Falling through the cracks

When Kenyatta Aarif had her blood pressure checked at a farmers’ market in Oroville’s Southside neighborhood last fall, she knew the high reading alarmed two student nurses from Chico State. She assured the students, stationed across the street from her small soul-food restaurant, that she’d refill her prescription for medication right away.

In truth, Aarif didn’t have the money for the exam she needed to get a new prescription. So she told herself something different—that she’d watch her diet more carefully.

Then, a few weeks later, Aarif—who says she’s in her 40s—had two heart attacks and a stint inserted into a clogged artery at Enloe Medical Center in Chico.

Aarif’s inability to access affordable health care almost certainly led to an emergency that was far more expensive than the cost of an exam and a bottle of pills would have been. “It doesn’t make sense that in the richest country in the world, I can’t get health care,” Aarif said.

Yet, her story is commonplace in a country where millions of people are unable to access the kind of routine health care that prevents more expensive and disabling medical emergencies. The problem is especially acute in rural counties where there are fewer low-cost clinics, public-health services and prevention programs.

The lack of services in rural Northern California shows up in studies. Low-income Butte County residents have more than their share of chronic illnesses that would respond to management and prevention, and Butte County has higher-than-average rates in the state for both heart disease and diabetes.

The federal health-care-reform law will make millions of low-income adults who have no dependent children eligible, for the first time, for Medicaid—government health insurance that in the past was available only to impoverished families and disabled individuals. But it’s unlikely that lawmakers will fund the law’s public-health components that would help reduce health-care costs.

Aarif said she was released from Enloe with only the most general of instructions: Lose 100 pounds, lower your cholesterol and don’t smoke, doctors told her. Until she begins cardiac rehabilitation this spring, she’s on her own.

Aarif hasn’t smoked since the November day of her heart attacks, and her determination has inspired two of her neighbors to quit smoking as well. But she admits she isn’t sure how to go about such a huge weight-loss task, and armed only with some notations she made from a nutrition chart in her cardiologist’s office, she’s struggling.

“Nobody has told me how to take care of myself,” she said. “Not a lot of care has gone into this; I’m kind of flying blind. I guess keeping poor people alive is not good business. If you’re poor and alive, you’re using up too dang much money.”

Aarif may be right in her belief that poor people are considered too expensive. The House Budget Committee’s proposed 2012 budget, unveiled last week, would slash spending on programs that assist the poor and elderly, and would “fundamentally end Medicare and Medicaid as we know them,” warned Anthony Wright, executive director of the consumer-advocacy organization Health Access.

Even before the Republicans proposed spending cuts, a growing number of Northern Sacramento Valley residents were slipping through official safety-net programs. For people like Aarif who have a small income, qualifying for full coverage under CMSP—a county-run insurance program for indigent adults—is impossible.

In an interview late last year, Cristi Roach, Butte County eligibility program manager for food stamps and Medi-Cal (California’s Medicaid program), said she had 40 new caseworkers in training to handle what had been an enormous caseload growth over the two previous years. With social workers sometimes managing up to 500 cases each, a Medi-Cal expansion produced by the federal health-care-reform law will force her to “staff up” further, she said.

The federal law, set to take effect in 2014, will extend Medi-Cal to thousands of low-income adults by raising the income roof for eligibility.

Meanwhile, the federally funded, Yuba City-based Del Norte Clinics (www.dnci.org) are expanding to meet what will be a dramatic increase in demand for doctors who accept Medi-Cal insurance. But specialists who accept Medi-Cal will continue to be difficult to find, health-care providers say.

That’s one reason the public-health components in the new law are crucial to its success. “Preventing disease is very important to lowering costs and bettering outcomes,” said Ken Logan, a doctor at Del Norte’s Chico Family Health Center.

In countries that have lower health-care costs and better access, “preventive care is always a big part of it,” Logan said. Instead, in this country, “we wait and do the fancy bypass when they come in.”

The new federal law calls for tobacco-cessation and nutrition programs, and an expansion of breast-cancer education and screening. Such public-health components would be welcome in Butte County, which struggled to meet demand for breast-cancer screenings for uninsured women last year.

In October, when Chico organizations and businesses partnered with the California Health Collaborative to run a free, one-day mammogram screening for uninsured women, they were overwhelmed by demand. Women began lining up at the local radiology clinic at 4:45 a.m. in the rain.

Congress, meanwhile, is poised for a fight over funding health-care services to the poor and to the generations of elderly that follow the Baby Boomers, and over the new law itself.

Northern California’s second district Congressman Wally Herger pledged on his website to “help lead the effort to repeal ObamaCare” after winning the chairmanship of the House Ways & Means Subcommittee on Health earlier this year.

Health Access’ Wright admitted this week that the benefits provided by government programs may soon be “winnowed away.” But Medi-Cal will still provide “basic coverage, and is preferable to being uninsured,” he said. And it may be possible to restore funding in the coming years, he added.