On May 26, 2000, U.S. Senators Dianne Feinstein and Barbara Boxer urged the U.S. Department of Health and Human Services to extend a Medicaid waiver, which was granted to Los Angeles County in 1995 and is scheduled to expire June 30.

In a letter to Health and Human Services Secretary Donna Shalala, the California Senators said the waiver extension is critical "to enable Los Angeles County to move toward self-sufficiency and stabilize its health care services system" and avoid "service reductions and lay-offs ranging from 1,500 to 4,000 health care providers."

"As the health care provider of last resort, Los Angeles County now manages the largest public health care system in the United States, serving almost one million patients annually," the Senators wrote.

"The County supports three million outpatient visits, 150,000 inpatient days and 500,000 emergency room visits every year. One out of five of the County's residents is poor. While the U.S. poverty rate is 12.7 percent, Los Angeles County's poverty rate is 22 percent. The County's uninsured rate of 33 percent for adults far exceeds the nation's rate of 18 percent. The number of working uninsured is projected to grow by 300,000 to 3 million by 2005. To put this in perspective, the number of people without health insurance in Los Angeles County exceeds Arkansas' total population.

Additionally, the Senators noted, the growing population of managed care has reduced revenues to County hospitals because many private plans.

"Under the existing waiver, Los Angeles County has taken a system that was on the brink of collapse in 1995 and made it more stable. The County has made notable progress in fulfilling the initial objectives of the waiver.

For example, the County has decreased County inpatient beds by nearly 28 percent and increased ambulatory care services by 800,000 visits. Ambulatory care services has been expanded from 45 to 170 sites and many hospital-based services have been moved into freestanding community health centers. Overall system efficiencies put in place have saved $42.9 million in fiscal years 1998 and 1999 and $70.9 million (projected) for fiscal years 1999 and 2000.

"We believe the County has taken and is committed to taking many constructive steps to accomplish the waiver's goal of restructuring health care services, stabilizing the system, and moving more services from hospitals to outpatient settings. The County has developed three-year and five-year self-sufficiency plans and has committed an additional $60 million over current County expenditures. Without an extension of the existing waiver, the County could face service reductions and layoffs ranging from 1,500 to 4,000 health care providers."