helped him identify his father.

Prompted by that mix-up, the New York State Missing Persons Clearinghouse drafted a set of guidelines for hospital administrators who receive information requests about missing persons from police or family members. The guidelines include about two dozen steps for hospitals to follow, including notifying the front desk, entering detailed physical descriptions into a database, taking DNA samples and monitoring emails and faxes about missing persons.

California guidelines stipulate that if a patient is unidentified and cognitively incapacitated, "the hospital may disclose only the minimum necessary information that is directly relevant to locating a patient's next-of-kin, if doing so is in the best interest of the patient."

At L.A. County+USC, most John Does are quickly identified: They either regain consciousness or, as in a majority of cases, friends or relatives call asking about them, Crary said.

Still, the hospital does not always succeed. From 2016 to 2018, 10 John and Jane Does remained unidentified during their stays at L.A. County+USC. Some died at the hospital; others went to nursing homes with made-up names.

But Crary said she and her team pursue every avenue in search of an identity.

Once, an unidentified and distinguished-looking older man with a neatly trimmed beard was rushed into the emergency room, delirious with what was later diagnosed as encephalitis and unable to speak.

Acting on a gut instinct that the well-groomed man must have a loved one who had reported him missing, Crary checked with police stations in the area. She learned instead that this John Doe was wanted in several states for sexual assault.

"He was done in by a mosquito," Crary mused.

"It is a case that I will never forget," she added. "The truth is that I am more elated when we are able to identify a patient and locate family for a beautiful reunification rather than finding a felon."

This KHN story first published on California Healthline, a service of the California Healthcare Foundation.

Heidi de Marco: heidid@kff.org, @Heidi_deMarco

The four proposed bills share a common goal: avoiding some of the thorny issues around drug pricing and instead getting at the ways branded drug manufacturers use patents and other tools to keep lower-priced generic competitors from reaching patients.

This story was published May 7, 2019, by Kaiser Health News.

By Rachel Bluth, Kaiser Health News

Congress isn't making much headway in finding a solution to the problem of soaring prescription drug prices, but lawmakers from both parties are tinkering on the edges with legislation that aims to increase competition among drugmakers.

A comprehensive piece of drug-pricing legislation is a high priority for Senate Finance Committee Chairman Chuck Grassley (R-Iowa) and Sen. Ron Wyden (D-Ore.). And it could be introduced by mid-June, according to congressional staff.

But while that is hashed out, a slate of options to reform drug patents is working its way through the Senate Judiciary Committee, which had a hearing Tuesday featuring academics, patient advocates and a representative from the pharmaceutical industry. Their mission: to increase competition without decreasing innovation in the industry.

"I think we're dangerously close to building a bipartisanship consensus around change," Sen. Dick Durbin (D-Ill.) said during the hearing.

The four proposed bills share a common goal: avoiding some of the thorny issues around drug pricing, like whether the government will set drug prices or negotiate with manufacturers on what federal programs will pay. Instead, the patent reform proposals get at the ways branded drug manufacturers use patents, and the legal monopolies that are granted with patents, to keep lower-priced generic competitors from reaching patients.

"A package of patent reforms are important because they fix systemic problems that allow prices to go up and keep them high," testified David Mitchell, the president of Patients for Affordable Drugs, a Washington, D.C.-based advocacy group focused on lowering prescription drug prices.

Sen. John Cornyn (R-Texas) offered specific examples of drugs that have benefited from system issues, including Humira, an expensive drug for arthritis and psoriasis that is protected by 136 patents.

That's called a "patent thicket," because it prevents a generic alternative from entering the market for more years—in this case, until 2023 for a drug first approved for use in the United States in 2002. "Is there anyone on the panel who'd like to defend the status quo?" he asked.

"There is no way a biosimilar can deal with a hundred patents," testified Michael Carrier, a professor at Rutgers Law School. "This is an abuse of the system."

Among the proposed bills, the Stop STALLING ("Stop Significant and Time-wasting Abuse Limiting Legitimate Innovation of New Generics") Act—the bipartisan brainchild of Sen. Amy Klobuchar (D-Minn.) and Grassley—is supposed to put a stop to "sham" citizen petitions to the FDA. Critics say these petitions are often introduced by drugmakers under the guise of patient advocacy to slow FDA approval of new generic medicines. "Nearly every one of these citizen petitions is brought by a brand company. None are filed by individuals. I love the legislation. I would go even stronger," Carrier said.

Grassley is also the lead sponsor on the bipartisan Prescription Pricing for the People Act of 2019. It directs the Federal Trade Commission to investigate mergers of pharmacy benefit managers, the middlemen that negotiate between drugmakers and health plans.

Klobuchar and Grassley teamed up again on another measure, the Preserve Access to Affordable Generics and Biosimilars Act, which they say would end "anti-competitive behavior"—specifically, deals struck between branded companies and generic companies to keep a generic, or a biosimilar, off the market. Klobuchar, a Democratic presidential candidate, has frequently discussed her opposition to this practice on the campaign trail.

James Stansel—the executive vice president and general counsel of the Pharmaceutical Research and Manufacturers of America, a drug industry trade group, and the lone voice of the pharmaceutical industry on the panel—cautioned against moving too aggressively on this point. "We want to make sure we don't do something that's anti-competitive in the hopes it would be pro-competitive," he said.

