Dec 7, 2013
Posted on Dec 13, 2012
Dealing with the complex problems of the poor is one of the most difficult challenges facing Obamacare as the historic health reform law slowly but steadily enters American life.
Throughout the country, health professionals, politicians and health care activists are meeting about how to implement the Affordable Care Act now that it has been upheld by the Supreme Court and President Barack Obama’s re-election.
I attended one of these sessions recently and saw the potential for Obamacare in the nation’s impoverished communities. Among the topics was autism, a disability in which—as is true of much of American medical care—treatment is rationed on the basis of wealth.
Areva D. Martin, an attorney who advocates for children with special needs such as autism, called care for the disorder “a microcosm” of inadequate treatment of the poor, with insufficient diagnoses, limited and scattered facilities, and caregivers—parents, other relatives and friends—so burdened with two or three jobs and low incomes that they can’t fight for help in a bureaucratic system.
Martin spoke at a conference at St. John’s Well Child & Family Center, which has 140,000 visits a year from residents of South Los Angeles, home to many thousands of working-class Latinos and African-Americans. St. John’s provides primary, dental and mental health care; a team approach to complex ailments; and diagnosis and treatment of HIV/AIDS. It is one of more than 8,000 community health clinics across the nation serving more than 20 million poor people, according to the National Association of Community Health Centers.
Jim Mangia, president and CEO of St. John’s, told me that Obamacare is providing funds for new buildings and remodeling at the center’s main South L.A. facility and satellite clinics in the broad area of poverty that stretches for miles south of the office towers, expensive restaurants and high-priced homes of affluent Los Angeles.
Obamacare funding of Medicaid for the poor will put 12,000 St. John’s patients, presently without health insurance, on the government care program. By paying for these patients, Medicaid will provide funds to St. John’s, which now has to finance its care from donations and other scarce sources.
Autism requires a range of services administered by doctors, schools, health clinics, speech and behavior therapists, psychologists and others. To put all these components together requires parental sophistication and an ability to fight the system. For those in South L.A., it also means finding help at facilities that are often a long bus ride away.
Attorney Martin learned how poverty makes this difficult when she attended a parental meeting to find ways of helping her autistic son learn to read. She knew how to fight the system, unlike some of the poor mothers and fathers she met. Help, she found, is hard to obtain “if you are not educated, if you are not used to dealing with bureaucrats, if you don’t have a job that allows you time to go to two zillion meetings, if you are working three jobs.”
In a series published a year ago, Los Angeles Times journalist Alan Zarembo reported that state spending for treatment of autism is tilted toward whites in more affluent areas. For autistic children between the ages of 3 and 6, the critical period for treating the disorder, the Times found that California spent $11,723 per child for whites, $11,063 for Asians, $7,634 for Latinos and $6,593 for African-Americans.
St. John’s CEO Mangia said that his organization, helped by Obamacare funds, is planning a large center for special needs children, including those with autism, on a new medical campus being built in South L.A. to replace the old Martin Luther King Jr. Hospital.
“There will be early identification, intervention, mental health care, counseling, speech, psychological and occupational therapy, all the things these kids need here,” Mangia said, services now reserved for “upper-middle-class kids whose families can afford it.”
Autism is just an example. By putting money into community health clinics, expanding Medicaid, and financing improved primary and comprehensive treatment, Obamacare will improve life throughout the country for the poor suffering from diabetes, heart disease, HIV/AIDS and other complex ailments.
Such care should have been available a long time ago. Medicare for all would have been better. But at St. John’s and community health centers throughout America, dedicated health care professionals are making Obamacare work. So are others engaged in setting up the exchanges that will make a variety of insurance policies, with subsidies for the low income, available to those now uninsured.
Their work is the beginning of a journey that will end only when Obamacare—if it is successful—makes decent health care a right rather than something reserved for those who can afford it.
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