Homeless Healthcare Los Angeles: The Dignity of Choice

By Laura J. Nelson

The second of a two-part series on the services provided by Homeless Healthcare Los Angeles.

imageThe gravelly squeak of a shopping cart’s wheels against the cracked sidewalks of Skid Row pierces the hot silence of a March day in Los Angeles. In the middle of the handful of streets called the epicenter of the Los Angeles homelessness epidemic, only a handful of cars pass by, and no pedestrians.

Inside the Center for Harm Reduction a block away, it’s even quieter.

The building, next to the Los Angeles Needle Exchange, houses an array of programs designed by non-profit Homeless Healthcare Los Angeles to help the homeless cope and adjust to their new lifestyles once they’re off the streets.

“We see people on the streets at the Beverly building, we meet people coping with drug issues at the Needle Exchange, and here, we’ve progressed to people who are in the aftermath of all that turmoil,” said Delia Mojarro, the Community Assessment Service Center director for HHCLA. “We saw this program as a missing piece to all the services that we offer.”

On opening day at the end of March, almost no one came in. But in the two months since CHR’s annex opened, more than 15 people have begun working with a case manager. Once the center is in full swing, case managers predict a load of more than 100 clients.

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Homeless Healthcare Los Angeles: The Stages of Change

By Laura J. Nelson

The first of a two-part series on the services provided by Homeless Healthcare Los Angeles.

imageThe clients who walk through the doors of Homeless Healthcare Los Angeles share many of the same stories: homeless, jobless, struggling with addictions, estranged from family or friends who could support them through addictions and medical crises.

They’ve come on court orders or hospital referrals or their own will power, hoping one of the city’s most unique homeless support programs can give them what they need.

That raw need is what empowers the employees of HHCLA. They hope that instead of shoehorning their clients into a certain plan or program, they can help them with whatever they need. HHCLA dreams of getting rid of homelessness someday, but in a city where one in 100 residents is a transient, that won’t happen soon.

So instead, HHCLA attacks the problem of homelessness with a uniquely holistic approach called “harm reduction” — addressing the immediate needs of the homeless, whether that means medical care, education or drug treatment.

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Cuts to Medi-Cal hurt South LA residents

imageMamie Stamps lives in a little blue house in Watts. Her 17 grandchildren call her Bear in the Big Blue House, after their favorite cartoon. The inside is cramped; framed pictures of her family plaster the room like wallpaper. Stamps lives alone here. Her kids have grown and moved out; her husband died in 1992.

Stamps is now retired. She worked for 20 years at Children Institute International, where she cared for abused children.

“I did everything for them that I did for my babies. Raised them. Did everything for them. You just fall in love with the kids,” Stamps paused and laughed, caught in a memory. “It was nice.”

Like many people in the area, Stamps lives on a fixed income; like many people in the area, Stamps suffers from multiple health problems, and; like many people in the area, she relies on Medi-Cal to help her with health care costs.

Stamps has an arrhythmia and stigmatism. Today, she spent six hours at the Watts Health Center on her regular check-ups for her eyes and heart.

“I depend on Medi-Cal,” said Stamps, as she pours a cup of ice tea from a plastic pitcher she removed from an avocado-colored refrigerator. “Shoot, I don’t know how many times a year I see the doctor. A lot of times, quite a few time.”

But in January 2012, Stamps’ health care bills will increase.

On March 24, Gov. Jerry Brown signed 13 bills into law, aimed to reduce California’s $26.6 billion budget deficit. Combined, the bills cut the budget by $11.2 billion. One of the bills, AB 97, affects Medi-Cal, California’s version of the federal Medicaid program.

Medi-Cal offers health insurance to the elderly, those below the poverty line and the disabled.

The governor’s office projects the cuts will save the state $557 million. Health care activists, however, say the cuts will significantly burden low-income communities.

“Medi-Cal covers the sickest and most vulnerable people in California,” said Jessica Rothharr, program director for budget advocacy for Health Access, a health care advocacy organization.

