HealthyCal.org is an independent, non-profit journalism project supported with initial funding from the California Endowment. The site’s mission is to inform Californians about public health and community health issues, to engage readers in an ongoing conversation about matters ranging from health care policy to land-use, transportation, environment, criminal justice and economic policy, and to show how all of these things are connected.

By Ron Shinkman

Amidst great uncertainty about federal health policy, Covered California announced Tuesday that insurance premiums on the state-run exchange will rise on average 12.5 percent next year, an increase that is slightly lower than in 2017. The agency reiterated that it has a containment plan should the Trump administration cease to provide cost-sharing subsidies for lower-income exchange enrollees.

All 11 insurers currently offering coverage on the state’ exchange will return in 2018, although Anthem Blue Cross will withdraw from Southern California.

The premium hike for 2018 is down from the 13.2 percent average increase for this year, but still much higher than the low single-digit rate hikes announced for 2015 and 2016.

Covered California Executive Director Peter V. Lee noted that if consumers shop around for different plans in each tier of coverage, they could keep their rate increases down to 3.3 percent.

“For consumers, no increase is a good increase, but Covered California did a good job in these uncertain times,” said Betsy Imholz, director of special projects for Consumers Union in San Francisco.

Imholz credited the exchange for taking a tough negotiating stance with the health insurers and ensuring that competition remains in place in most of the state. According to Lee, 82 percent of Covered California’s enrollees will have three or more health plans to choose from.    

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By Claudia Boyd-Barrett

The future is hot.

As climate change heats up the globe, Californians can expect to face longer and more extreme heat waves like the ones sweeping through parts of the state this summer, experts warn.

Seniors, who are more prone to heat stress than younger adults, will be among those most affected by rising temperatures. With the over-65 population projected to expand rapidly in the coming decades, the accompanying hotter weather could place an enormous burden on emergency and health care infrastructure.

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By Hannah Guzik

If Washington, D.C. legislators approve cuts to government health care, California’s rural counties are among those who will suffer most, according to a new report.

Those who live in the state’s rural counties—which are largely in Northern California—are more likely than urban residents to be enrolled in the low-income health program called Medi-Cal, according to the report released June 6th from the Georgetown University Center for Children and Families and North Carolina Rural Health Research Program.

Medi-Cal covers 28 percent of adults and 54 percent of children in California’s rural counties, researchers found. Meanwhile, in the state’s metro areas, 21 percent of adults and 44 percent of children are enrolled in the health program.

Before the federal Affordable Care Act and state reforms opened the gates of Medi-Cal to most low-income adults and children, a quarter of the state’s rural residents under age 65 were uninsured. But by mid-2015, that uninsured rate had fallen to 11 percent.

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By Hannah Guzik

Amidst anxiety about potential federal funding cuts to health programs, California has one bright spot. The state’s new tobacco tax is expected to generate about $1.2 billion next fiscal year for the state’s low-income health program.

Now, California legislators and Gov. Jerry Brown are battling over how to spend the money.

Immigrant rights’ advocates are asking the state to use a portion of the Proposition 56 funding to expand health coverage to undocumented young adults.

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By Lisa Renner

For Steve, a senior in rural Stanislaus County, problem-solving therapy helped him conquer mild depression.

“The first step in improving is finding the problems,” said the 63-year-old Oakdale resident, who requested that his last name not be used because he doesn’t want to be stigmatized for having depression. “Once you find and define them, then you can work on how to overcome them.”

Steve is one of about 80 seniors who have participated in a study to determine the effectiveness of problem-solving therapy in reducing depression in rural seniors who live in the Central California counties of Stanislaus, Tuolumne and Calaveras.

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By Lisa Renner 

Richmond resident Jervice Youngblood is grateful that she receives government-subsidized child care for her 2-year-old daughter while she works as a transit driver.

“I do not have too many family members I can depend on to watch my daughter,” she said. Without the subsidy, “I wouldn’t be able to go to work and make money and it would be hard to pay my bills.”

Youngblood is among the few qualifying low-income parents who use child-care subsidies for children 2 and younger. According to a report released in March by policy group Children Nowonly 9 percent of eligible infants and toddlers have state-subsidized child care.

Eligibility for these subsidies is based on state income eligibility guidelines, set at 70 percent of the state median income — or $46,896 for a family of four, said Stacy Lee, managing director of early childhood project integration for Children Now.

Those who work in the child-care field say the chief reasons the subsidies are underused are a severe shortage of child-care spots for that age group, insufficient hours offered by day care providers and reluctance on the part of parents to leave children that young in day care.

