By Jennifer E. Arevalo Ruiz, Community Clinic Consortium
Since the Affordable Care Act was signed in March of 2010, more than 4 million Californians have gained access to health insurance. Individuals and families can now stay on their parents’ private employer sponsored health insurance up to the age of 26, preventative health care services are free of cost, and individuals with pre-existing conditions cannot be denied health insurance.
According to Covered California, during the second enrollment period, the nine greater Bay Area counties — including Solano County — enrolled 93,592 individuals. This is a very exciting time for those eligible to apply for health insurance! Unfortunately, there are an estimated 3 million individuals in California who will remain uninsured after full implementation of the Affordable Care Act in 2019. About half of the individuals who will lack insurance will be eligible for state funded Medi-Cal or subsidized insurance through California’s Health Exchange, Covered CA.
Many of these folks who will remain uninsured may experience difficulties in enrolling that prevent them from getting coverage. Some may also still find it unaffordable to enroll, even with access to subsidized coverage. And others will have immigration concerns that inhibit them from enrolling themselves or their eligible family members. In California, there are approximately 125,000 young adult immigrants who are eligible for full scope Medi-Cal but may be unaware of their eligibility or are concerned that getting Medi-Cal will harm their immigration status in the future.
The other half of remaining uninsured Californians will continue to lack insurance because they are explicitly excluded due to their immigration status. Not only does excluding this population from access to health insurance have negative health and financial impacts on individuals and their families, but it also has a seriously negative impact on California’s economy. In 2009, according to the Center for American Progress, denying health insurance to this population cost California upwards of $20 billion in lost productivity alone.
Currently, there are two policy efforts at the federal and state level that can help this population gain health insurance access. The first is President Obama’s Executive Order, which provides Deferred Action status to an expanded population of Childhood Arrivals and to parents of citizen and/or permanent legal resident children. Though this executive order is currently being challenged in the courts, should it be implemented, up to half a million Californians could gain access to state funded Medi-Cal, according to a policy brief by the UC Berkeley Center for Labor Research and Education and the UCLA Center for Health Policy Research.
The second policy effort is a California State Legislative bill called SB 4, a bill that many are calling the Health for All bill. This bill proposes to include children who remain uninsured due to their immigration status into Medi-Cal, assuming they would be otherwise eligible using existing income qualifications.
While we don’t yet know how these policy efforts will turn out, it is important that we encourage those who are already eligible for health coverage to enroll in the opportunities available to them. These efforts will ultimately help us get closer to living in a state where everyone has access to the health insurance they need to keep themselves and our communities healthy.
Jennifer Arevalo is the Community Affairs Manager at the Community Clinic Consortium, a member of Solano Coalition for Better Health.
September 22, 2015
[Martinez, CA] – The Contra Costa County Board of Supervisors approved a plan today in a 4-1 vote to expand access to healthcare for residents regardless of immigration status. The decision comes six years after the Board voted to bar undocumented adults from participating in the County’s Basic Health Care Plan.
“Today was a huge victory in bridging the gap of health equity in Contra Costa County. The Contra Costa CARES program demonstrates the commitment of our elected officials and healthcare leaders to work together for the benefit of everyone in this county,” said Alvaro Fuentes, Executive Director of the Community Clinic Consortium representing community health centers in Contra Costa County. “The vote today echoes the voices of thousands of individuals – locally and statewide – committed to improving the health of their communities by ensuring that everyone has access to quality and affordable health care.”
The approved plan will allocate $500,000 in County funding toward the program. Led by the Consortium, a diverse set of public and private health systems stakeholders developed the program to help meet the healthcare needs of those not covered by the Affordable Care Act. Several local partners who participated in the development of Contra Costa CARES are anticipated to match the County’s contribution. As a result, the program is expected to be implemented with a total of $1,000,000 to serve approximately 3,000 residents. Meanwhile, estimates from the UC Berkeley Labor Center show that in Contra Costa County the undocumented population may be closer to 19,000.
The Contra Costa County Board of Supervisors’ decision comes on the heels of Monterey County’s expansion of healthcare access for undocumented residents. This year, 35 rural counties in California and Sacramento County also expanded access to healthcare for undocumented adults and expansion of Medi-Cal access to undocumented children in the state was approved in the Governor’s budget. Contra Costa represents the 47th county in the state to provide access to healthcare for its undocumented adult population.