Many people on Medi-Cal are already having trouble making ends meet.

“For a lot of these families, they’re the first one to lose a job,” said Dr. Ricky Choi, pediatrician at H & M Human Services Community Healthy Center in Oakland. Choi is also the Chairman of the National Physician’s Alliance of California, a group that officially opposes the cuts. “They’re the first ones who can’t get their kids out of a struggling school; they’re the ones that are really bearing the brunt of the recession.”

The changes to Medi-Cal may seem small. But the little adjustments will add up to a big impact for many recipients.

AB 97 has many provisions, but there are three that health care activists see as especially pernicious: Increases in patients’ co-pays, an annual soft cap of 7 doctors visits, and; a 10 percent pay cut for providers.

Ultimately, opponents to the cuts argue, the plan will cost more than it saves.

Co-Pays equal prohibitive costs

Effective in the new year, Medi-Cal recipents will have to pay a $5 co-pay on doctor visits and medications (currently, both are free). Emergency room visits will now cost $50 up front, and inpatient care will run a person $100 a day.

This may not seem like a lot. But for Stamps, that means not buying as many groceries. That means not being able to buy her grandson a little gift when she sees him every Sunday for church.

“I like to buy him little trucks,” smiled Stamps, peering down into her hand through coke-bottle classes, as though she could see the truck. “I love the way he looks when I give him those.”

Choi sees first-hand how the poor already triage their resources. Ninety-nine percent of Choi’s patients are 200 percent bellow the poverty line.

“In some cases, they can’t even afford Christmas presents, let alone pay for additional co-pays and premiums,” said Choi. “These changes will be a significant burden to the low-income community.”

Rothharr says the increase in co-pays won’t bring in a lot of revenue. In fact, according to Rothharr, hospitals and doctors don’t even want the burden of collecting $5.

“This is just an additional barrier to care,” she said. “The way it saves money is not because of the income received. The way it saves money is by reducing the amount of care.”

People can’t afford to go to the doctor, so the volume of patients’ visits and prescriptions filled is reduced.

“It’s a pretty sneaky and immoral way to go about it,” Rothharr continued. “It’s reducing access to care, reducing utilization of care by those who need it most.”

The new $50 co-pay on ER visits will also cause problems. Many people on Medi-Cal don’t have that much money lying around. But if a person is truly in need of medical attention, ERs cannot turn them away under the federal law Emergency Medical Treatment and Active Labor Act (EMTALA).

“It means Emergency rooms will eat it,” said Rothharr. “It’s a horrible system and that’s why the hospitals were strongly opposed because what are they supposed to do?”

This undue strain on hospitals means worse care – especially in less affluent neighborhoods where uncompensated visits will be more common.

Caps on visits means less care for the most needy

Even if a Medi-Cal patient can fork over the five bucks for a visit, the cuts will cap the number of times he or she can see the doctor in a year.

Rothharr worries that this will deter people from seeking medical attention when symptoms first show – and when they might be able to be cured.

“What you’re doing is having those people decide which of those doctors visits to skip, which of their regular tests and checkups to skip,” she said.

This is especially difficult in people with chronic conditions who need regular checkups, such as diabetes, high cholesterol and cancer survivors.

“It is not workable, and what it means is that people are going to die,” said Rothharr.

Stamps has never thought about how many times she sees the doctor a year. But now she’s going to have to. Both her conditions require regular check-ups; she depends on them. Now she doesn’t know what she’ll do.

“I’d just have to suffer through it,” she said. “I can’t afford any private medicine.”

Both children and pregnant women are exempt from the seven-visit cap.

In the original proposal, Brown wanted a hard cap of 10 doctors visits – meaning that patients could not see a physician more than 10 times, no exceptions. The Committee on Budget ultimately compromised with the soft cap of seven.

A soft caps means that a doctor could see a patient more times if they self-certify that the visit was medically necessary.

“But what you’re asking the doctor to do is take a chance in seeing that patient in the hopes that Medi-Cal will agree and pay them,” said Rothharr.

