While Sacramento lawmakers debate which insurance reform bill is best suited for California, those on the front lines have their own ideas. KPCC's Special Correspondent Kitty Felde speaks with health care professionals at Southern California clinics.
[Sound of knock on door, then, "Hola, coma esta? Bien."]
Kitty Felde: Dr. Amy Nguyen is checking in with diabetes patient Margo Guitierrez. She checks the latest blood test, urges Gutierrez to take an aerobics class at the local "Y," and then she opens a brown paper sack filled with medications.
Dr. Amy Nguyen: Mira, yo tengo las medicinas. No se gusta esta. No. Este es para cholesterol...
Felde: The drugs are free. So is the check-up. Gutierrez has no insurance. But she's pleased with the care she receives at the Community Health Alliance of Pasadena, or CHAP.
Margo Gutierrez: Because this place is very good for me. You know, it's uh, the attention is good, my doctor is nice person.
Felde: This is one of more than 25,000 patient visits at CHAP. Two-thirds of the clinic's costs are covered by the state and federal government. That's because 90% of these patients, just like Margo Gutierrez, have no insurance.
That could change if Sacramento passes one of nearly half a dozen health insurance reform measures getting batted around in the Capitol halls. But some medical professionals are concerned the bill the governor signs – whatever it is – might not cover their needs.
Dr. Luis Artavia, Medical Director of the Community Health Alliance, says a good plan should cover prescription drugs for his patients.
Dr. Luis Artavia: When I give 'em a prescription I ask them, "can you afford this?" And if they can't, you know, what's the point? They're not going to fill it. So then, you know, Plan B. Samples, patience assistance program, do whatever it takes.
Dr. Ulin Sargeant: Mental health is a huge problem. Huge, huge problem.
Felde: That's what Dr. Ulin Sargeant wants to see: Coverage for mental health care. She's a staff physician at CHAP, and she says we pay to care for the mentally ill anyway.
Sargeant: They have no insurance, and therefore they think they can't go to a doctor, and so their bipolar disorder gets out of control, their depression gets out of control, schizophrenia, they end up in jails, they go to ERs again, and all of our monies end up in the emergency room.
Felde: State Senator Sheila Kuehl and Speaker Fabian Nunez say their plans would cover both prescription drugs and mental health care; Senate President Pro Tem Don Perata's plan would mandate drug coverage. But details are few.
State Senator George Runner's plan doesn't address either. He says all the plans are "conceptual rather than detailed."
[Sound of street noise, knock on a door]
Felde: Just east of downtown L.A., a blue and white motor home is parked outside a Boyle Heights health clinic.
Penny Hooks: This is the mammo room, and someone's in there right now, the dressing room, and our little waiting area and the examining room is right behind, and this is where we see the majority of our patients.
Felde: Penny Hooks is a Physician Assistant with the Elizabeth Center for cancer detection. Between three and four dozen women get free mammograms every day in this mobile van. An equal number are screened at the Elizabeth Center's office in downtown L.A.
Few of these women have insurance. Two-thirds of the cost of breast cancer screening is covered by a specific government program. When it comes to a statewide insurance program, Penny Hooks thinks other preventive programs should be covered.
Hooks: Women in particular, since I'm in women's health, should be able to come in and see a doctor for prenatal care, for routine gynecological examinations.
Felde: The insurance proposals of Speaker Nunez and Senator Kuehl include provisions for "preventive care." Senator Runner would allow hospitals to redirect resources to clinics for preventive care.
Senator Perata would cover so-called "evidence-based preventive services." And Governor Schwarzenegger's proposal mentions prevention for diabetes, tobacco use, and obesity. There is one other item that all the health care professionals insist must be part of any plan:
"I personally think everyone should have health insurance, okay, that's the primary thing."
"Well I think we need to get coverage for everyone, including the non-documented."
"If children deserve coverage then everyone deserves coverage. Insurance for all!"
Felde: Of all the plans in Sacramento, only two would guarantee that every Californian would be covered by insurance: the Governor's plan, which is still not in writing yet, and the single-payer plan backed by Sheila Kuehl. The Governor has threatened to veto that plan if it's passed by the legislature.