OAKLAND, Calif.--Laura Lopez was running late. Inside the common room at Street Level Health Project clinic on Oakland’s International Boulevard, two Cambodian women and two Eritrean men were waiting for her. The group, representing Cambodian Community Development, Inc. and Eritrean Youth for Change, were here for one last meeting to prepare for an upcoming community health fair.
With the help of Lopez’s clinic, the refugee organizations were reaching out to their members to help them get basic health services at the May 19 fair, as well as helping them to enroll in state and county food and medical programs. The community advocates, working in partnership with the East Oakland Building Healthy Communities initiative, want to enroll poor and working-class people in healthcare programs that have become newly available to them under the Affordable Care Act (ACA), the federal healthcare reform law passed in 2010.
Lopez bustled in. A petite Peruvian immigrant with a purposeful, high-energy manner, disarmingly punctuated by bursts of laughter and teasing, she was all business on this day. “We wanna know how you guys are doing — your numbers,” she said.
Talaya Sin, one of the Cambodian women, spoke up first. “I’ve been running into some problems. One is that it’s hard for me to explain what health care is.”
Without missing a beat, Lopez and Kim Barstow, one of Street Level Health’s program managers, brainstormed with Sin to figure out ways to communicate about health programs, including photocopying pictures of identity cards to enroll in Medi-Cal and HealthPAC, Alameda County’s health program for uninsured residents.
The Affordable Care Act faces a Supreme Court ruling this June on its constitutionality, but Gov. Jerry Brown has pledged that California will move forward in implementing many of its provisions, including the Health Benefits Exchange, an online marketplace for affordable insurance plans.
Despite the many controversies surrounding health reform[TN1], the ACA has major implications for uninsured people and people of color. Its expansion of Medi-Cal eligibility to everyone under 133 percent of the federal poverty level means that thousands of low-income people who didn’t meet the program’s previous requirements can now receive health coverage.
In California, it’s estimated that 1 to 2 million uninsured people will receive insurance under Medi-Cal expansion, and another 4 million will get insurance through the Exchange.
“The real crucial question for people is what is health insurance (under ACA)? What does it cover, does it pay for my doctor, my procedures, medicines?” said Dr. Damon Francis, medical director for the Urban Male Health Initiative of Alameda County. “If we can take this moment not just to expand coverage but to redefine what healthcare is from a community perspective, we can potentially make a lot of change. It’s not going to be easy, but the system can’t go on the way it is right now. It’s too expensive and not providing the quality we need.”
Oakland’s health advocacy and social justice communities are working to harness the resources of the ACA and direct attention toward the deep problems of East Oakland, where life expectancy is 10 years shorter than in wealthier parts of the city, and health outcomes are determined by high unemployment and homicide rates, lack of grocery stores and chronic diseases. Unemployment in 2010 was up to 31-35 percent in East Oakland, compared to 16.9 percent in Oakland overall, according to a report by the East Bay Alliance for a Sustainable Economy. There are only two supermarkets, which severely limit access to healthful food for local residents. The Eastmont Mall hosts a medical clinic but the wait for an appointment can take six months or longer.
Outreach is a critical part of implementing the ACA in California, where people of color make up about 60 percent of the population, and nearly 7 million people have limited English proficiency, which is more than twice the number of any other state, according to a report by the California Pan-Ethnic Health Network. These communities are the least informed about health coverage, yet have the most pressing need for it.
Lining the walls of Street Level Health Project’s clinic are paper flags representing 31 countries. Much of the clinic’s patients are undocumented Latino day laborers who have nowhere to go but emergency rooms in the event they get sick or injured. In two tiny examining rooms, the clinic’s doctor and volunteer herbalist treat patients for muscular pain and skin problems from on-the-job injuries and exposure to chemicals. Such health conditions as diabetes, hypertension, and gastrointestinal issues are common among them. They provide what Dr. William Wallin, the clinic’s part-time doctor, refers to as “Third World medicine:” first-aid, blood pressure checks, a plate of hot food, health workshops and classes. Referrals to Highland Hospital or La Clinica de la Raza are given for more serious conditions.
One of the most important services Street Level Health provides is simply in reaching out to immigrants and giving them a way to talk about their lives, Lopez said.
“As an immigrant you don’t think about yourself, you think about how to pay the bills, send money home—we put ourselves as the last person. I tell them, sometimes we need to lose one day of work and go to a doctor before you end up in Highland Hospital and lose a month or two months, ” she said.
Increasingly, Street Level Health is seeing more native-born white and African American patients walk through its doors as a result of people losing their jobs and health insurance in the economic downturn.
East Oakland also has been a resettlement site for a small but increasing numbers of refugees fleeing political repression in Burma, Bhutan, Nepal and other countries. Through one of their volunteers, who works at Eastmont Mall’s clinic, Lopez heard about a group of 22 Burmese refugees who were HIV positive and getting no health care. Thus began the clinic’s work with the East Bay Refugee Forum and its members.
At the prep meeting for the community fair, Lopez and the refugee leaders were strategizing about how to pre-screen as many of their members as possible for health coverage enrollment at the May 19 event. This is no easy feat. At prior similar events, thousands of people eager for medical care had to be turned back for lack of required documents.
Jiwan Subba and Laxman Mahat from the Bhutanese Community in California have arrived to the meeting late from work. They raised the issue of Eastmont Mall’s and Highland Hospital’s six-month wait for primary care appointments. “By the time somebody gets an appointment, they’re dead,” Subba observed.
Mahat added that it happened to one of their community members.
According to the Kaiser Family Foundation, thousands of deaths each year are attributable to lack of insurance.
The group went back to troubleshooting more problems, such as refugee families unsure of what they’ve enrolled in because the children filled out the applications for their parents. They discussed what counts as “proof of income” for Medi-Cal if the person gets paid under the table.
By the day of the WeConnect community health fair, all but one of the Eritreans have enrolled in health coverage—a testament to the legwork done by the community organizations.
“When we think about healthcare reform, we have to be very strategic about who we target. We need to talk about homeless people, re-entry, undocumented people. Who can do the outreach who already have this connection with this community?” Lopez said. “A lot of them don’t understand this system. We realized we’re well-suited to work with them—we know what the barriers are.”
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Tram Quang Nguyen is an Oakland-based writer and the author of We Are All Suspects Now: Untold Stories from Immigrant Communities after 9/11