If Medi-Cal will reimburse, the payments take months to receive.

“It transfers the burden of more paperwork on physician and provider,” explained Choi.

Ten percent provider pay cut, fewer doctors

Doctors in California aren’t required to see Medi-Cal patients. And now they’re less likely to than ever.

The new budget decreases the amount received from Medi-Cal by 10 percent.

“We’re already near the very bottom in terms of states that provide reimbursement,” said Choi.

Many providers simply won’t be able to keep their practice open at the lower rate. Others will limit the number of Medi-Cal patients they see. As a result, there will be fewer doctors for Medi-Cal patients – and more demand for the ones who are. It will also be harder for Medi-Cal recipients to find a doctor.

“This is concern for providers who are really honestly seeking to provide the best care they can for their patients,” said Choi. “Unfortunately, these cuts are going to make it harder to do the jobs that we feel passionate about doing.”

The true costs

Myrna Schnur is the co-convener of the Grey Panthers of Berkeley, a social service non-profit organization that advocates for social programs in bills facing Sacramento.

The Grey Panthers have been watching AB 97 closely.

“Not only is it immoral and horrifying, it is financial foolish to cut Medi-Cal,” said Schnur.

The Legislative Analyst’s Office, the nonpartisan fiscal advisor to the state, did not account for increased use of ERs and county clinics when calculating the savings of AB 97.

This oversight is why the American Association of Medical Assistants, the Association of Emergency Physicians and the National Physicians Alliance all went on record opposing this bill.

“It’s penny wise and pound foolish,” Rothharr said. “You’re not dealing with the underlying need for care.”

In addition to a rise of uncompensated care, patients will also be sicker when they do seek medical help. Not only will that cause unnecessary suffering, said Choi, but they’ll be more expensive to treat.

“While it might not show up in the budget or the books, quite frankly it’s going to increase the overall costs of health care in California,” said Choi.

The Grey Panthers see the cuts as a human rights issue. Cutting Medi-Cal is myopic, says Schnur, and further disenfranchises the already disenfranchised.

“We’ll see an increase in hunger, adding more stress to food banks,” said Schnur.

“Clearly, this will lead to a humanitarian disaster,” said Rothharr. “We are talking about California going backwards into something that looks a lot more like a third world country.”

Choi also sees Medi-Cal cuts as a justice issue. For example, the plan will cut vision services.

“If you can’t see, you can’t do very well in school,” he said.

Choi says the changes will affect his families at the clinic immediately.

“These people are already, bearing the brunt of this recession,” he said. “They are the least able to handle this accumulated impact of all these cuts in services.”

Stamps knows she will feel it.

“I budget my money closely,” she said. “I have to. It’s all I have.”

Advocates, citizens, leaders celebrate first birthday of health care bill

By: Julia Deng and Candice Winters


Listen to a story by Annenberg Radio News:


Lawmakers and advocates for health care revision joined voices and sliced into a large white birthday cake to celebrate the one-year anniversary of the Affordable Care Act (ACA). The auditorium at Cedars-Sinai Medical Center hosted a panel of speakers. Some spoke about how the act helped them. Others advocated continuing support for President Barack Obama and the law.

Dave Jones, California’s insurance commissioner, doesn’t see how anyone could not support the act.

“The money that we want to go toward our physicians and our nurses and our hospitals and our community clinics, the insurance companies view as a loss,” Jones said. “This law, the Affordable Care Act, makes sure they’re putting more of the money they’re collecting from us and our employers into provisions for health care.”

image The law was signed by Obama one year ago and will be phased in over a span of three years. For Nina Sharky, the act brought about a change in heath care coverage, but it wasn’t one she’d hoped for.

“The coverage that I have now is a shell of the coverage that I bought 20 years ago,” Sharky said. “And there are no laws that prevent them from changing coverage whenever they feel like it. Unfortunately, there is a wonderful provision in the ACA that can’t help me because it doesn’t come in until 2014. There are 800,000 people just like me.”

