Public and Community Health Problems
Community & Public Health
Professor Morthland January 14, 2011
I believe one of the greatest achievements in the 21st century will be the availability of affordable health care coverage for all American citizens regardless of their financial status.On March 23, 2010 President Obama sidned the health care reform legislation into law.
The bill constitutes the biggest expansion of the federal health care guarantees in more than four decades. The President emphasized that some 4 million small-business owners will be able to get tax credits to help cover the cost of producing health insurance to their ...view middle of the document...
“We’ve seen a huge impact in the emergency room volume,” he said. Arrowhead has the second-busiest emergency room in the state based on daily visits.”
Ordinarily, federally qualified health centers and their associated clinics would help provide services to the increasing number of uninsured, but they are few and far between in the region, which spans a vast territory approximately the size of Maine.
Bradley Gilbert, CEO of the not-for-profit Inland Empire Health Plan said that although every county has a requirement to provide services to the uninsured, in the Inland Empire they are covering a fraction of the population, only 30,000-40,000 people are enrolled in medically indigent adult programs- a fraction of the more than one million who don’t have insurance.
One of the areas that Gilbert identified as having the most severe shortage of health centers is the High Desert, a region stretching from the Cajon Pass in western San Bernardino County east to the Arizona and Nevada borders, because it has no federally qualified health centers, but a population of several hundred thousand people living there. Gilbert believes that there’s less access in San Bernardino County than in the neighboring County of Riverside.
“The entire High Desert has no dedicated entitiy for primary care of uninsured people.” (L. McSherry, California Healthline Regional Correspondent).
California’s counties, by law, are the health care providers of last resort for residents age 18 and older who cannot afford care. For these medically indigent adults (MIAs), the county programs are a vital part of the state’s health care safety-net, which also includes public hospitals and clinics and Medi-Cal, California”s health insurance program for low-income residents. Because Medi-Cal is generally reserves for certain groups, eligible children and youth, low-income parents, and the aged, blind or disabled- the county MIA programs are the main source of care for those without Medi-Cal coverage, including childless low-income adults and undocumented residents.
County MIA programs fall into two distinct categories, the California Medical Service Program (CMSP) counties and the Medically Indigent Serive Program (MISP) counties. The 34 CMSP Counties have authority to contract out for the administration of their MIA program, which is a uniform set of benefits similar to Medi-Cal.
The 24 MISP counties which include San Bernardino County manage their own programs, setting their own rules about services and eligibility. The Medically Indigent Service Program (MISP) counties provide services through county- owned and operated clinics and hospitals or through contracts with private providers. MISP counties can have very different rules on eligility and service coverage.
Ten of the MISP counties are participating in a federally funded coverage initiative (CI) to provide more comprehensive and preventive services. Nine of these have two or more programs running concurrently. Nine...