Saban Free Clinics offer invaluable health services, but the locations cannot possibly accommodate the rising number of uninsured patients in L.A. (Catherine Green)

 

 

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While the people of Los Angeles County struggle to find work and put food on the table, maintaining health tends to lose priority status.

When medical problems arise, however, the underinsured are often left without options beyond emergency rooms and clinics. Now their growing numbers in the face of the economic downturn are threatening to overwhelm low-cost services in the Southland.

L.A.’s clinics and emergency rooms have been inundated in recent years with uninsured patients seeking care. It’s a problem that reaches across the country: ER visits nationwide jumped 10 percent in 2009, according to a report this fall by the U.S. Centers for Disease Control and Prevention. 

That sharp increase points to a growing pool of people without more conventional access to care. The industry is making some strides to accommodate them—health services added 6,000 jobs in the last year. But at the same time, social assistance employment slid by 1 percent. Adding staff at this rate makes for slow progress, leaving more than 2 million uninsured Angelenos to fend for themselves.

Vesta Middleton has had to get creative to find health services. She visited CareNow L.A.’s massive free clinic Oct. 21 at the Los Angeles Memorial Sports Arena for a dental checkup and, she hoped, a new pair of glasses. 

She knew of other options around the city, but wanted to take advantage of the clinic’s variety of offerings under one roof. “After a certain time, Medi-Cal is gone and then you have to either try to go to an ER or something and seek help,” she said as she waited for her number to be called over the arena’s loud speaker. “But since they have this out here today and it’s free, why not take the chance?”

Across town, Patricia Torres has come to rely on more permanent low-cost options since moving to L.A. eight months ago. Torres left behind her job, and coverage plan, in Florida. The 40-year-old spent a recent Thursday night inside the waiting room of The Saban Free Clinic on Beverly Boulevard while husband Eddie met with a dentist. 

She wasn’t sure how long she’d be waiting in a plastic chair under the fluorescent lights, but she had only good things to say of the clinic’s care.

“You know what, California has a lot of help, right? Because in Florida, it’s not like this,” she said.

Her husband works as a salesman nearby; their visits were at the very least convenient.

“So, here, many clinics to help people who don’t have a job, maybe don’t have insurance. In Florida, I never hear that,” she said.

Abbe Land, co-CEO of Saban, said budget cuts and a general downward trend in revenue have significantly threatened the clinic’s ability to offer that help. She said the clinic was only able to “remain whole” because of outside funding and donations. “We have an incredibly broken health care system,” Land said. “There’s a lot of bandaids.” 

Saban and other clinics have had to pick up the slack left by a widening gap in access to medical services. “It’s a shame that we as one of the most prosperous countries don’t have national health care,” Land said. “When people are down and out, they have to come to safety-net providers.”

Health insurance researchers were unsurprised to find the number of fully insured residents fell sharply in correlation with the economic downturn.

“There’s no question that the huge jobless rate resulted in a decline in job-based coverage,” said Shana Lavarreda, director of health insurance studies at UCLA Center for Health Policy Research. “Public coverage couldn’t absorb all of those people.” 

October's CareNow Free Clinic drew thousands to receive otherwise inaccessible health services. (Catherine Green)

Laverreda said L.A. County’s rate during that period hovered at about the same level, nearly 20 percent of all residents, due to a “bit of an exodus” from an area that already accounted for the state’s highest number of uninsured.

L.A. County’s Department of Health Services is making an effort to address the imbalance even before President Barack Obama’s federal reform takes effect in 2014. Healthy Way L.A., a program to expand no-cost coverage, aims to stem the bleeding and prepare residents for the new services they may find two years from now. 

Patients eligible for Healthy Way L.A. can take advantage of emergency, primary and specialty care, as well as mental health and chronic disease management services and access to medication.

To qualify, residents between the ages of 19 and 64 must live in the county and be U.S. citizens or have legal permanent status for at least the last five years. They must also earn less than $14,500 annually per person, $29,700 for a family of four.

Michael Wilson, a department spokesman, said much of what needs to be done to serve the newly insured involves changes to infrastructure. Most of them have typically received episodic care, meaning providers would likely never see patients again after a single visit. 

“Right now we’re working to encourage what’s called empanelment, where we match doctors with a certain number of patients,” Wilson said. Setting up a team of physicians for each patient in a medical home model, he explained, would establish consistency and give patients a chance to build relationships with their doctors. 

Healthy Way L.A. began accepting patients in July of this year. By September, the program had already enrolled more than 76,000 residents.

Planning ahead for the expanded coverage has helped to avoid further burdening the city’s finances. The funding for Healthy Way L.A.’s services was factored into the annual budget, and is supported by federal grants and county taxes. 

“I think the coverage will be just fine,” Lavarreda said of the expansion, “because it’s tapping into the existing safety-net system these people are already using.” She called it a “win-win,” noting that providers would be reimbursed for patients they already had, thereby sidestepping the potential hindrance of limited county funds.

“When health care reform passed, people didn’t know how bad the situation had gotten, and it has been getting steadily worse,” Lavarreda said. “Many people are waiting for 2014 to get here as quickly as possible.”

But Patricia Torres still won’t be eligible under the expansion given her relatively recent arrival in the county. At first, she said she wasn’t worried about having lost coverage because “Now I’m healthy,” but when CareNow’s clinic came up, her anxiety became apparent. 

“It’s good,” she said of the full-service event, “especially because it’s not easy to have insurance. It’s too expensive.” She said she didn’t know if she would ever have job-based coverage again. 

“It’s worried, because if you’re sick, you don’t have… “ Torres trailed off, her voice swallowed by the din of the waiting room. But she wasn’t quiet for long. “Thank God this clinic can help.” 

Reach reporter Catherine Green here; follow her here.