On January 1, 2014, one of the most important changes in the history of the American health care system—the expansion of Medicaid to cover all legal residents whose incomes are within 133% of the federal poverty level*—will take effect as part of the health reform law, known as the Affordable Care Act.
While the health care crisis in America has affected everyone, the poor have suffered a disproportionate burden—in financial cost, reduced quality of life, and shortened life expectancy. Following are just a few of the thousands of Venice Family Clinic patients who, in their current financial situations, will gain health coverage under the expansion of Medicaid, which in California is known as Medi-Cal.
For some, it will be the first time in their lives they have had health insurance. And all patients, besides being able to continue visiting Venice Family Clinic, will enjoy access to new, affordable options for primary and specialty care, mental health services, laboratory and diagnostic services, and prescription medications.
Brittany Tyler Kemp LeGault is just 23 years old, but already she is battling numerous chronic diseases, including diabetes, asthma, and hypothyroidism. Apart from a three-month stretch when she was covered by Medi-Cal as a youth, she has always been uninsured and, until she found Venice Family Clinic, often was only able to access treatment in emergency rooms.
“I was diabetic and I didn’t know it,” she says. “I was constantly sick and constantly suicidal because I was in so much pain.”
Over the last two years, though, she has managed to get her conditions under control with regular visits to Clinic, where she gets her insulin, lancets, test strips, and needles, as well as thyroid, asthma, and sinus medications. Still, she is homeless, unemployed, and unable to buy private coverage on her own. Medi-Cal might be the only coverage she will get for quite a while.
“Since I started coming here, everything has gotten considerably better, but this is the only place I can go,” she says, seemingly overwhelmed by the prospect of Medi-Cal coverage. “That would be the best thing ever.”
Curtis Johnson, 58, has been on both sides of the health insurance divide. For years, he had coverage through his job as a sales manager at a local car dealership. But after he had a stroke, in early 2006, he lost his job and was unable to afford the $1,800 per month it would have cost him to keep his insurance through COBRA.
“As far as going out to buy it on my own, it was even more expensive because I was coming off a stroke,” he says. “I had also had a recent hip replacement, I have high blood pressure, high cholesterol, and glaucoma, and I’m diabetic. Insurance companies look at my record and completely shake their heads.”
He has been a patient of Venice Family Clinic ever since he lost his insurance and has succeeded at getting most of the specialty care he has needed through referrals to volunteers, as well as by calling in a few favors from his former doctors.
“This organization is wonderful. It’s a real blessing. But I think [the expansion of Medicaid] is a wonderful thing, particularly for people in my situation. If your income drops like mine has, it’s not possible to pay for insurance.”
Frances Casarez, 58, has been a patient of Venice Family Clinic for the past four years. While her three children are all insured through their employers, the last time she was insured was 20 years ago, when she was a field worker in Idaho. Going years without regular medical attention during middle age caused or exacerbated numerous health issues, including back problems, anxiety, declining vision, and dental pain. In addition, twice in the last two and half years she had to visit an emergency room—once for her back and once for chest pains—and she is still paying off the bills.
“I don’t even have money to make payments,” she says.
She, too, has no desire to switch health care providers, but she understands the limits to Venice Family Clinic’s services and looks forward to plugging into the larger health care system once she has her Medi-Cal card.
“Oh, that will be great,” she says. “They’ve done what they could here, and I love my doctor. I wouldn’t change, unless I had to move. But I could get so many more things taken care of.”
* Per 2011 guidelines: $14,484 for an individual, $29,726 for a family of four
Thanks to a funding waiver from the federal government, the State of California does not have to wait until January 1, 2014, to begin building the framework for the expansion of Medi-Cal. Already, counties across the state have begun enrolling low-income and uninsured people in special programs with Medi-Cal-like benefits. In Los Angeles County, this program is known as Healthy Way L.A., and while it is technically not insurance, it furnishes payment to clinics and hospitals for providing care to enrollees. And on January 1, 2014, qualified enrollees will be automatically enrolled in Medi-Cal.
This story appeared in the Spring 2011 issue of Encounters. Click here to view the entire newsletter.