L.A. County supervisorial candidates

Hilda Solis, left, Bobby Shriver, Sheila Kuehl and John Duran are running for the L.A. County Board of Supervisors. (Lawrence K. Ho / Los Angeles Times / May 19, 2014)

The most prominent candidates to fill seats this fall on the Los Angeles County Board of Supervisors have very personal reasons to be interested in healthcare.

One is an HIV-positive West Hollywood city councilman. Another left the Obama administration in part to care for her mother.

A third is a former legislator who battled unsuccessfully for single-payer health insurance. A fourth is an activist who raised millions to fight HIV in Africa.

But whoever emerges from the field of 11 candidates competing in two districts will have to take a big-picture approach when they assume office in December if they hope to help the county navigate federal healthcare reforms.

In separate interviews, District 1 candidate Hilda Solis and District 3 contenders John Duran, Sheila Kuehl and Bobby Shriver described their visions for the second-largest public healthcare system in the nation, with four hospitals and 19 regional clinics.

Solis, a former Labor secretary who is heavily favored to fill termed-out Supervisor Gloria Molina's seat, emphasized preventive care, calling on the county to work more closely with nonprofits and clinics in local communities.

Duran, Kuehl and Shriver, all vying to replace Supervisor Zev Yaroslavsky in a district that includes parts of the Westside and the Valley, also praised the role of partner organizations in keeping communities healthy.

"I don't think we always have to think about adding more county workers but rather using existing [private contractor] systems that are there and providing them with additional funding," said Duran, a West Hollywood city councilman who is HIV-positive.

Duran, a critic of the county's response to AIDS during the 1980s, in recent months has complained that the public health department has been too slow to respond to meningitis outbreaks.

Investing in partnerships with clinics and nonprofits is a vision that marries well with Affordable Care Act reforms, which provide money for community clinics and emphasize primary care and prevention. But supervisors are also responsible for the county's own $3.8-billion health system, which will face new challenges under the law.

Historically, its patients — many so poor they had to be subsidized by taxpayers—had few other places to turn. Today, thanks to health reform, more than 600,000 formerly uninsured county residents have policies through the Covered California exchange and Medi-Cal. They can now seek care at private hospitals — taking their insurance dollars with them.

The threat of losing patients just as they gain the ability to pay represents a major financial uncertainty for the county. Officials worry that without significant improvements to the quality of county health operations, delays and other problems could eventually drive insured patients away, drying up dollars that could keep the public healthcare system afloat.

To prevent such an outcome, Solis said the health services department would need to "step up" to make it easier to access care and to "bring up the level of expertise and training" among staff. She also said she wanted the county to renew efforts to use parcel tax revenue to establish a trauma center in the eastern San Gabriel Valley.

But Solis said she would not necessarily make a similar call for money to ease sometimes severe crowding in the emergency department at Los Angeles County-USC Medical Center, which is in the 1st District. (Studies have suggested that at least initially, an influx of newly insured patients might increase traffic in already overburdened emergency rooms.)

Though she would like to see the hospital have more beds, Solis suggested it might make more sense to ease crowding by redirecting patients to nearby facilities with more space.

"Whatever is flexible, whatever the budget could handle," she said.

Shriver cited his healthcare experience working with entrepreneurs to launch the RED campaign, which provided HIV medications for millions in Africa.

"Competition is good," he said. "Questioning is very good for the system, because it causes old practices to change."

He said using technology to streamline county systems — an effort that is already underway — is key for improving the customer experience.

Longtime healthcare reformer Kuehl, a former lawmaker, expects Obamacare to deliver more, not fewer, patients to the county, and said she thought it would ultimately alleviate emergency room overcrowding by improving preventive care.