August 31, 2017
In government, good intentions frequently have unintended consequences. Unfortunately, many of these unintended consequences can have irreversible impacts, costing lives, chilling innovation and disintegrating community institutions that have reliably served our neighbors for decades.
That’s the case with AB 1250. This legislation has a purportedly noble goal: to protect employment security for public employees. But in actuality, it constructs an elaborate system that locks out the nonprofits and medical specialists that ensure that some of our community’s most vulnerable residents receive care.
The bill would require all county contractors — many of whom are nonprofit Community Benefit Organizations (CBOs) — to spend a significant portion of their modest budgets on expensive audits, burdensome paperwork and administrative overhead.
In the short run, this would divert critical resources from vital services.
In the long run, it could force hundreds of community organizations to shut their doors, leaving tens of thousands of people with limited resources — including survivors of domestic violence, those living with mental illness and families who are homeless — out in the cold.
Almost 65 percent of Contra Costa County’s mental health services are contracted out to provide much-needed additional capacity to the county’s health delivery system. Partnerships between these organizations and the Health Services Department ensure that residents benefit from the cultural responsiveness, expertise and skill they have to offer, while remaining flexible enough to continually innovate and improve their practices.
Outside contracting is particularly necessary in situations where labor is scarce and few people have hyper-specialized expertise. If a disease is relatively rare, why have the county hospital hire a full-time doctor just to serve a handful of people? It makes much more economic sense for a few counties to contract one shared doctor to serve an entire region.
AB 1250 would make it cost prohibitive for a doctor or health group to choose that arrangement. On top of that, there are many emergency services that must be contracted out to protect public safety. The simple truth is that no health department can employ enough professionals to staff and manage the entire system on its own.
Other organizations, such as Rubicon Programs in the counties of Contra Costa and Alameda, deliver services that help the unemployed find jobs. Due to its nonprofit status, Rubicon is able to pool varying sources of funding to maximize its impact. It also can build close, active partnerships between local businesses and community groups, allowing them to develop comprehensive supports that help individuals find a job, establish a career and achieve economic mobility. This holistic, hands-on approach is not one that a government agency could manage effectively.
It all comes down to this: AB 1250 is an existential threat to our local health care delivery systems. It’s a one-size-fits-all policy that solves no real problems and creates new ones.
The 21 members of the Human Services Alliance of Contra Costa – in partnership with the county – serve more than 360,000 residents. Millions more are served in Alameda, San Francisco and across the state. These organizations already face potential cutbacks instituted by the federal government. They cannot afford to further jeopardize their ability to provide high-quality services.
No one wins when you decrease quality and access to services.
Dan Geiger is the director of the Human Services Alliance of Contra Costa. Jane Fischberg is the president and CEO of Rubicon Programs, a nonprofit serving Contra Costa and Alameda counties.