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By Derek Walter

On a recent Tuesday morning, a bustling health care clinic is filled with the sounds you’d expect to hear from children who need to see the doctor. Coughing, sneezing and sighs from an upset stomach fill the air.

But this isn’t a doctor’s office or emergency room. Instead it’s at Gaston Middle School in Fresno. While the enhanced services are a welcome addition for students, faculty and staff members who are trying to keep everyone well, there’s another purpose that it serves — helping kids stay in school or make a more rapid return.

The clinic, which is run by health provider company Clinica Sierra Vista, isn’t just a larger school nurse’s office. It’s a full-blown clinic, which features primary-care services, pediatric care and immunizations. The school district said during a board meeting last year that the free clinics would be paid for by health providers and federal subsidies.

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By Linda Childers

Seeing one of her sons struggle to breathe is an all too familiar sight for Natalie Sua of Fresno. Three of her six children have been diagnosed with asthma, a chronic disease in which the airways swell and produce extra mucus.

In the past, when one of the three, who are all boys, had a severe asthma attack, Sua would rush him to the emergency room. But, now, thanks to Fresno’s Asthma Impact Model, she has learned how to reduce asthma triggers in her home and largely keep her sons’ asthma under control.

“We used to visit the ER three to four times a year, or more, when one of the children had a bad asthma attack,” Sua said. “In the past year, we’ve only had to go once or twice.

Launched in 2013, the Asthma Impact Model, focuses on helping low-income families in the Central Valley better manage their children’s asthma, thus avoiding ER visits. The program was designed by the Central California Asthma Collaborative and Clinica Sierra Vista, a Fresno health clinic.

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By Derek Walter

For Jen Smith, just feeding her family requires mind-bending effort — three times a day. That’s because her 8-year-old son Marty Smith is allergic to a host of foods, including those that contain or are cooked in peanut oil, soy or dairy.

He has a condition called eosinophilic esophagitiswhich is exacerbated by food allergies and causes his esophagus to become inflamed.

To get dinner on the table, Smith, a teacher in Clovis, must carefully examine all ingredients and find recipes that work with her son’s limited diet. She ends up spending hours each week on extra food prep for her son and hundreds of dollars annually on specialty foods that her son isn’t allergic to.

Coping with food allergies can be daunting for any family, but, due to the extra labor and grocery costs, they often hit low-income families hardest.

“When you buy packaged foods expect the price to double or triple,” said Smith, who carefully budgets food expenses to feed her family of five on a teacher’s salary. “If I’m baking something with chocolate chips, I have to use a specific brand that is far more expensive. But it’s the only choice, because everything else is made with soy.”

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By Hannah Guzik

If the federal Affordable Care Act is repealed, as some Republican lawmakers and President-elect Donald Trump have proposed, nearly 5 million Californians could lose health coverage, according to a new report.

In the last two years, the health law has enabled about 3.7 million California adults to enroll in the state’s low-income health program, known as Medi-Cal, and 1.2 million residents to receive subsidies to help them pay for insurance through Covered California. Repealing the health law could have a “devastating impact” on these groups, according to the December report from the UC Berkeley Center for Labor Research and Education and the UCLA Center for Health Policy Research.

In recent days, Trump and some Republican legislators have said that they want to repeal the health law and replace it with something else. It’s unclear whether the replacement would still provide funding for health coverage to adults under Medi-Cal or provide subsidies to those who purchase insurance on the state’s exchange.

Under the ACA, the number of uninsured residents in the state has decreased by almost half, from 6.5 million in 2013 to 3.3 million in 2015, according to the report. Since the majority of the health law’s provisions took effect in 2014, California has seen the largest decline in the uninsured rate of any state nationwide.

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By Claudia Boyd-Barrett

Amid life’s everyday challenges and responsibilities, two worries weigh constantly on Jorge Zaleta’s mind.

The first is the health of his intellectually disabled son, Jorge Zaleta Jr., who at 15 years old needs around-the-clock supervision.

Second, Zaleta worries about his and his wife’s undocumented immigration status, which he fears could get them deported from the United States at any moment — leaving their son, who is an American citizen, to fend for himself.

“You’re always living under that uncertainty, that from one moment to the next, (while you’re) walking in the street or driving, you might get stopped,” said Zaleta, a Spanish speaker who immigrated to the United States 17 years ago and lives in Oakland. “We don’t have stability as a family to be able to give (our son) stability.”