As people all across California prepare for the holiday season, this November marks an especially important time for all Californians. That’s because Nov. 15 is the beginning of the second open enrollment period for Covered CA.
Covered CA, which was put in place as a result of the Affordable Care Act, is California’s own health insurance marketplace. Through Covered CA, California residents can choose from among several quality health insurance plans offered in their region. Those with qualifying incomes can also receive financial assistance when purchasing health plans through Covered CA to help them pay the cost of their monthly premium. Some consumers will also qualify for plans with reduced out-of-pocket costs, including lower co-pays, co-insurance, and deductibles.
As a result of the Affordable Care Act, all plans offered through Covered CA, as well as all health insurance plans offered through the individual and small group markets, also provide coverage for the following 10 essential health benefits:
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Though the Human Papillomavirus vaccine, which protects against cervical cancer, is not required to attend school, it is strongly recommended by the Centers for Disease Control and Prevention. There are vaccines available to protect both males and females against some of the most common types of HPV.
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They provide comprehensive, high-quality, affordable primary and preventative care. But health centers do more than just provide health care. They’re transforming communities by going above and beyond traditional providers. They set themselves apart by providing a wide range of services to improve the overall health of their patients and communities including patient education, fitness programs, nutrition classes and even enrollment into health insurance programs to help their patients pay for care.
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In support of this day, the World Health Organization and partners around the globe are engaging in efforts to raise awareness and to advocate for policies such as increased taxes on tobacco.
Despite campaigns like World No Tobacco Day and the tremendous strides the United States has made in recognizing the harmful effects of tobacco, tobacco use still remains the leading preventable cause of death in the U.S, according to the Centers for Disease Control and Prevention.
According to the 2014 Surgeon General’s Report on Smoking and Health, smoking cigarettes and exposure to secondhand smoke result in one in five deaths in the U.S. each year – roughly 480,000 people.
Smoking tobacco not only leads to increased risk of heart disease, stroke and lung cancer, but it also increases the risk of death from all causes for both men and women, according to the CDC. Smoking tobacco can also negatively impact pregnancy and birth outcomes, oral health, vision and bone health, and can increase the risk of developing diabetes and many types of cancer.
Not only is smoking bad for your health, but it is also bad for your wallet, with smoking-related diseases resulting in roughly $96 billion in health care costs each year, according to the CDC
Though only 13.8 percent of adults in California are estimated to be smokers, a recent presentation to the Board of Supervisors by the Solano County Health Promotion and Community Wellness Bureau stated that more than 21 percent of adults in Solano County are smokers, and more than 10 percent of ninth- through 12th-graders smoke. According to the Solano County Tobacco Prevention and Education Program, tobacco use results in the death of more than 780 Solano County residents each year.
While all of this may seem like bad news, the good news is that quitting smoking and the use of other tobacco products will have tremendously positive impact on your health. According to the CDC, after one year of cessation, your risk of developing heart disease will drop dramatically. After two to five years of being smoke free, your risk of stroke could return to the same level as a nonsmoker. And within five years, your risk of developing cancer in the mouth, throat, esophagus and bladder will drop by half.
Thankfully, in Solano County there are many resources available to help those who are interested in quitting the use of tobacco products. The Solano County Tobacco Prevention and Education Program can provide you with information on resources in your area, including in-person and online classes.
Visit www.tobaccofreesolano.org for more information. In addition, you can visit your local community health center to find out what health education and tobacco cessation services they offer.
So, in honor of this year’s World No Tobacco Day, consider the ways in which you can improve your health and the health of your community by reducing your exposure to tobacco this summer.
Whether you want to quit smoking, encourage a family member to do so, or advocate for different policies in your community, there are a lot of ways to improve your health by reducing your exposure to tobacco and having a smoke free summer.
Morgan Westfall is a Project Coordinator at the Community Clinic Consortium, which is a member of Solano Coalition for Better Health.
As more Californians gain access to health insurance, however, it is important for consumers to understand how to use their newly acquired insurance.
A 2013 study by the Journal of Health Economics found that many consumers don’t fully understand the details of their health insurance plan. Of those consumers surveyed in the study, only 14 percent were able to explain the differences between basic insurance concepts such as deductibles and co-pays.