The act eliminates the clauses that exclude children who have certain medical conditions from being offered health insurance. Los Angeles congresswoman Karen Bass says this act has met opposition from republicans in Congress. They say with the federal and state budgets in such dire straits the country cannot afford to pay for it. Although there are some who are excluded from ACA benefits, Bass says it does more good than any available alternative.

“This is something that effects all of us,” Bass said. “I spent two and a half years in this hospital, coming to this hospital day in and day out with my step-daughter going through chemotherapy for leukemia. She’s now gonna be 20 years old, in great health. The reason she will have health care coverage today, is because we’re celebrating the one year anniversary of the affordable care act.”

Bass says that most Californians don’t know enough about health care. She hopes these events will change that.

OPINION: Planned Parenthood and the Rape of American Women

Sikivu Hutchinson is the editor of blackfemlens.org and a senior fellow with the Institute for Humanist Studies. Become a fan of Blackfemlens on Facebook.

imageLately, the sound of galloping hooves and rustling white sheets has risen in a deafening squall from the Capitol. Like their Klan ancestors, elite white males in Congress’ political lynch mob are once again savaging communities of color. The House’s vote to gut Planned Parenthood is a criminal act against poor and working class women and their families. In many rural and urban neighborhoods there are few affordable alternatives to the health care provided by Planned Parenthood and other reproductive rights service providers. These clinics are the frontline of preventive care in poor working class white communities and communities of color, providing pregnancy and STD testing, contraception, pap smears, abortions, and counseling for families with little to no health coverage.

Ever since its midterm elections’ sweep, the far right has ramped up its unrelenting drive to theocracy, using reproductive rights as its battleground. Drawing on the sabotage of ACORN, Speaker John Boehner and a host of other GOP and so-called Blue Dog Democrat fascists are bound and determined to take down Planned Parenthood. Extending Hyde Amendment restrictions on federal funding for abortions to private providers is central to their agenda. Too spineless to criminalize women who seek abortions outright, Religious Right politicians instead choose to pillage health care provisions that keep women from falling deeper into poverty, illness, and economic dependence. Hiding behind Orwellian claims of being pro-life, far right politicians exercise draconian control over the bodies of poor women and their families in the name of God, guns, and bloody fetuses. Why not just jail ‘em all and let God sort ‘em out?

It should be no revelation that when poor women are denied access to decent affordable reproductive care—including access to safe abortions—families and communities suffer. While federal and state governments dismantle education and health care funding, the American military regime goes untouched. Because black and Latino communities are on the frontlines of imperialist military recruitment and educational inequity, few people of color would argue that government handouts to the military industrial complex should trump education funding. However, reproductive justice just doesn’t have the same political cache or urgency amongst progressives of color. Consequently, conservative reactionary forces within the African American community have successfully allied with the Religious Right in a revived anti-abortion billboard campaign targeting black women. This propaganda has cropped up recently in black and Latino Southern California neighborhoods. By implying that aborting black babies makes them an “endangered species,” these billboards evoke plantation era regimes of social control.

In essence, bad “genocidal” black women don’t know their place, don’t know that they were put here to be God’s sacrificial vessels and don’t seem to grasp that only evil promiscuous misguided Jezebels get knocked up. They also haven’t gotten Sarah Palin’s “telegram” that women who are forced to have unwanted children will earn more, achieve higher education levels, and have a markedly better quality of life than women who aren’t. These ignorant bad black women destroy black communities with their arrogant self-absorption and unchecked sexual license. After all, black women who exercise control over their own bodies and destinies commit race betrayal and gender sacrilege.

How do we know these gospel truths? Powerful white male legislators, black preachers, and Christian soldiers like MLK’s anti-abortion activist niece Alveda King tell us so. They tell us that abortion is the greatest civil rights threat of our era. Like their Islamic fundamentalist comrades in the Middle East, these pro-death marauders know all too well that female sexuality is a dangerous commodity which only the jackboot of big government can control. Complicit with black hyper-religiosity and black nationalist delusions, silent progressives of color give them this license.