Zaleta and his wife are among hundreds, if not thousands, of undocumented parents in California struggling to take care of U.S.-born children with special needs while at the same time living in fear of deportation. These parents face the same pressures any parent of a special needs child contends with: making sure their child gets the medical care, therapy, educational help and supervision they need, while balancing jobs and household responsibilities. But these families also grapple with the uncertainty of living in the shadows, and are barred from receiving the full range of government assistance that could help them care for their disabled children.

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By Lynn Graebner

One third of California residents and half of the state’s children qualify for Denti-Cal, the state’s Medi-Cal dental program. So leaders in counties like Santa Cruz, where 82 percent of the dentists don’t take Denti-Cal, are seeking new ways to serve this long-suffering low-income population.

“Most California dentists want nothing to do with Denti-Cal,” stated an April report by the Little Hoover Commission, an independent state oversight agency. It hammered Denti-Cal — calling it a broken system that has alienated its partners in the dental profession. Less than half of Denti-Cal beneficiaries use their benefits because they simply can’t find a dentist who will see them.

That has left counties, community clinics, nonprofits and private dentists to cobble together programs and safety nets for thousands of residents. Some of those are showing promise and some counties plan to expand them by applying for part of the $740 million state and federal agencies have allocated for the new Dental Transformation Initiative. It is meant to incentivize more dentists to offer preventative dental care to children.

While the California Dental Association, counties and private dentists say this is an encouraging step, there’s a long way to go to reviving the dysfunctional system, they say.

Dientes Community Dental Care, a community dental clinic receiving federal funding through Santa Cruz County, decided to commission its own report: Increasing Access to Dental Services for Children and Adults on the Central Coast, released in April. It showed that of the 80,000 people on Medi-Cal in Santa Cruz County, only 31 percent of them were able to see a dentist in 2014. Thirty-one percent of children under age 11 in the County have never seen a dentist and seniors on Medicare have no dental benefits except for extreme needs.

“Insurance does not equal access,” said Laura Marcus, Dientes’ executive director.

Despite its expansions, Dientes has to reject about 20 calls daily for dental service. Gaye Hancock was among them. She lost her job during the economic downturn and is working again but now has Denti-Cal. She started calling Dientes two years ago and finally resorted to getting her teeth cleaned at the Cabrillo College Dental Hygiene Clinic by student hygienists. They found cavities and bone loss which have forced Hancock to chew on just one side of her mouth since 2014.

“I’m 63, I’m just fighting to keep my teeth healthy,” she said.

As a result of the Santa Cruz report, the Santa Cruz County Oral Health Access Steering Committee emerged, including Santa Cruz and Monterey County government, education and dental industry representatives among others. They plan to present strategies in December 2016.

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By Claudia Boyd-Barrett

It took a year for Elvira Gomez of El Monte to realize something was wrong with the therapy her son was supposed to be receiving at school.

Jose Antonio Suarez, then 5 years old, was scheduled to see a therapist once a week in his kindergarten class at a Los Angeles County elementary school. But in 2014, a year after the therapy started, Gomez had yet to see any improvements in her son’s hyperactive and aggressive behavior.

“I went to the school and asked, ‘How often is the therapist going (to the classroom)?’” recalled Gomez, a native Spanish speaker. She was shocked to find out that the therapist came only once or twice a month.

“I thought, I have to be more on top of this,” she said.

Gomez is one of thousands of parents across the state who have struggled to get their children adequate mental health services at school. She’s also part of a population that advocates believe is especially vulnerable to having their children’s special education and mental health needs neglected: parents with limited English skills.

Legally, school districts are supposed to provide students experiencing emotional and behavioral difficulties with mental health assessments and individualized services to help them benefit from their education. But a report earlier this year by leading advocacy organizations found half of all students with these difficulties get no mental health help at all.

Other students who do receive services, the researchers found, frequently don’t receive them enough or don’t receive the right kind of intervention to make a difference.

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By Derek Walter 

It’s not just students that are trekking off to school for another year of learning. Many parents will be headed to class as well, as schools are ramping up their efforts to make sure they see parents more often than at the beginning of the year or back to school night.

The goal isn’t to find volunteers to make copies, but to partner with parents in helping to improve student nutrition, sleep and other health habits that can impact school performance.

Schools are now required to address parent engagement as part of the state’s Local Control and Accountability Act, a law implemented in 2013 that gives school districts more autonomy over their own funds.

Some districts, particularly in the Central Valley and Los Angeles area, are taking advantage of the new law and hoping parent outreach translates into better student health and academic performance. The thinking is that parents who are more involved will feel a greater tie to the school and will motivate students to be more engaged.

