Community Medicine: Access to Care Contra Costa County

1. Community Medicine:Access to Care Contra Costa County Francisco J. Dorado, MD Contra Costa Regional Medical Center , Family Medicine Resident March 3, 2009

2. Summary I. Background of Uninsured II. Epidemiology of the Uninsured III. Health Coverage Programs IV. Who is not Accessing Care V. What is Contra Costa Doing to Help VI. Intervention VII. Future:Universal Health Coverage?

3. Background • >47 Million uninsured and we spend 17% of GDP, or $2.4 trillion * • Health care spending in Switzerland, Germany, Canada and France are about 10% of GDP according the Organization for Economic Cooperation and Development • The US is the only industrialized country without a safety net of insurance programs/universal health care • We rank 42 in the world for life expectancy ‘08** *Institute of Medicine (http://www.iom.edu/CMS/3809/54070/63118.aspx) **https://www.cia.gov/library/publications/the-world-factbook/rankorder/2102rank.html

4. Contra Costa Health Indicators Uninsured rate for immigrants in California is 30-40%* • Over 10 thousand uninsured children living in Contra Costa* and many more adults • Rates of asthma in African American children are (63/10,000) five times compared to White children (13/10,000)** • Latinas have teen rate of birth 54.1/K more than twice the county overall 23.4/ K** **Source: 2007 CHAPE, CC Public Health *E. Richard Brown, UCLA School of Public Health

5. Contra Costa Health Indicators • African Americans and Latinos, as well as people living in San Pablo, Richmond, Richmond, Pittsburg, Bay Point are more likely to die from diabetes compared to the county overall** • Residents of Bay Point die 11 years younger than those living in Orinda** • **Source: 2007 CHAPE, CC Public Health

6. History of Insurance* • Medicare 1965 and Part D in 2003 • Medicaid/Medi-Cal 1965 (Title XVIII and XIX of the Social Security Act) • SCHIP (State Children’s Health Insurance Program)/Healthy Families 1997 • FQHC Status • Local Initiative/CCHP since 1973*** • Basic Adult Care-Basic Health Care 8,500 enrolled in 2007.** • $45 million over 3 years from federal funds for Health Coverage Initiative** *http://www.cms.hhs.gov/History/Downloads/CMSProgramKeyMilestones.pdf ** Director’s Report January 2009, pg 8 ***http://www.cchealth.org/health_plan/about_us.php

7. Income Guidelines and Health Coverage Programs

8. Federal Poverty Guidelines (FPG) 2008 FPG guidelines for a 4-person family: • 100% FPL = $21,200/year • 150% FPL = $31,800/year • 200% FPL = $42,400/year • 250% FPL = $53,000/year • 300% FPL = $63,600/year

9. Who are the uninsured? • « • 1 • 2 • 3 • 4 • » http://www.contracostatimes.com/search/ci_11692891?IADID=Search-www.contracostatimes.com-www.contracostatimes.com

10. Picture from Monument, Concord • “Day laborers face long odds of getting work as they wait by the Monument Boulevard McDonalds on Thursday Feb. 12, 2009 in Concord, Calif. The Pew Hispanic Center released a report Thursday saying "the unemployment rate has increased more and the share of the working-age population that is employed has fallen more for immigrant Hispanics than for other racial and ethnic groups in the first year of the recession." (Karl Mondon/ Staff) Contra Costa Times 2/13/09

11. Example • Rosa and Adolfo are immigrants who are in the process of adjusting their immigration status. • Adolfo owns his landscaping business and they make $1800/month • They have one son, Jose, age 5 and one on the way • Maria is awaiting for Medi-Cal approval

12. Example (continue) • Based on income Rosa qualifies for Medi-Cal • Jose qualifies for CHDP (not insurance) • Adolfo qualifies for BHC • Maria has coverage by Medi-Cal while pregnant then may apply for BHC

13. What happens? • Newborn will maintain Medi-Cal for first year • Jose will only come in for CHDP (wellness visits) • Adolfo wants to adjust immigration status and does not want Government subsidized insurance. Maria is the same. • Family of 4, one will have insurance

14. Access to Healthcare Coalition/ Contra Costa Public Health • Founded in 1998 • Mission is to “Improve access to health care for all children and families in Contra Costa” • Dozens of community organizations represented • Help hotline: 1-877-503-9350

15. Partners in Access • Kaiser Permanente • Planned Parenthood (Concord, Richmond, Antioch) • La Clinica (Concord, Pittsburg) • Brookside Community Health • Doctor’s Hospital • John Muir/Mt. Diablo • New Connections/East Bay Perinatal • Access to Health Care Coalition • School districts

16. Intervention/Recommendation • Promotion of existing programs to qualified family members at prenatal visits, newborn exams, OB triage and CHDP visits. • Education about changes in immigration questions and health benefits not counting against becoming a citizen. • Time will change stigma associated with using government subsidized health coverage

17. Challenges • More people who have lost their jobs and employer sponsored insurance are now dependent on CCHS & ER’s • Budget cuts $15 million dollars from Contra Costa Health Services by March ‘09* • Increasing loss of tax revenue as a result of housing crisis, decreasing tax base • http://www.contracostatimes.com/search/ci_11777623?IADID=Search-www.contracostatimes.com-www.contracostatimes.com

18. Universal Health Coverage? • SCHIP expansion—4 million more eligible • Stimulus bill includes $19 billion for electronic medical record, & funding for COBRA coverage • “So let there be no doubt: Health care reform cannot wait, it must not wait, and it will not wait another year”. President Obama’s Feb 24th speech to Congress

19. Yes, we can! “¡Si, se puede!” Cesar Chavez 1927-1994