Despite expanded health insurance, LA County faces big challenges
This story originally appeared in the Los Angeles Daily News.
Despite enrolling half a million people in health insurance under the Affordable Care Act last year, Los Angeles County still has more uninsured residents than all but five states.
Caring for those uninsured people — and keeping them out of emergency rooms — falls largely to the county government and a network of community clinics.
“Even if you don’t have insurance, you still have access to care,” said Tangerine Brigham, deputy director of the Los Angeles County Department of Health Services.
Newly released census data paints a detailed picture of the county’s 1.55 million uninsured:
- Nearly half of them, 46 percent, are noncitizens, according to an analysis by the Center for Health Reporting.
- 39 percent are high school dropouts.
- 23 percent earn less than $25,000 a year, near the federal poverty line for a family of four.
- 69 percent are Latino.
With some exceptions, noncitizens can’t get federal health care aid.
L.A. County is filling the gap for noncitizens with My Health LA, a $61 million program launched last October that has enrolled 131,000 people. Any L.A. County resident who earns 138 percent or less of the federal poverty level — $33,465 for a family of four — is eligible, Brigham said.
L.A. is one of 47 California counties to offer basic health coverage for undocumented immigrants, according to Health Access California, a group that advocates such coverage. The 11 counties that don’t offer it include three of the five largest: San Bernardino, Orange and San Diego.
The state will begin offering health insurance for about 170,000 undocumented children beginning May 1. Approved as part of the 2015-2016 state budget, Medi-Cal for undocumented children is expected to cost about $40 million annually. It was approved largely along party lines with Democrats supporting and most Republicans opposing it.
California stands out in offering health coverage to undocumented immigrants. To win support for the Affordable Care Act in Congress, President Barack Obama explicitly promised that the federal law would not cover them.
While Obamacare scored big successes in some parts of L.A. County, it failed to deliver in others. The biggest gains in health insurance coverage came in Compton, Pomona and Inglewood, where the insured rate grew by at least 8 percentage points from 2013 to 2014. Meanwhile, the insured rate grew by half as much in Pasadena, Torrance and Glendale.
And in El Monte, where 27 percent of residents lacked insurance in 2013, the uninsured rate hit 29 percent last year. It was the only city in L.A. County where the uninsured rate got worse under the Affordable Care Act.
San Bernardino County also saw mixed results, according to the American Community Survey. The uninsured rate fell by 6 to 8 percentage points in San Bernardino, Rialto, Ontario and Chino. But in Chino Hills, Redlands and Rancho Cucamonga it fell by 2 percent or less. And in Upland, the change was so small, a reduction of 0.3 percent, that it could be explained by statistical error.
Many current and formerly uninsured — immigrants and citizens alike — get health care at community clinics such as San Fernando-based Northeast Valley Health Corp. and Valley Community Healthcare in North Hollywood.
The Affordable Care Act, also known as Obamacare, and My Health LA, as well as others, have had a huge impact on community clinics.
“More and more people are covered,” said Kim Wyard, chief executive officer of Northeast Valley Health. For example, the uninsured rate among Northeast’s adult patients has fallen from 65 percent in 2011 to 33 percent.
Meanwhile, Valley Community Healthcare has opened a new center in North Hills because of increased business, President Paula Wilson said.
Most patients at Northeast Valley and Valley Community Healthcare are poor. Those who are uninsured pay on a sliding scale based on income. Both clinics offer primary care, dentistry and other services such as counseling. Among their goals is to give patients a “medical home” so they won’t go to an emergency room at the first sign of trouble.
A 1986 federal law requires ER’s to treat people during medical emergencies regardless of ability to pay. But the cost can be high, both financially and medically. That’s particularly true if the patient goes to the ER for treatment of a chronic condition such as diabetes, which will only get worse if it isn’t managed properly.
Both clinics are participating in a project with Valley Presbyterian Hospital in Van Nuys to track their patients who visit the hospital ER or are treated as inpatients. Usually the clinics have no idea that their patients have gone to the hospital, let alone what happened to them there.
During the three-year, $1 million project, funded by the UniHealth Foundation, the clinics will get hospital records and in turn follow up with their patients. That should improve the patients’ health and reduce costs.
The county still hopes to push down its uninsured rate, which, at 15.6 percent, is 3 points higher than the state rate.
“We need to do a lot of work in educating people about the coverage options available to them,” Brigham said.
At Valley Community Healthcare and Northeast Valley, staffers routinely screen patients to see if they’re eligible for the Affordable Care Act, My Health LA or other programs.
“What we find most successful is going to locations they frequent,” Valley Community’s Wilson said. “Really going to soccer fields where these families congregate on a Sunday.”
“Trust is a major, major issue,” said Olga Duran, Valley Community’s member services director. Because of anti-immigrant sentiment, many immigrants and relatives of immigrants hesitate to enroll.
Churches are important allies in getting people signed up, Duran said. But you have to go out and ask people.
“They’re not going to come to you,” Duran said. “We have to go to them.”
The numbers are daunting: In Northeast Valley’s turf alone, Wyard estimates the number of uninsured will be 200,000 in 2016.
“We’re running as fast as we can, not only to get the message out but to provide service,” Duran said. “But there’s a lot of work to do.”