Read more stories from Sikivu Hutchinson:
OPINION: Heretics, Humanism, and “the Hood”
OPINION: American terror and the dehumanization of gay youth
OPINION: The Prosperity Gospel according to Eddie Long

Photo courtesy of Political Junkies

Healthcare in South Los Angeles means fewer services and longer waits


Funding goes to new building for patients at Compton clinic

By: Emily Frost and Dan Watson

Listen to the audio story:


Read the audio script:

It is 5:30 a.m., and we just pulled into the parking lot at St. John’s Well Child and Family Center in Compton. There is already a line of about four of five people. It is drizzling, and it is very dark.

Antonio, who goes by Tony, was first in line. He seemed pretty proud about it. When he had come before, he said he was about 13th in line; he had counted. This time, he told his wife he was going to be first, and he was. But he was expecting that about 8:30 a.m., when the clinic opens, that he would be in and out. He hoped it would only take about 15 minutes, so it would not shoot down his whole day.

Melvin Richardson arrived a little after 7:30 a.m.

“I had stomach problems one day that led me to find out I had a hernia,” Richardson said. “I just recently, in the last 90 days, got laid off. I was working for a big trucking company, and they closed down. I was there for six-and-a-half years,” Richardson said.

Richardson is now without insurance.

“It is a little crowded. And the wait time, personally it is a little long. ‘Cause I think I came like, last week, and I had an appointment for like, 1:30, and I didn’t get out of here until 4:30,” Richardson said.

Jesus Rios also waited quietly. He, too, was an out of work trucker.

“You know the line, look at that now, it’s growing,” said Rios, laughing. “You know, I come over here because I finished my medicine.”

At St. John’s, Rios’ diabetes medicine is free, unless the clinic runs out. If it does, his medication costs about $200 for a month’s supply at the pharmacy. That is nothing, though, compared to his visit to the emergency room.

“See, I go to the hospital for one day, forget it,” Rios said. “Those people have no heart. They send me a bill for $2,000, $2,000 for nothing,” Rios said.

Rios made sure to arrive early because if there are not enough doctors that day, the clinic will turn people away after the first 10 or 15 patients. If Rios does not get a chance to be seen, “You go home and try to find medicine with your friends,” he said.

And he will get there earlier next time.

By mid-morning, Richardson, who was coming in preparation for his hernia surgery, was running out of patience.

“This right here is outrageous,” he said. “I hope they get me out of here. It’d be their best bet to get me out of here because I will get a little louder again. And I hate to say it, but that’s what it takes sometimes. I don’t want to be up here eight hours. I have a life to live the same way they have.”

Tony was also reaching a breaking point. Though he was first in line and thought he would be in and out in 15 minutes, the clinic staff could not find his file. He was still waiting five hours later.

“He can’t find it,” Tony said. “He says he lost it. I can’t believe it. I no go to my work today, but coming over here. I was first, the first guy waiting outside. Five, yeah, I think it’s been five hours.”

By the end of the day, the clinic had seen 85 people; many waited all day.

Mobile clinic offers free eye care for disadvantaged youth

Listen to the audio story here:

Vision Service Plan, also known as VSP, launched its Mobile Eyes program in 2005. The program started as a part of the Hurricane Katrina disaster relief efforts.

Since then, three mobile clinics have visited 38 states and provided free eye exams and glasses to more than 14,000 people in under-served populations.

Forum explores impact of health care overhaul

imageLeticia Rodriquez, a nutrition assistant with the Watts Health Care Corporation and SEIU 721 member with her three children.

South Los Angeles residents gathered for a community health forum on Saturday, March 27, held at the Bethune Park, to hear Rep. Laura Richardson speak about the impact of President Obama’s health care overhaul on community clinics and hospitals.

“The bill is not perfect, but it’s a good start,” said Richardson, who just flew back from Washington D.C., after last weeks final vote on the bill. “From here we can begin to make improvements.”