One way consumers can get a better handle on their health insurance policy is by understanding the different types of cost associated with their plan. There are typically four different types of cost included in a health insurance plan: Premiums, co-pays, co-insurance and deductibles. It’s important to factor in all of these different types of costs when picking a plan and using it.
Now, let’s review what some of these terms mean.
A health insurance premium is the amount of money a person pays periodically – usually monthly – to buy an insurance plan. In order to keep your health insurance, you must continue paying this amount for your entire benefit year.
A co-pay or co-insurance is separate from what you pay for your premium. These terms refer to the amount you have to pay out of your own pocket every time you go to the doctor or receive a service. A co-pay is a fixed amount that you pay for a service. For example, the $20 you pay every time you see your doctor would be a type of co-pay. Co-insurance refers to the percentage of the cost of a service that you are responsible for paying. Some plans charge either co-pays or co-insurance, while others may include a combination of the two.
A final type of cost that is important to understand is a deductible. A deductible is the amount a consumer must pay each year before their health insurance will start paying for a portion of their health care costs. For example, if you purchased a plan with a $500 deductible, this means that you will have to pay $500 out of your own pocket in addition to your monthly premium before your health insurance will start paying for you. Before you meet that deductible, you will be responsible for paying the full cost of any services you receive. Co-pays and co-insurance costs will come into effect after you have reached the deductible in the plan you have chosen.
Thankfully, most plans are now required to have an out-of-pocket maximum. This means that there is a limit on how much you are expected to pay out-of-pocket through deductibles, co-pays and co-insurance during the policy year before your insurance will cover 100 percent of your health care costs. Most health plans are also required to cover preventative services and screenings, such as mammograms and pap smears at no cost to you.
While many of these costs may seem overwhelming, especially if you’ve never had health insurance, it’s important to remember that having health insurance can not only protect your health but can also protect you financially in the event of an emergency or unforeseen medical circumstance. Ultimately, this will enable you to take the preventative measures necessary to protect your health today and ensure a healthy future for tomorrow.
Morgan Westfall is a Project Coordinator for the Community Clinic Consortium, which is a partner of the Solano Coalition for Better Health.
Though Valentine’s Day, along with February’s American Heart Month, has passed, Americans should still be thinking about their hearts. That’s because continual promotion of good heart health and awareness of heart disease is important.
Heart disease, which refers to several types of heart conditions, is the leading cause of death for both men and women in America. It results in roughly 600,000 deaths per year, according to the Centers for Disease Control and Prevention.
Coronary artery disease is the most common type of heart disease in the United States and can lead to angina (chest pain), heart attack, heart failure and arrhythmias, according to the CDC. The main risk factors for heart disease are high blood pressure, high cholesterol and smoking. There are also several other risk factors for heart disease, including having diabetes, being overweight or obese, poor diet, physical inactivity and excessive use of alcohol, according to the American Heart Association.
According to both the CDC and the American Heart Association, there are many things you can do to reduce your risk of heart disease. Remember to eat a healthy diet low in saturated fat, trans fat, cholesterol and sodium. You should also exercise regularly, maintain a healthy weight, limit your alcohol use and avoid smoking.
Another great way to maintain or improve your heart health is to make sure you have the health coverage you need. Having access to health insurance allows you to get your cholesterol and blood pressure checked regularly, both of which are key in understanding your risk for heart disease. In addition, having access to health coverage allows you to access preventative care as well as timely treatment if you do develop heart disease.
According to the National Health Interview Survey conducted by the Centers for Disease Control and Prevention, roughly 7.3 million Americans with cardiovascular disease were uninsured before implementation of the Affordable Care Act. In addition, according to the American Heart Association, being uninsured puts people at greater risk for cardiovascular disease and stroke.
Thankfully now that implementation of the Affordable Healthcare Act is well under way, you can get the health coverage you need to really keep your heart doing its best. Here in California, consumers who are uninsured now have access to health insurance through either Covered CA or expanded Medi-Cal. Those who purchase coverage through Covered CA may even have access to financial assistance, in addition to being able to choose between quality plans that cover the 10 essential health benefits.
In addition to new coverage options being made available under the Affordable Care Act, consumers can also no longer be denied health insurance because of pre-existing conditions such as high blood pressure or a congenital heart defect. This means that people who already have heart disease or risk factors for it can no longer be denied access to insurance because of these conditions.
For more information about what new coverage options may be available to you, go to www.coveredca.com. You can also visit your local community health center to find out more information about signing up for health coverage, as well as resources for keeping your heart healthy.
