CIRS Blog about Rural California

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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 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 SEAN COCKERHAM AND MICHAEL DOYLE

WASHINGTON — California Republicans representing some of the nation’s most Obamacare-dependent areas in America took a giant political risk on Thursday by voting to repeal the landmark health care law, as they believed their political danger was eased as they got something to brag about back home.

They said they were convinced for much the same reason as so many other undecided Republicans who helped give GOP leaders the health care win they had so desperately sought: The addition of $8 billion to the bill to help with insurance costs for people with pre-existing conditions.

The congressmen dismissed estimates that the money isn’t nearly enough: an analysis by the liberal Center for American Progress said it would subsidize care for only 76,000 people out of millions.

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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 Paulina Rojas

SAN BERNARDINO, Calif., Weeping as she narrated her story, Lupé (not her real name) an undocumented immigrant living in the Inland Empire, said she began feeling helpless and scared when her young son began having convulsions a few years ago. Like her, he had no health insurance.

Luckily for her, the nearby SAC Health System (SACHS), a federally qualified health clinic that does not turn uninsured patients away, enrolled the boy as a patient. The medications the clinic provided kept the boy’s convulsions under check.

Last May, when California launched its Health for All Kids program, SACHS helped enroll Lupé’s son in full-scope Medi-Cal, California’s name for the government program for poor people known as Medicaid in the rest of the nation.

Designed to provide health insurance for undocumented children who were left out of the Affordable Care Act because of their immigration status, the Health for All Kids is largely (71 percent) funded by the state, with the rest paid out of federal funds for emergency coverage.

Lupé’s son is among an estimated 250,000 children in California who have so far benefited from the program, said Dr. Jason Lohr, a family medicine practitioner at SACHS.

Lohr was a panelist at a February 7 round table ethnic media briefing here co-sponsored by New America Media and SACHS. Some 51 stakeholders, advocacy groups and media participated.

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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 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 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 Lily Dayton

In the predawn hours of Oct. 3, 2012, two farm labor crews arrived at fields southeast of Salinas to harvest lettuce. A light breeze blew from the north across rows of head lettuce and romaine. As the sun rose higher in the sky, the workers started to smell an acrid odor that some described as paint, others as cilantro seeds or diesel fumes. The workers’ eyes began to burn and water; many complained of nausea, headache, dizziness and shortness of breath. No pesticides were being sprayed at the time, but still, the workers were displaying classic symptoms of pesticide illness.

The source of the odor was drift from a pre-plant strawberry field—a 25-acre barren plot of soil that had been fumigated the day before with a mixture of highly toxic and volatile chemicals 1,3-dichloropropene (also called 1,3-D and sold under the brand name Telone) and chloropicrin.

On the morning of Oct. 2, the fumigant had been injected into the soil through a drip irrigation system beneath high- barrier tarps. Eighteen hours later, 43 people—many of them working as far away as 2,000 feet south of the field—were sickened from poisonous gases that had escaped.

This case, like so many others listed in the state’s Pesticide Illness Surveillance Program, highlights a major problem with pesticides—they don’t necessarily go where they’re intended and, once applied, they don’t necessarily stay there.

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By Hannah Guzik

Although more than half of California’s children are enrolled in the state’s low-income health program, the state does not report how many of them are born at a low birth weight, receive a developmental screening in their first three years of life or have a suicide-risk assessment if they have a major depressive disorder.

These are just a few of the indicators that the federal government uses to assess the quality of the Medi-Cal program, which will cost the state about $18 billion this year.

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By Lynn Graebner

Thousands of residents in rural disadvantaged communities in the Salinas Valley may soon have help avoiding drinking water from domestic wells and small water systems contaminated with dangerous levels of nitrate.

A grass roots pilot project by the Environmental Justice Coalition for Water (EJCW) is helping rural low-income residents organize their communities so they can apply for grants for drilling new wells or for infrastructure to connect to municipal systems.

“We’re trying to connect people into a regional network,” said Vicente Lara, Central Coast program coordinator for the Coalition. “A lot of people think they’re the only ones experiencing this problem. This is a regional issue.”

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By Daniel Weintraub

California is a land of health extremes, and to see what that means, you need only travel a few miles from the state Capitol.

Placer and Yuba counties border each other about a half hour’s drive north of downtown Sacramento. Both places are largely rural. But the similarities end there.

Placer’s residents are, on average, much healthier than their neighbors across the county line. A person living in Yuba County is much more likely to suffer from chronic disease and die at an early age than someone living in Placer. In fact, Placer’s residents are among the healthiest in California, while Yuba’s are among the sickest by many measures.

The easiest explanation for the difference is wealth. Health and wealth are connected, here and almost everywhere in California and across the country. No one is sure exactly why they go together, but the answer is more complicated than the fact that people with higher incomes also tend to have better access to medical care. Even when access to care is the same, health disparities remain, because a large share of a person’s health is determined by things outside a doctor’s office or hospital room.

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By Lynn Graebner

Counties all over California are cheering the state’s decision to expand Medi-Cal to more than 1.4 million low-income adults – and bracing for the $1.3 billion the state expects to take away from county health services over the next four years.

Counties should see savings on January 1, 2014, when Medi-Cal expands to include childless adults under the age of 65 with incomes less than 138 percent of the federal poverty level or $15,856 for an individual annually. The federal government will pay 100 percent of the costs for new enrollees from 2014-2016 and 90 percent in 2020 and beyond.

“On paper, you’d think there would be savings,” said David Luchini, Assistant Director of the Fresno County Department of Public Health. But the UCLA Center for Health Policy Research predicted in a Sept. 12, 2012 report that three to four million Californians would remain uninsured in 2019. Counties say it is way too early to count on savings from the ACA and to chop away at county health care safety nets.

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By Leah Bartos

With all Americans required to enroll in health insurance under the Affordable Care Act, will the existing safety net clinics become a thing of the past?

For generations, grassroots-style community clinics have worked to fill the coverage gap. Their mandate: to treat any patient who walks in the door, regardless of ability to pay.

But by January of next year, all those patients should have health insurance. In theory.

Despite the requirement  — and penalty fee for noncompliance — a projected 3 to 4 million Californians will remain uninsured through 2019, according to a UC Berkeley Labor Center study. Of the remaining uninsured, the report projects that nearly 40 percent still won’t be able to afford coverage, and that three-fourths will be U.S. citizens or lawfully present immigrants. More than half will include households with incomes at or below 200 percent of the federal poverty level.

For many, California’s safety net clinics will continue to be their best — or only — option for care.

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Recovery in the Valley

California began to recover from the 2008-09 recession in 2012. Employment rose from 16.2 million in January 2012 to 16.5 million in November 2012, and the unemployment rate dropped from 11.3 to 9.8 percent.

In Fresno county, a bellwether for the San Joaquin Valley, the labor force was stable at 441,000 in 2012 but employment rose from 367,000 to 380,000. Fresno's unemployment rate dropped from 17 percent in January 2012 to 14 percent in October 2012.

fresno-county-map

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