There's also the CREATES ("Creating and Restoring Equal Access to Equivalent Samples") Act, introduced by Sen. Patrick Leahy (D-Vt.) with 31 bipartisan co-sponsors and endorsed by nearly every witness on Tuesday's panel. It's supposed to crack down on branded companies that refuse to sell samples of their drugs to generic companies, a necessary step to increasing the number of generics on the market.

Versions of all four of those bills have also been introduced in the House and advanced out of the House Judiciary Committee.

"The American people are being played for chumps," said Sen. John Kennedy (R-La.). "Just chumps. And it's got to stop."

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.

The reallocation of state money 'would exacerbate our already limited capacity,' a local health director says.

This article was published May 8, 2019, by Kaiser Health News. It was also published by The Sacramento Bee.

By Samantha Young, California Healthline

California Gov. Gavin Newsom wants the state to provide health coverage to low-income young adults who are in the country illegally, but his plan would siphon public health dollars from several counties battling surging rates of sexually transmitted diseases and, in some cases, measles outbreaks.

Public health officials describe the proposed reallocation of state dollars as a well-meaning initiative that nonetheless would have "dire consequences" to core public health services.

There have been 764 confirmed cases of measles this year through May 3 in 23 states, including California, the highest number since 1994, the Centers for Disease Control and Prevention reported Monday. State public health officials also are struggling to address record rates of sexually transmitted diseases, with more than 300,000 cases of gonorrhea, chlamydia and syphilis reported in 2017.

The reallocation of state money "would exacerbate our already limited capacity to respond to outbreaks and public health emergencies," said Jeff Brown, director of Placer County's Health and Human Services Department, which has responded to three measles cases so far this year.

California already allows eligible immigrant children up to age 19 to participate in Medi-Cal, the state's Medicaid program for low-income residents, regardless of their immigration status. The current budget sets aside $365.2 million to pay for the coverage.

In his 2019-20 budget plan, Newsom proposes expanding eligibility to unauthorized young adult immigrants from age 19 through 25.

His office estimates it would cost nearly $260 million to cover them in 2019-20. While state and federal governments usually share Medicaid costs, California would have to bear the full cost of covering this population.

To help pay for it, Newsom proposes to redirect about $63 million in state funds from 39 counties, arguing they would no longer need to provide health benefits to low-income young adults covered by the state.

"As the state takes on responsibility for providing health care to undocumented adults, counties' costs and responsibilities on indigent health care are expected to decrease," Jenny Nguyen, a budget analyst at the state Department of Finance, told lawmakers at a recent legislative hearing.

Under the governor's 2019-20 budget plan, which requires legislative approval, 35 mostly small and rural counties expect to lose about $45 million in state money that funds health services for uninsured residents, including undocumented immigrants. Those counties—which participate in something called the County Medical Services Program—aren't expected to feel an immediate financial impact because the program has a budget surplus.

But four counties—Placer, Sacramento, Santa Barbara and Stanislaus—would take big and immediate hits to their public health budgets, officials say.

The amount of money the governor wants to divert from them to cover unauthorized immigrants under Medi-Cal is far more than the counties now spend on comprehensive health services for those immigrants, local health officials said.

"The idea that these dollars would be offset is just not accurate," said Mary Ann Lee, managing director of Stanislaus County Health Services Agency, who described the governor's budget proposal as "alarming."

For example, Stanislaus County estimates it would lose $2.5 million under the governor's budget plan. When officials studied the population served by their health centers, they found only 18 individuals were young adults who might not have legal immigration status. The total cost to provide care to them: just $1,700 a year.

Sacramento County, which reported a 300% increase in syphilis cases in the past four years, would have to shutter its newly opened STD clinic if the county loses an estimated $7.5 million in state funding, Dr. Peter Beilenson, the county Health Services Director, told lawmakers.

And while Sacramento County provides primary health care to an estimated 4,000 undocumented immigrant adults, just 100 are ages 19 to 25, and they are the least expensive to cover, Beilenson said.

"We agree with the idea behind this, increasing coverage for [those who are] undocumented," Beilenson said. But losing those funds would force the county to close its STD clinic and terminate some communicable disease investigators "at a time when we now have measles cases in the region and we don't want to be shutting those services down."

The 40 confirmed cases of measles reported in California as of May 1 include three in Sacramento County.

As a result of the reduced funding, Sacramento County also would have to slash health services to its unauthorized immigrant residents—the very people Newsom aims to help—by an estimated 75%, Beilenson added.

Whether lawmakers will approve the governor's proposal is unclear.

Several already have expressed concern, including state Assemblywoman Eloise Reyes (D-Grand Terrace), who said, "I think it is clear that this would be terrible for those counties."

Officials with the Department of Finance told lawmakers at the hearing that they were aware of counties' concerns but that the "governor's budget stands as it is."

The governor is scheduled to release a revised budget proposal by May 14, before the legislature votes on it this summer.

"I hope there will be some reconsideration," said state Sen. Richard Pan (D-Sacramento), chairman of the Senate Health Committee. "There's a disconnect there."

This KHN story first published on California Healthline, a service of the California Health Care Foundation.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.