Whether you want to start eating healthier, exercising more, or getting enrolled into health insurance coverage, now is the perfect time to take the steps you need to keep your heart healthy!
Morgan Westfall is a Project Coordinator at the Community Clinic Consortium, a partner of Solano Coalition for Better Health.
By Celina Keshishian
This holiday season, there’s a new conversation Americans are having as millions across the country gain access to new and affordable health coverage. While this is a historic and momentous step forward, it’s easy to forget that millions of Californians will be left out of receiving the gift of health this holiday season.
With an estimated 7 million uninsured, California has the largest number of individuals with no health insurance in the country. New health coverage options available under the federal Patient Protection and Affordable Care Act are enabling millions to enroll in health insurance that they previously couldn’t afford. Thanks to Medi-Cal expansion in the Golden State, 1.4 million Californians will be newly eligible for the program.
And yet, after all is said and done, it is estimated that 3.1 to 4 million Californians will remain uninsured according to the UC Berkeley Center for Labor Research and Education and UCLA Center for Health Policy Research.
Approximately 1 million are predicted to be undocumented populations who have been explicitly excluded from participating under federal law. This means that three-quarters of the uninsured will be U.S. citizens or lawfully present immigrants who may be eligible for Medi-Cal or purchasing coverage through Covered California. Obstacles including lack of access to a computer or materials in their native language will hinder some populations from learning and enrolling into new health plans. For some, changes in circumstances like gaining or losing employment will result in coverage gaps. And for an estimated 40 percent, the promise of health care reform to provide affordable access to coverage will not be so affordable after all.
Providing care to the remaining uninsured will remain a major challenge for communities across California, including Solano County. Often, the option of last resort – hospital emergency rooms – is extremely costly, forcing those without a reliable source of care to put off necessary preventative health services. Ensuring access to a reliable source of care for the remaining uninsured and preventing costly emergency room visits is both prudent and economically sound policy.
The critical role community health centers play in serving our most vulnerable populations cannot be underestimated. Community health centers across California and in Solano County are a critical source of care for uninsured and underinsured populations and will continue to be even as we enter a new era in health care. Establishing and maintaining coordinated systems of care that incorporates community health centers, hospitals and county health systems will help ensure a responsive health care system that properly meets the needs of its populations.
Communities across the state are working together to promote sustainable safety-net health care services for these populations. As we move into the new year, let’s celebrate our community health centers for their noble service and unwavering dedication to serving their communities. And let’s all agree on a common resolution to finding an affordable and accessible solution to providing health care for California’s remaining uninsured.
Celina Keshishian is a Project Coordinator at the Community Clinic Consortium, which is a partner of Solano Coalition for Better Health.
By Vivian Nguyen
Nearly two decades have elapsed since Nora Vigil first arrived in El Cerrito, California from her native Peru. For years, she struggled to assimilate into what she calls the “American way of life.” However, when she joined Mujer, Salud y Liderazgo, a women’s empowerment program sponsored by the Latina Center in Richmond, she began to feel like she truly belonged.
“For my first few years here, I tried to adapt to this new country,” Vigil said. “Becoming a part of Mujer, Salud y Liderazgo really helped me go back to my roots and recognize the issues in my Latino community.” Awareness of these problems compelled Vigil to become a facilitator for sub-programs on topics such as domestic violence, mental health, and unemployment. Currently, she serves as a board member for the program.
Although she did not know it at the time, Vigil’s experience as a Mujer would be a major influence on her decision to join the community health movement. When private insurance premiums became too much of a financial burden for Vigil and her husband, they were referred to LifeLong Brookside Community Health Center by a friend who was also a patient advocate for the clinic. Vigil and her husband were extremely satisfied with the high-quality, affordable care that they received at LifeLong. After three years as a patient, she decided that it was time to give back.
An opportunity to do just that presented itself when LifeLong partnered with Community Clinic Consortium to launch the pilot Health Promoter Program in the summer 2012. The 10-week leadership training program is designed to build the capacity of LifeLong patients to become educators and advocates for their community. Upon completion, trainees become certified volunteers and commit to a minimum of one year working as a LifeLong Health Promoter.
“Patients make good health promoters because they know what the community needs and the kinds of services they should receive,” said Vigil, who graduated with the first cohort of Health Promoters on August 22, 2012.