Under the congresswoman’s 37th district, which includes Watts, Willbrook, Compton, Carson, Long Beach and Signal Hill, the bill will fund $11 million towards clinics, improve coverage for 299,000 residents and will extend coverage to 92,500 uninsured people.

“In America you have the right to life. You can’t have a life if you don’t have a healthy life,” said Richardson.

The bill will also begin to close the Medicare Part D drug coverage gap known as the “donut hole” for 63,000 senior citizens, said Richardson.

Under the “donut hole” system, Medicare beneficiaries were required to pay 25 percent of their medication after paying deductibles and premiums. Once the plan exceeded the $2,830 limit, they had to pay the full cost of their medication. After they finished spending more than $3,000, they qualified to only pay 5 percent of their costs.

“Senior citizens shouldn’t have to choose between food or medication,” said Richardson.

The congresswoman also endorsed the involvement of the health care workers union, SEIU 721, in negotiating contracts and organizing possible strikes.

“It’s so important that SEIU be at the bargaining table,” said Richardson after giving an anecdotal speech on her mother’s days as a Teamster labor unionist. “With the 30 million people that will be receiving health care, a lot of money is going to be made, and health care workers should receive reasonable wages and pensions.”

Following Richardson’s applauded speech, a nutrition councilor from SEIU 721, told the audience the union is fighting to save the Watts Health Care Corporation, an urgent health care center that extended its service hours after the closing of the King Drew Medical Center emergency room in 2007.

“The clinic may have to shut down its extended services and cut staff, which will increase lines and wait time,” said Luz Leon who has worked for the Watts Health Care Corporation for more than 18 years.

After the emergency room was shut down, the Watts Health Care Corporation, located less than two miles away from the King-Drew hospital, was allocated money from the Los Angeles Medical Preservation Fund. The bill provided $100 million a year to help neighboring clinics and hospitals expand their services. This permitted the Watts Health Care Corporation to extend its work hours and remain open on Saturdays.

The bill, however, did not contemplate funding past 2009-2010. The MLK-Drew “replacement hospital” will not open until December 2012 at the earliest, and this is projected to be a partial opening.

SEIU 721 is now trying to gain support for the SB 1409 bill that would prolong the additional funding.

Managers of the Watts Health Care Corporation are also in negotiations with SEIU 721, to bargain their employees’ contracts that expired in January. The managers wants to raise their employees’ monthly premiums for families of two or more, from $20 to more than $500, said Leticia Rodriquez, a nutrition assistant at the clinic.

“It’s scary. If they raise the premium, we are going to have to go without health insurance,” said Rodriquez, a mother of three children. “Our income is over the guideline for Medical.”

The problem with health care access in South Los Angeles, Rodriquez said, “is that people who have no income qualify for public services, but small businesses and companies can’t do that.”

SEIU is planning to hold another community forum April 6 to further discuss the needs of community clinics in South Los Angeles.

“Count me in the fight,” Richardson said.

Mobile medical clinic to come to South L.A.

Free health services are coming to South Los Angeles next month.

Lawmakers announced Wednesday that the Remote Area Medical mobile clinic will be setting up shop at the Los Angeles Sports Arena from April 27 to May 3.

Last summer, the Remote Area Medical clinic at the Forum in Inglewood drew in 6,300 uninsured and under-insured people.

It was the largest in Remote Area Medical history, eliciting the help of 3,827 volunteers to provide $2.8 million in free services.

Unfortunately, the demand was higher than the supply.  Last year’s mobile clinic had to turn away thousands.

This year, Remote Area Medical is attempting to engage enough doctors, dentists, and healthcare professionals to treat and feed 1,200 people a day.

“When you turn away as many thousands of people are we did, and I was unfortunately the person who had to go out and give them the bad news, you want to go back and say, ‘Let’s try it again,’ ” Stan Brock, a Remote Area Medical sponsor, said in an interview with the Los Angeles Times. “These were nice folks. It never ceases to amaze me, every time we do one, the condition of people in this country and how many cannot get the basic care they need.”

For more information, check out Remote Area Medical’s website.