UMC pitch for state health programs meets resistance

Thursday, Nov. 11, 1999 | 10:30 a.m.

CARSON CITY -- A pitch by University Medical Center to have Clark County take over some of the state's health programs met with resistance from at least one rural county legislator Wednesday.

William Hale, chief executive officer for University Medical Center, proposed Clark County be given the responsibility of running a children's health insurance program and Medicaid, both of which are operated by the state.

He argued this would produce a single health care system in Clark County, avoid duplication and result in less confusion among the public. It could lead to cost savings.

His hospital, he said would not run the program but it would be operated by a nine-member board, seven of them appointed by the Clark County Commission, which now serves as the board of trustees for University Medical Center.

His presentation was made to the Governor's Steering Committee Conducting a Fundamental Review of State Government. And it drew a quick response from Assembly Minority Leader Lynn Hettrick, R-Gardnerville who said Clark County wants the state to supply the money for these programs but it wants to make the decision on how they operate.

"You would take control of the budget out of the hands of the state," Hettrick complained. These programs, he said would be based on the number of clients Clark County decided to serve and not on the money supplied by the state. Otherwise the state would have to supply the money on any decision made by Clark County.

State Sen. Maggie Carlton, D-North Las Vegas, worried that residents who are now turned down by one program can seek help from other agencies. She said a citizen would get a single rejection under the plan and might not have anywhere else to turn for help.

State Human Resources Director Charlotte Crawford told the committee Hale suggestion, which has been made for three years, needs more study. For instance, she said who would make the decisions on the benefits and whether they would be expanded.

Hale said the federal government determines the eligibility in Medicaid, a program for the medically needy that is financed 50-50 by the state and federal government. The other program would be "Check-Up" which provides insurance coverage to children of the working poor. The federal government pays 65 percent and the state 35 percent.

Robert Hadfield, executive director of the Nevada Association of Counties, said "Clark County is a machine, experiencing rapid growth." But there are five counties which have declining economies. He said he supports the creation of the plan for Clark County. "But it must be crafted so there is some protection against adverse impacts on the rest of the state."

May Shelton, director of social services for Washoe County, said it needs to study the plan further before reaching a decision.

Hale said Clark County and his hospital "are convinced that public programs which support health care for the uninsured can be run more effectively and efficiently at the local level." The plan also calls for other hospitals in Clark County to share in treating the indigents or nonpaying patients.

Hale said the state would have to get a waiver from the federal government to take over these programs. He suggested it could be accomplished in one year for the children's insurance program and in 3-4 years for Medicaid.

Eventually, Hale envisioned starting a program to treat all other uninsured patients. Nevada, he told the committee has the highest uninsured rate in the nation.

Starting this program, he said would draw additional federal money into Nevada. But Crawford said this would require extra state money and all of the counties to cooperate.

Hadfield has said previously that many rural counties now are strapped for cash and are at the maximum $3.64 property tax limit.

Hale said, "We could have to come up with creative ways to help the small counties."

Later during the committee meeting, member Dale Erquiaga said there's been a lot of testimony about the financial problems of rural Nevada. "Why do we have so many counties?" he wondered. "They are creatures of the Legislature. Shouldn't they be consolidated?"

"These counties are too poor," Erquiaga of Reno said. Just because they were created in 1865 doesn't mean they should be continued today, he said.