Her cohort identified diabetes as the highest priority health issue, followed by obesity. According to Vigil, LifeLong addresses these concerns by providing diabetes education classes for its staff members, along with Cooking Matters courses on healthy eating habits and culinary practices. Through programs such as these, health promoters are given the opportunity to work with the community, which Vigil says is the most rewarding aspect of being a promotora.
“As a health promoter, I can be a resource for future generations,” Vigil said. “[When I first joined the program], I was thinking more about myself and my own health but now I realized how important it is to lead the community for the rest of the women and for the future generations.”
And planning for the future is just what Vigil aspires to do as the new Assistant Coordinator for the Health Promoter program, which is currently seeking members for its second cohort. In addition to her work as apromotora, Vigil is the LifeLong representative for the Healthy Richmond Hub Steering Committee, which works to improve the health and safety of all neighborhoods in Richmond, California. She also serves on the Greater Bay Area Committee within Vision y Compromiso, an organization that partners with community health workers to increase access and improve quality of bilingual and bicultural health care for Latinos. Through her journey from patient to promotora to community advocate, Vigil hopes that her passion for health equity and her dedication to her community will inspire others to follow suit.
“If you really want to help the community, you have to put your heart into it,” Vigil said. “It’s very important to keep in mind that you don’t just represent the clinic that you work for—you represent the community.”
Vivian Nguyen is the Community Affairs Intern at Community Clinic Consortium.
Although National Health Center Week 2013 is officially coming to an end, educating policymakers and the public about the value of community health is an ongoing process.
In efforts to highlight the contributions of community health center personnel, the East Bay Area Health Education Center (AHEC) has chosen to showcase the successes of two dental professionals from La Clínica de la Raza.
Check out their “Profiles of Success” below!
Dr. Mariam Hashoush, DDS
Associate Dental Director at La Clínica de la Raza Monument
Dr. Mariam Hashoush is the Associate Dental Director at La Clínica de la Raza Monument, a community health center that has served Contra Costa County since its establishment in 2003. She received her B.S. in Biology from Cal State Hayward (now Cal State East Bay) and her DDS from the University of California, San Francisco.
Dr. Hashoush chose to do her first dental rotation at La Clínica de la Raza Fruitvale so she could stay close to home and care for her children. Her rotation program consisted mostly of fillings, cleanings, extractions, and other preventative work. However, after finding herself especially connected to the patients and staff members at La Clínica, she was inspired to pursue a career at a community health center. Dr. Hashoush went on to complete a second rotation at La Clínica Fruitvale and applied to work at La Clínica upon graduating from UCSF. She originally got a job working 3 days a week at the Fruitvale site and 2 days a week at the Vallejo site. After two months she applied to work at the Monument site in Concord, where she still works today seven years later. Dr. Hashoush considers it a great privilege to be able to serve the community as a dentist.
“Working at a health center, the feel is different. You feel like you have more down to earth relationships and you are making a huge difference in people’s lives. I’m doing it because I love it, because I care. This is my passion. This is where I want to be.”
— Dr. Mariam Hashoush
Associate Dental Director at La Clínica de la Raza Fruitvale Dental Clinic
Dr. Monica MacVane-Pearson is the Associate Dental Director for La Clínica de la Raza Fruitvale. After receiving her DDS from McGill University in Canada, she started a one year residency program at Dugoni School of Dentistry at the University of the Pacific (UOP). Through the Advanced Education in General Dentistry (AEGD) program at UOP, Dr. MacVane-Pearson did her dental rotation at La Clínica Fruitvale, where she gained valuable pediatric experience and exposure to community dentistry. She found herself to be a strong supporter of La Clínica’s prevention-based model towards oral health improvement, as well as its dedication to enacting positive changes at the community level through events like health fairs. While she did not initially plan on establishing a career in community health, she greatly enjoyed the ability to help both individuals and communities through her work at a community health center. After completing her residency program, Dr. MacVane-Pearson accepted a position at La Clínica Fruitvale and has served as the clinic’s Associate Director for the past five years.
“Before my rotation with La Clínica, I didn’t know about clinics like this and systems like the federally-qualified health center (FQHC) system. One of the reasons I didn’t go back to Canada was because we didn’t have clinics like this there [at the time]. My true calling as a dentist is to help people this way.”
— Dr. Monica MacVane-Pearson