St. John's Well Child and Family Center community clinic in South Los Angeles is one of those affected by Thursday's Supreme Court decision on the Affordable Care Act.
The waiting room at St. John’s is often packed. The patients who come here are mostly uninsured adults: recently arrived immigrants, African-Americans and Latino residents from the wider South L.A. area who live far below the federal poverty level.
They have very few other options for care besides community clinics, and they suffer disproportionately from chronic illnesses such as diabetes, heart disease and asthma.
But by August of this year, St. John’s will be able to reach twice as many patients — that’s when its expansion and renovation project will be completed, paid for by a $9.4 million rollout in federal funds.
St. John’s CEO Jim Mangia says he is confident that from now on and through 2013, federal money will continue to support community clinics. Most crucial will be the hundreds of millions of dollars that will be allocated nationwide for prevention; something that’s sorely lacking in the uninsured population, he says.
“There’s going to be dollars, federal dollars, to support those kinds of prevention programs which are very cost effective and produce a lot of positive health results for our patients," said Mangia. "So I think we’ll see a significant improvement in population health, particularly for the underserved populations that we see in South L.A.”
St. John’s sees about 150,000 patient visits a year; 40 percent of the adults have diabetes, while 20 percent of children have asthma.
By following the Affordable Care Act’s mandate since it became law in 2010, the clinic has made it a priority to help patients’ medical and social needs. They now have fitness and nutrition support services, and behavioral health counseling. They’ve also expanded prenatal care and will be doubling its number of dental and pediatric specialists.
Like many other community clinics of its size in a major urban area, the workload at St. John’s is very heavy. It's about to become more so with the new ruling.
In the adult care section, a new patient walks in every five minutes — and the doctors and nurses, on average, each see 25 patients a day.
Lisa Cederblom, a family nurse who’s worked at St. John’s for the past seven years, says the clinic can only begin to address one of the main chronic problems here: poverty.
“We live in a city of great wealth, and we live in a city of great poverty. And the poverty is sometimes invisible — but here it impacts the kind of work that we can do," said Cederblom, referring to the extra challenges faced by community clinics. "I mean, we have kids and actually adults as well, who we take roaches out of their ears because they can’t keep their homes clean. … These are issues that really do plague our patients.”
The expected expansion of Medi-Cal funding, one of the main provisions of the health care law, will not be able to alleviate poverty in this part of L.A. But it is expected to make care available, at no extra cost, to nearly 1.8 million uninsured, low-income Angelenos.