Uncovered California: Despite insurance, some left without care
Glossary of terms
Affordable Care Act
Also known as Obamacare, the law requires that every American have health insurance with the idea that health insurance becomes more affordable when everyone enrolls. It offers subsidized health insurance based on income levels. It also expanded Medi-Cal to cover more people living in poverty, particularly those without children, and made it illegal for insurance companies to deny care to individuals with pre-existing conditions. There is a tax penalty for anyone not enrolled in a health insurance plan.
Each state has its own version of the Affordable Care Act. Californians have the Covered California insurance exchange. Those who are low-income or are not enrolled in employee benefits may enroll in private insurance through Covered California. The program offers different levels of insurance – higher or lower premiums – depending on income level.
Under the Affordable Care Act, Medi-Cal was expanded to offer insurance to non-disabled childless adults ages 19 to 64 who have incomes at or below 138 percent of the federal poverty level. It also expanded coverage to non-disabled adults who are parents or legal caregivers for children and have an annual income of less than $16,395.
Covered California walk-in assistance sites
There are currently no walk-in assistance centers in Auburn that help with enrollment in Covered California, according to the Covered California website.
The most convenient walk-in site is Well Space Health in Roseville: Call (916) 410-0576 for more information.
For other services, contact Placer People of Faith Together at (530) 401-3768 or visit Ppoft.org.
Editor’s note: This is the first of two parts taking an in-depth look at the impact of the Affordable Care Act in Auburn. Part two will run in Tuesday’s edition of the Auburn Journal.
Charlene Sanborn loved being a mother to her three boys, and when they were grown she loved being a grandmother to their children. She would drop everything to babysit her grandchildren. In fact, she loved everybody’s children. When her boys were growing up in Placerville, the Sanborn house was the place to crash after school and on the weekends. Later, when she worked as a teacher’s aide, she went home and told her family stories of the cute things the kids had said and done that day.
Growing up, the Sanborns had a lot of love, but they didn’t have much money, so their mom had gone without health insurance most of her life — until the Affordable Care Act went into effect in January, 2014, and along with so many other Californians she was able to enroll in Medi-Cal for the first time.
Sanborn finally had health insurance, but it wasn’t enough to save her life.
In October of that year she was diagnosed with stage three cervical cancer and wouldn’t live another two years.
“It’s a Catch-22,” said her son, Todd Pittman, who now lives in Cool. “Without Obamacare, we would have never even known she was sick.”
Sanborn isn’t alone. Even with health insurance under the Affordable Care Act, patients are finding they can’t get the help they need.
Because more people are insured, doctors and emergency rooms are as busy or busier than ever, which means that patients have to wait longer and drive farther to find the care they need, particularly specialty care.
The poorest patients — those with Medi-Cal — have the fewest number of doctors available, and in areas like Auburn that have a high population of elderly patients, the problem is worsened by the amount of care needed per person.
“They didn’t walk the system all the way out,” said community organizer, Lisa Boch. “Medi-Cal was inundated with (new patients).”
Boch works for Placer People of Faith Together, one of eight groups contracted to sign up Placer County residents for insurance benefits through Medi-Cal and through the Covered California exchange.
As an example of the flood of newly-insured, in the Auburn zip codes alone close to 5,000 residents enrolled in Medi-Cal between 2012 and 2015, according to Linda Patterson, division director at Placer County Health and Human Services.
That number doesn’t include those who are newly insured through Covered California.
The problem is a complex one, with no easy answers.
‘Really high hopes’
The Sanborn family was under the impression that their mom’s health had a good outlook.
“We were told (the cancer) was totally treatable,” Pittman said. “We had really high hopes.”
But Pittman believes his mom was bounced around to different specialists because nobody wanted to accept Medi-Cal.
“All of a sudden it was a waiting game about who could take her insurance,” he said. “Two weeks here, two weeks there, nothing was happening, and the cancer was just growing.”
The cancer wouldn’t wait.
In February of 2015, Sanborn finished radiation and chemotherapy. Afterward, she couldn’t afford a more extensive CT scan of her entire body to be sure that she was cancer-free, but Medi-Cal paid for a PET scan of her abdomen, and she looked healthy.
She thought she was in the clear.
A month later the seizures began.
She got the CT scan.
“She had a tumor the size of a mandarin orange on her brain,” Pittman said.
She needed surgery, but that was another waiting game.
“It was terrible,” Pittman said. “It was a nightmare.”
That summer, when his mom became incoherent, Pittman couldn’t wait another day. On a tip from a friend, he put his mom in a wheelchair and rolled her into an ER where they started the process over again, and she finally had the brain surgery she needed.
His mom lived another month.
She died August 3, 2015, at the age of 63.
“Everyone is so glad they have insurance, but the truth is doctors don’t have to take it if they don’t want to.”
Finances don’t work for some doctors
Officials say doctors want to take insurance for low-income patients, but doctors can’t afford it.
The rate that California reimburses doctors for Medi-Cal is one of the lowest in the country, said Dr. Robert Oldham, Placer County public health officer, so there are few doctors, particularly specialists, who can afford to take Medi-Cal patients, so they have to travel as far as Sacramento or the Bay Area for the care they need.
“They want … to take care of poor patients,” he said. “It doesn’t pencil out for them.”
The state’s guideline is that a single doctor should have no more than 2,000 patients, and that, while there may be longer drive times to see a specialist, a patient should not have to drive more than 10 miles or 30 minutes to see a primary care physician, said Katharine Weir, spokesperson for the state’s Department of Health Care Services.
The state monitors access for all Medi-Cal enrollees, she said, and hasn’t found widespread access issues.
Currently, it takes new patients in Placer County about three or four months to get an appointment with a primary care physician, Oldham said.
“The system is flooded.”
So many patients, so little time
Remember that old episode of “I Love Lucy,” where Lucy and Ethel work at the candy factory and can’t keep up with the pace of the chocolates heading down the conveyor belt? Now imagine the doctors as Lucy and Ethel, and the patients as the chocolate, each one requiring more time than the doctors have, and you have an idea of how the system is working.
Except in this scenario, no one is laughing.
One concern is that 2,000 25-year-olds and 2,000 80-year-olds require an entirely different level of care, said Christine Giger, president of Sutter Medical Group. In places like Auburn where residents have a few more wisdom lines than average, doctors have to spend much more time with each patient, so 2,000 patients may be too many. Doctors can’t keep up with the need.
Another concern is that primary care physicians are retiring, Giger said, and they’re difficult to replace because medical students don’t want to become primary care doctors anymore. It doesn’t pay as well as the fields of specialty. Plus, being a family doctor is harder work than the specialties, so fewer doctors want to do it, leaving those who need a good old-fashioned check-up, waiting in a long line.
Read Tuesday’s edition of the Auburn Journal for a look into emergency rooms and the challenges for those insured through Covered California.
Reach reporter Tricia Caspers at email@example.com