Daniel Zingale

Viewpoints: Low-income health programs need to live on

Published: Wednesday, Mar. 6, 2013 - 12:00 am | Page 15A

The state legislative session is now in full swing, and lobbyists and advocates are descending on Sacramento to talk health care coverage – who should be eligible and how they should get it.

It's a debate you might have expected Obamacare to end. But though California and millions in our state will benefit when the president's plan kicks in next January, about 3 million to 4 million Californians, the majority of whom are legal residents, will remain uninsured.

It's an unconscionable hole that will cost California dearly over the long term. Just ask Mercedes Montano, a 27-year-old from Los Angeles, who until recently was a pre-med student at California State University, Los Angeles.

Like many Californians, Montano's mother brought her here from Mexico when she was 7, to better their lives. "My parents worked hard, paid our taxes, and made me study to get good grades," she said. Her dream was to become a primary care doctor to serve her community.

Then a tingling sensation began in her limbs, growing so bad that soon she couldn't feel them. Eventually she lost the use of an arm and a leg.

Her condition left her desperate. But as an undocumented resident, she couldn't get health insurance through school. Instead she went to a chiropractor, who only confirmed she needed medical attention.

After scraping together $600 for an exam, Montano was diagnosed with a degenerative disease causing pinched nerves along her spine. The doctor said the condition could have been detected in childhood and that early treatment would have prevented these severe problems. But she never had access to medical insurance, didn't know how to get help, and went without regular checkups as a child.

The doctor recommended surgery, but Montano didn't bother to ask the cost.

"No matter what it was, I couldn't afford it," she said. Instead, she goes to a chiropractor three times a week, struggling to pay between $600 and $900 a month to keep the use of her arms and legs.

Montano had no choice but to drop out of school and get a job to pay for the therapy she can afford.

This is a crazy way for a health care system to operate, one that crushes dreams and ultimately does not save us money. Eventually people like Montano do seek medical help, usually when the pain has grown so bad they can no longer ignore it, often at a time things have worsened beyond any chance of paying for it, sometimes when their lives are already ruined.

Californians collectively foot the bill. The cost gets passed on to all of us in the form of uncompensated care and higher insurance premiums.

We need a cost-effective, efficient, and humane way for all Californians, including Montano, to access basic health care services and preventive care that provides checkups and screenings to catch problems before they become crises. It might cost $30 to get a flu shot. But end up in the hospital with influenza and we'll pay thousands.

Fortunately, a solution is already in place. Two years ago, low-income health programs were set up in 52 of California's 58 counties to provide a temporary method of providing care to many uninsured Californians until Obamacare starts in 2014.

While the programs offer more limited coverage than Medi-Cal or private insurance, they do offer the critical basics – including preventive and primary care services like check-ups and screenings.

But these programs expire at the end of 2013 when Obamacare kicks in, and the 500,000 Californians in them will get shifted into full Medi-Cal coverage. However, Californians like Montano will be left out and still need help.

It makes no sense to let this critical community infrastructure dissolve.

These county-based programs should continue to cover the remaining uninsured. The state should maintain its support to California counties that operate these invaluable programs, and find other ways to fund safety-net health providers in the few counties that don't.

Keeping these county low-income health programs open will ensure that access to care is consistent across California for the remaining uninsured. The state wouldn't be writing the counties a blank check – it would provide more transparency and accountability, tied to actual patients enrolled, with counties accountable to provide the preventative basics, not just episodic, emergency room care. Ultimately all Californians should save money as more people receive checkups and fewer end up in emergency rooms.

The people who would walk through the doors of these low-income health programs, like Montano, are the future of California. Our success as a state is inextricably bound to theirs. Immigrants like Montano arrive healthy and want to live responsible and productive lives.

Keeping them healthy is good for our economy. Young strivers like Montano can become tomorrow's doctors, high-tech workers and engineers. But simply crossing our fingers and hoping they'll somehow stay healthy, without making it easier for them to do so, is self-defeating. Investing in our human capital is the best way to fuel our state's growth. We are in this together.

Daniel Zingale is a senior vice president at the California Endowment, a private philanthropic health foundation. He is a leader of the Health Happens Here campaign (www.healthhappenshere.org)

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