Originally published in The Argonaut on September 20, 2019

This article was produced as a project for the USC Center for Health Journalism’s California Fellowship.

When he lost his job as a finance officer at U.S. Bank at the start of the Great Recession in 2007, Kenrick Bascom also lost his health care coverage.  After suffering from a consistent pain in his abdomen, the Venice resident was referred to the nonprofit community health center Venice Family Clinic where he was diagnosed with potentially fatal kidney cancer.

There blocks west of the clinic is Third Avenue, a street notorious for its transformation into an outpost for the homeless of the Westside. The block is often littered with tents, bicycles, RVs, forgotten dreams and broken spirits.  That’s where “Jojo,” who did not want to give her real name, spends most of her time. Three years ago, on a chance visit to Venice Family Clinic, she learned that she had pancreatic cancer, which soon spread to her stomach.

What neither Bascom nor Jojo knew at the time of their respective diagnoses was due to the passage of a then-highly controversial law passed by Congress, they would both be eligible for potentially life-saving surgery.

And if a Trump administration challenge to that historic healthcare law— the Affordable Care Act— is successful, low -income earners who lose their jobs and the homeless could be denied coverage and possible life-saving medical procedures.

In July, Justice Dept. lawyers argued in federal court that the law should be invalidated because of the so-called mandate to purchase insurance under a state-run healthcare exchange has been eliminated.  Legislation passed in 2017 by the Republican-controlled Congress stripped out the financial penalties that most people would have been required to pay for noncompliance with purchasing low-cost insurance.

At Venice Family Clinic, doctors enrolled both Bascom and Jojo in Covered California, the state exchange under the Affordable Care Act.

“My surgeon told me that the cancer would have metastasized to other parts of my body eventually. I don’t know what other options I would have had without the Affordable Care Act,” said Bascom, whose surgery was performed at Keck Medical Center at USC.

Jojo’s also grateful for the Venice Family Clinic and St. Joseph Center, a Venice social services provider three blocks away from Third Avenue, also helped her during her medical crisis.

“They’ve been like a dream for me. They helped me set up my appointments and found me a place to live so I could recuperate after my surgeries. I don’t know what I would have done without them,” said Jojo, a slim woman dressed in jeans and a gray T-shirt who would up on Third Avenue after healthcare costs left her bankrupt.

“I’ve already had two surgeries and now I’m down to just one more. After that I’ll be cancer free.”

Since the passage of the Affordable Care Act in 2010, over five million Californians like Bascom and Jojo have received healthcare coverage.

According to the nonpartisan Henry J. Kaiser Family Foundation, 20 million American have gained health insurance since the law was enacted.

Prior to the implementation of the Affordable Care Act,  adults experiencing homelessness  could not qualify for Medicaid  or Medicare unless they worked a  set number of hours per month or if they could prove that they had a disability, were over 65 or pregnant, according to the Center on Budget and Policy Priorities, a progressive think tank that analyses  how government policies impact the public.

States such as New Hampshire and Arkansas do not exempt those who are homeless from the work requirements. States like Kentucky limit the exemptions to six months and in other states only the chronic homeless—typically a person who has been on the streets for five years or more— are excluded from the work requirement.
The federal law allowed adults in states that accepted the Medicaid expansion under the Affordable Care Act with incomes of 138% of the poverty line to enroll in a state exchange, regardless of disability and work status.

Now the Trump administration is permitting states to take away medical coverage if they don’t work a certain number of hours, which could have a devastating effect on many of the working poor and the homeless, experts say.

“It will be rolling back the clock to a time when millions of people, including millions with preexisting conditions, could not get health coverage.  There could very well be direct damage to any coverage for a huge portion of the population,” said Nadereh Pourat, a professor at the UCLA Fielding School of Public Health. “You’re talking about all those who gained coverage that were not covered before would now be losing coverage.”

Venice Family Clinic Executive Director Elizabeth Benson Forer agrees with Pourat about the ripple effect it could have on those less fortunate and the entire healthcare industry.

“The number of people that would become uninsured again would be devastating. The Affordable Care Act has been in place for almost a decade. Without the Medicaid expansion, we would end up with all those folks who would now be uninsured, which could potentially cause a real collapse of our healthcare system,” she said.

According to the clinic, they serve over 27,000 patients annually and 4,000 of them are homeless. Since the passage of the Affordable Care Act, there has been a 34%increase in the number of patients served, from 20,223 in 2014 to 27,136 in 2018.

Prior to the law’s passage, 25% of the clinic’s patients were covered by some form of insurance, including Medi-Cal: insurance reimbursements were 25%: since the Affordable Care Act became law, 75% of patients are covered by Medi-Cal.

Robert Brooks, 53, has been camping out in the Ballona Wetlands for several years and living on the streets for 12 years. Outreach teams from St. Joseph’s Center visit the encampment frequently but he rejects their overtures to visit a doctor. Brooks acknowledges alcoholism and that his health has deteriorated since his time on the streets.

While he recently acquired a Medicaid card, he prefers not to go to the hospital for heart murmurs and diabetes that have gotten worse since he became homeless.

“I don’t like hospitals because people die in hospitals,” he said.

Pourat says unchecked illnesses that linger such as Brooks’ diabetes could exacerbate an already alarming public health crisis.

“We could see more treatable illnesses such as diabetes, hypertension and other treatable conditions increase.   If there are changes to the law the most vulnerable people will inevitably fall through the cracks,” she said.  “You want a healthy community and a healthy workforce and that doesn’t happen if you leave people behind.”

Jojo was largely unaware of how the Affordable Care Act impacts public health until her health crisis.

“I never really thought about it but I’m glad that it’s there,” she said.

Bascom, who will celebrate five years of being cancer-free in December, wonders why politicians want to tamper with a law that has saved lives.

“I think it would be a great social injustice if we were to dismantle it,” he said.  “Without the assistance of the doctors at Venice Family Clinic and the Affordable Care Act, I would not be alive today.”