Health Plan Gives Working Poor a Shot

The mysterious rash that lives on 16-year-old Coreena Parraz first appeared like little bug bites on her forearm, then quickly spread up her body and invaded her back.

She itched and endured for a year without seeing a doctor because her mother, Dolores Parraz, can’t afford her company’s health benefits.

Eventually, Parraz saved enough money for a doctor’s appointment, but his costly advice was simply that Coreena needed a skin specialist.

“We’ve been using an over-the-counter lotion to control it. But it’s depressing,” said Parraz, a single mother of three who lives in Pacoima. “She doesn’t wear short-sleeve shirts anymore, and we’re desperate to find out what is wrong.”

Like thousands of other low-income families in Los Angeles, Parraz is caught in a health-care conundrum. Her $600-a-week salary is too low to pay for medical benefits but too high to qualify for Medi-Cal, the state- and federally funded health-care program.

Her other children, Max, 5, and Ariana, 6, haven’t seen a doctor since 1994.

“I’m damned if I do and damned if I don’t,” Parraz said.

Similarly frustrated about government efforts to reform health care, a San Fernando Valley group took action. The nonprofit organization, Valley Organized in Community Efforts joined with a network of public and private neighborhood clinics to form a pioneering health-care program specifically for low-income families in the northeast Valley, where most of the area’s working poor resides.

“This, indeed, does sound unique,” said Lourdes Rivera, staff attorney for the National Health Law Program in Los Angeles, an advocacy group for the poor. “It’s similar to the way HMOs started, except this time it’s being developed from the bottom, instead of the top.”

The community-based program--called Vida, the Spanish word for life--was launched with a three-year, $500,000 grant from the Woodland Hills-based California Endowment, a nonprofit health-care foundation.

Next month, the Los Angeles County Board of Supervisors will consider providing an as-yet undetermined amount of money for Vida as it considers an $8-million proposal to expand ambulatory care and relieve the pressure on county emergency rooms.

About 130 uninsured residents have already applied to join the program after attending meetings at Santa Rosa de Lima Church in San Fernando, and hundreds more are expected to attend meetings later this month. In December, 300 families will be selected to receive Vida membership cards for the one-year pilot project, which begins in January.

“We hope senators and congressional representatives look at this and say ‘Hey, what a great idea,’ ” said Dean Lopez, a VOICE organizer who helped develop the program. “We want other communities to see that they can replicate this and take charge, too.”

The Vida project was conceived last year by VOICE and attorneys from San Fernando Valley Neighborhood Legal Services. Lopez and attorney Beth Osthimer began by distributing surveys and conducting focus groups with uninsured people to identify obstacles to obtaining care.

Many respondents complained of treatment delays, including horror stories of waiting 12 to 20 hours in hospital emergency rooms. Others found the red tape daunting and asked for simplified forms. But a recurring request, especially among Latinos, was for a health-care program that delivered respect.

“We discovered that many people, even if eligible for Medi-Cal or public health care, were reluctant to seek care because of the way they were mistreated or discriminated [against] by intake workers,” Osthimer said.

Language barriers and lack of transportation also posed obstacles to obtaining care. Some immigrants said they avoided the entire system because they feared reliance on public health would be used against them when they sought to become citizens.

The research led to a low-cost, basic health-care program distinguished by its single-page application form, numerous locations and emphasis on health education.

At the local clinics, members will receive primary health services, such as checkups, X-rays, prescriptions, preventive care screenings, immunizations and even help with questions frequently posed by immigrants about using medical services.

“It’s not a traditional, licensed health plan,” Osthimer said. “It’s a grass-roots model where people get a card and will receive health services. With the card, we’ll track their use.”

The program does not cover emergency care or treatment for catastrophic illness.

To be eligible, a family of four can have an income of no more than about $32,900. The monthly cost is about $10 for a single person to $25 for a family of up to 10.

Through a partnership with the county Department of Health Services, members use any of 26 community health clinics. All locations are accessible by bus, and organizers hope to expand Vida to include bus tokens and transportation vouchers.

The first 300 families must agree to release their medical records to clinics and attend quarterly meetings to discuss Vida’s progress. After three years, program officials hope to have 1,200 members.

“We’re not selling, we’re not hyping. We’re not marketing for some HMO,” said Mike Clemens, a VOICE member. “We just think it’s outrageous that so many people don’t have health care. And we have something that might be good for them.”

Four months ago, the state launched its $500-million Healthy Families insurance program, targeting low-income families that don’t qualify for Medi-Cal. Critics say the program has stumbled, however, because of its complicated, IRS-style application form, a failure to educate poor communities about the plan and a perception that Healthy Families carried the stigma of welfare. Furthermore, Healthy Families solves only half the medical problems of the working poor: It covers only children.

Vida leaders say that although they have managed to avoid such pitfalls, they will not be competing with Healthy Families or Medi-Cal.

“We’re not trying to steer people from other programs. If we find some families can get a better deal through Medi-Cal or Healthy Families, we’ll help them transfer,” Clemens said.

Organizers said that to overcome the shame some feel when applying for assistance, they trained community members so applicants could be signed up by a familiar face.

At a Vida meeting at Santa Rosa de Lima Church last month, about 30 people who had participated in the initial Vida surveys squeezed into a classroom to learn the basics of cold-calls and organizing meetings. Clemens, who led the meeting, emphasized the importance of getting feedback about service.

“If we find out these clinics are making our people wait for hours, we’re going to do something about it,” he said.

At that, a feeling of empowerment swept over several people in the room. Heads nodded in agreement. When asked how he felt about the Vida project, San Fernando resident Gene Torres slammed his fist on the desk and summed up the mood.

“It’s about time,” he said. “We got it and it’s here.”