Poorest county in California leaves uninsured in limbo

Under the Affordable Care Act, a million and a half of uninsured Californians should be covered by public health insurance before 2016. To prepare, the state began its Bridge to Reform, funded in part by the federal government. Ten counties, as diverse as San Francisco in the North, Orange in the South, and Kern in the Central Valley, are insuring low and middle-income residents now. In Fresno County, with the highest poverty in the state, county supervisors decided not to enter the program. Our reporter Farida Jhabvala Romero went to Fresno and has this report.


FARIDA JHABVALA: María Estela Luna looks fondly at pictures of her mother, father and brothers in her house in Selma, in California’s Central Valley.

LUNA: When we were young, we all worked in the field. My parents would take us there to harvest grapes and fruit.

JHABVALA: The images are still glued to panels shown at the funeral of her mother, who died a month ago. Luna went to the funeral but could not see her mom before she died because she herself was very sick. She had a painful urinary tract infection that spread to her kidney. It can be deadly if not treated on time.

LUNA: Lots of vomit, and I had a lot of fever and I couldn’t get up from bed.

JHABVALA: Luna did not see a private doctor immediately because she does not have health insurance, and was worried about the cost. She lost her insurance last year when laid off from her job.

LUNA: This has been a very hard year for me. I used to make a lot of money. I made almost $50,000 a year. And when I was laid off and had to be on unemployment, well ah! I had never been on unemployment, I always worked.

JHABVALA: Luna still does not know how much her treatment will cost. She also cannot afford the medicine she used to take daily to control her asthma. She earns too much from unemployment to qualify for the public insurance Medicaid, called Medi-Cal in California. But does not have enough to buy private insurance. If Luna lived in one of the 10 counties participating in the expansion of Medi-Cal, she could get insured. But she lives in Fresno County, where the Board of Supervisors decided not to join the program. This was recommended by Dr. Eduardo Moreno, Director of the County’s Public Health Department.

MORENO: The county needs money and the money that we can use now we are using it to pay a hospital here in Fresno so that they take care of indigent people who need medical services. We are paying the hospital $20 million dollars per year.

JHABVALA: And the hospital Community Regional Medical Center says the real cost of caring for indigent patients who are uninsured was $80 million last year. Based on this data, Dr. Moreno estimates that expanding Medi-Cal now would be much more expensive for the county, even if the federal government reimburses half of the costs, as promised.  Some health professionals criticize that the county only took into account data from the current hospital agreement. 

HAMILTON: They are an expensive system. It’s a hospital! They are not meant to do primary care. Preventative care it’s not their job.

JHABVALA: Kevin Hamilton is the director of programs at Clinica Sierra Vista. He says the county could lower the cost of the new insurance by working with community clinics. Norma Forbes, director of Healthy Communities Access Partners, also estimates that the new insurance could cover about 50,000 people, twice as many patients than accepted for the indigent program. Forbes says that the county sees this as a good deal.

FORBES: The sweet deal is having a fixed cost for 30 years. That’s a hard sweet deal to beat. Now it completely leaves out the need for patients and people for healthcare.

JHABVALA: People like Maria Estela Luna remain without health insurance and Fresno is not preparing for 2014, when the health reform law requires most to have health insurance and applications for Medi-Cal could double in Fresno. Kevin Hamilton:

KEVIN: So all this stuff is coming down the road like a steamroller right at the county of Fresno! And what do we do? We blinked! Now we are going to get run over.

JHABVALA:  Hamilton and Forbes suspect that some of the supervisors oppose the new health law for political reasons and hope the Supreme Court revokes the law. This is something that Supervisor Phil Larson squarely denies, while the other two supervisors that voted against declined interviews with Radio Bilingüe. In the meantime, Maria Estela Luna has only one wish.

LUNA: I only ask god that I don’t get sick again, until I’m working.

JHABVALA: For the Weekly Edition of Noticiero Latino from Fresno California, this is Farida Jhabvala Romero.  


Broadcast was originally aired by Radio Bilingue

Audio file