Town Hall, Schmown Hall: Health Budget Cuts Still Brutal in California

Given the seemingly never-ending national news blitz about health reform town halls, it's easy to forget that California's dramatic health care budget cuts still are moving forward.

On Wednesday, community health clinics sued California Gov. Arnold Schwarzenegger, saying that he didn't have the authority to make last minute budget vetoes that cut their funding even further than expected, according to a story in the Los Angeles Daily Journal legal publication.

While this and a similar lawsuit are playing out, local safety-net clinics are surely considering what programs and services they'll need to cut to stay afloat.

Don't let the fire and brimstone antics of town hall protesters - as entertaining and newsworthy as they may be - distract you from the slower-moving but critically important health access story unfolding in your community. Are community clinics going to be able to provide the same number of free or low-cost flu shots? Will they provide the new swine flu vaccine? Will costs rise? Waiting lists?

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I'm also reprinting the Daily Journal story here, with permission, because it's behind an online pay wall.

Health Clinics Pile on Budget Lawsuits Against Governor

By Evan George, Daily Journal Staff Writer

LOS ANGELES - Gov. Arnold Schwarzenegger has scribbled outside the legal lines with his blue pencil, according to a lawsuit being filed Wednesday by free health clinics and disability rights groups whose operations were eviscerated by his controversial last-minute vetoes.

The lawsuit attacks the $489 million in additional cuts Schwarzenegger made to health care and other social programs in the budget, stripping services for uninsured patients, children, disabled people and victims of domestic violence.

The health clinics, some of their chronically ill patients and a disability support center are seeking to halt more than $200 million in cuts by filing straight to the First District Court of Appeal.

"The biggest concern is the impact on public health these budget cuts are going to have," said Jim Mangia, executive director of the St. John's Well Child and Family Center. "It is unconscionable and puts the whole state's population at risk."

Mangia's South L.A. clinic, which has 12 locations, lost about $1 million in state funding just to the budget vetoes. He said layoffs and cutbacks would be a blow to programs that have saved L.A. County thousands of costly ER visits, kept diabetic patients from losing limbs and prevented local Swine Flu outbreaks.

The cuts have created waves of debate in legal circles around whether Schwarzenegger had the authority to make them.

Wednesday's lawsuit is the second filed this week against the Governor's line-item vetoes. Armed with similar legal arguments, State Senate Pro Tempore President Darrell Steinberg (D-Sacramento) sued the state on Monday over the cuts. But while Steinberg has sued as an individual, not as a lawmaker, some argue that his case might be seen as a political or procedural squabble. It would be much harder for courts to make that argument against flesh and blood patients who can try to show a judge that they will suffer quick, irreparable harm.

Community clinics lost $86 million in the Governor's additional cuts, according to lawyers. The Healthy Families program, which covers uninsured children, took a $50 million hit while Medi-Cal was shrunk by more than $60 million.

"The extra harm done by the Governor to low-income individuals are truly things we cannot tolerate," said Barbara Siegel, managing attorney at Neighborhood Legal Services, part of a coalition that helps poor families tap social benefits.

Neighborhood Legal Services, the Western Center on Law and Poverty, Disability Rights Advocates and a pro bono team of Kirkland & Ellis is handling the case.

The Department of Finance has defended the vetoes as legal and crucial because they protect California's rainy day fund. "We think it is an open and shut case," said H.D. Palmer, director of the state's Department of Finance. "It was with reluctance, but out of necessity, that the Governor took the action he took. We believe it will withstand any and all court challenges," Palmer said.

Both the recent lawsuits are challenging vetoes Schwarzenegger made to budget sections that critics argue lie outside the reach of veto power. Siegel said whole sections of the budget that Schwarzenegger inappropriately swiped with his line item veto were not appropriations under his authority to cut.

"To us it means the cuts we are challenging were new acts, they were not amended, and they are not subject to a line item veto," Siegel said. "He became a legislator when he did these line item vetoes."

That distinction between new bills and holdover appropriations from the February budget has stirred spirited legal sparring this week between Schwarzenegger's legal team and critics. The legal dispute largely hinges on archaic case law from the 1920s, both sides said.

Jennifer Rockwell, the department's chief counsel, said the definition of an appropriation includes the types of line item vetoes he made because the term applies to any "specific sum of money from a fund that the executive branch can spend on a specific purpose."

Some legal observers said the health clinics would be more likely to persuade a state court judge to swiftly overrule the Governor's actions.

David I. Levine, a professor at UC Hastings College of the Law, described that strategy as, "people are going to die - here they are."

Levine, who teaches civil procedure and state law, said the difference between the two lawsuits filed this week was "a small formality" because both would have standing.