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By Fran Kritz

Dozens of freshmen headed to Humboldt State University this fall will have access to something most many of their classmates take for granted: a credit card they can swipe in exchange for food.

During the spring semester a new debit machine was installed at the university’s College Creek Marketplace, which lets the market now accept electronic benefit transfer (EBT) debit cards for many grocery purchases.

EBT was formerly known as food stamps, and now called the Supplemental Nutrition Assistance Program or SNAP. The marketplace is the only campus food outlet, for now, that accepts the cards. And Humboldt State is one of the few campuses anywhere in the U.S. that lets students, faculty and staff use an EBT card for grocery purchases.

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By Hannah Guzik

The sun has just nosed above the horizon when Maria Espinosa (not her real name) ties a bandana over her face to protect herself from pesticides and dust, and reaches for a blackberry bush. Paid by the amount of berries she picks plus a $3-per-hour wage, Espinosa works feverishly for 10 hours, stopping only briefly for short breaks and lunch. For that day in early May, Espinosa would receive no overtime pay.

California’s 441,000 agricultural employees harvest one-third of the nation’s vegetables and two-thirds of its fruits and nuts. The state’s 76,400 farms and ranches earned approximately $54 billion for their 2014 harvests, according to the most recent crop report. Yet the median personal income of farmworkers statewide is just $14,000 a year.

Unlike nearly all other employees in the U.S., farmworkers aren’t eligible for overtime pay unless they work more than 10 hours a day or 60 hours a week. Because of pressure from Southern lawmakers who wanted to maintain a low-wage black workforce, farm workers (along with domestic workers and other primarily African-American workforces) were exempted from the 1935 National Labor Relations Act, leaving them without federal standards for overtime pay, basic union organizing rights and other worker protections.

“We work very hard and make little. … Why should we be treated differently?” Espinosa says.

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By Derek Walter

When Alexis Gonzalez tells her story about overcoming child abuse, she’s surprised by how many people it resonates with. At one event after another in the Central Valley, she’s approached by audience members who can relate.

“People would disclose their own abuse and that they had never told anybody,” said Gonzalez, now 21. “People are actually taking something away from these public speaking experiences, and it’s started to become a natural part of my healing process. At first it was something that was part of the process to help myself, but it’s also been inspiring to do this for other people.”

Gonzalez, who speaks on behalf of the Fresno County Council on Child Abuse Prevention, was molested by her paternal grandfather when she was a girl. For years she suffered in silence, but is now sharing her story in the hopes that it can prevent other Central Valley children from experiencing abuse.

Children in Fresno and Tulare counties, which make up a large portion of the valley, are more likely to experience abuse than most of those that live elsewhere in the state.

Child abuse can take many forms — including neglect through malnutrition, emotional trauma or sexual abuse. While they don’t inherently cause abuse, poverty, drug addiction and family dysfunction can create environments where problems are more likely to erupt, experts say. Thousands of Central Valley families struggle with this toxic mix, punishing the most vulnerable.

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By Derek Walter

The Central Valley has long been plagued with some of the dirtiest air in the nation. It usually hits those with the most vulnerable lungs the hardest, including elementary school-age kids with asthma.

While the Valley’s air is trending in the right direction, it’s still a challenge for schools to facilitate physical education and outdoor sports, especially with the pressure to fight childhood obesity by keeping kids active.

Schools are turning to a number of solutions that leverage a real-time air-quality monitoring network with creative ways to keep kids moving even when they need to head indoors. As we inch towards the summer months and the temperature rises, schools are working on their alternative physical education plans.

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By Fran Kritz

Since Jan. 1, thousands more kids in California have had improved access to breakfast and lunch at school for little or no cost.

That’s when a new law took effect requiring schools that serve subsidized federally funded meals and post the application forms online to have those applications available in multiple languages. The new law will make it easier for non-English speaking parents to apply for meals for eligible kids.

“It is simply unconscionable that there are children who go throughout the school day hungry due to something as simple as a language barrier…” said State Senator Tony Mendoza, the bill’s sponsor.

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By Matt Perry

As farmer’s markets explode all over California and people start to view food as a form of medicine, family farms are emerging as the backbone of a blossoming “shop local” movement and the desire to reconnect with both neighbors and nature.

Yet an aging California population also means that older adult farmers – “agrarian elders” – are retiring at a record rate and taking decades of irreplaceable wisdom with them.

A California farming organization is now on a mission to help keep these small farms in the hands of family members or trusted employees to retain this important heritage.

For the past 15 years, California FarmLink has been fostering farm succession using a team of advisors around the state and “toolkits” to help with the process.

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