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Despite ACA Eligibility, Many Inland Empire Youth Remain Uninsured

SAN BERNARDINO, Calif. – Despite open enrollment for health plans through the Affordable Care Act, nearly a quarter of San Bernardino County’s 2 million-strong residents remain uninsured. Among children, some 35,000, or 9 percent, are uninsured, compared to the national average of 8 percent.

“There’s no reason why (the children) can’t be insured,” asserted Michael Schertell, deputy director for Children’s and Regional Programs for the San Bernardino County Department of Behavioral Health.

But he acknowledged that getting them insured could be challenging, given that around 20,000 of them fall into the category of homeless, defined as not having “a permanent setting.”

As San Bernardino struggles with its financial woes, the city has understandably seen an increased demand for mental health services for children, given that behavioral disorders are closely tied to social and economic issues.

Schertell was sharing those observations while on a panel at an ethnic media briefing here Dec. 4 organized by New America Media and sponsored by The California Endowment. The briefing focused on how the Affordable Care Act (ACA) could help San Bernardino County’s youth access mental and medical health care services, starting Jan. 1, 2014, when the ACA is fully implemented.

While many young adults are now covered by the ACA and able to remain on their parent’s insurance plan until age 26, the rules are different for former foster care children, once they age out of the system. At that point, they lose their coverage.

Schertell pointed out that that’s going to change in January, when Medi-Cal coverage will be extended to them until they turn 26, as long as they were enrolled in it while they were wards of the state.

Dr. Kim Clark, a professor in the Department of Health Sciences at Cal State San Bernardino, and currently on assignment with the San Bernardino County Superintendent of Schools, said in his presentation that schools in the county have been forced to cut back on counseling services for financial reasons. Many of them have nevertheless benefitted from a program the county’s behavioral health department has been offering. Under it, local community agencies contracted by the county provide students on-campus counseling.

Schools have the option of hosting those services, Clark said, but not every one of the county’s 32 school districts do.

Clark said that in order to get a true picture of how prevalent mental health disorders are among the San Bernardino County student population, school districts should modify the California Healthy Kids Survey schools administer every two years and include questions on drug problems, violence and sexual behavior.

“The irony is that they ask safe questions,” he said, noting that that could largely be because of “the political ramifications of determining that there are more mental health and/or sexual concerns than the district is willing to deal with.”

That, he said, is a pity given that data drive policy.

He also lamented what he called a “fundamental failure” by schools to not include health education in their curriculum. Educating students on health issues, he said, would decrease visits to emergency rooms and reduce needless medical expenses.

Panelist Linda Hart, president and co-founder of the African American Mental Health Coalition in San Bernardino, said that even though the ACA requires all insurance companies, whether participating in the private market or the online marketplace exchange, to cover 10 essential health benefits, including mental health and substance abuse coverage, unless youngsters with mental health disorders “feel comfortable” talking about their illness, no laws passed will help.

“The stigma associated with mental illness is so great, youth don’t want to reveal” they have a disorder, Hart said.

Panelist David Levitus, the state’s deputy director of the four-year-old national group, Young Invincibles, said that contrary to what many believe, a poll done by his group suggests that most youngsters between the ages of 18 and 34 want health coverage.

The Obama administration has said more than once that youth are crucial to making the ACA work because when they buy coverage they help to spread the risk and hold down premiums for everybody.

According to the Kaiser Family Foundation, some 27 percent of young people in that age group lack coverage largely because they are less likely to be offered coverage through their employers because many of them work part-time or hourly-wage jobs that offer no health benefits.

In places like the Inland Empire and its surroundings, Levitus said, there is an increase in substance abuse and other mental health disorders. Access to health care is crucial in these places, he said.

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