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Last month, the California Pan-Ethnic Health Network (CPEHN) convened over 200 community and healthcare leaders at our biennial conference Voices for Change: Mobilizing for Health Equity. At a time when we have seen attack after attack against the health and well-being of our communities, we came together to discuss how we can leverage our collective power to organize, advocate, and vote for equity.

To kick off the day, our keynote speaker, Maria Hinojosa, shared her inspiring personal stories around immigration, mental health, and being the first Latina in numerous newsrooms. Maria reminded us that we each have our own unique stories of resilience and that our stories have power.

“As people of color tell their stories, we build power, and we can change the larger narrative around us.” – Maria Hinojosa, Emmy-winning journalist

With Maria’s stories of resilience in mind, we shifted to the morning plenary where leading advocates discussed strategies for mobilizing around an intersectional health equity agenda. From reproductive justice, to LGBTQ rights, immigration, and climate change—the barriers that communities color face are multifaceted and complex. Panelists discussed all that is at stake for communities in the upcoming November midterm election, in 2020 and beyond. Zahra Billoo of CAIR-SFBA implored participants to ask themselves three guiding questions as we consider the sustainability of our work:

 “Who is not at the table and how can you invite them? How can we work smarter not harder because this is a marathon? [And] how can we can make civic engagement and activism part of our community’s lifestyle?” - Zahra Billoo of CAIR-SFBA


CPEHN staff were co-authors of a new research brief: “Managing Diversity to Eliminate Disparities: A Framework for Health,” featured in the September 2018 issue of Health Affairs. 

The brief used statewide health data to examine health care access, and quality of care by race/ethnicity, payer and region with regards to diabetes management, a chronic condition that disproportionately impacts communities of color in California. Wealthy regions exhibited the widest disparities—with advantages among non-Latino whites and people with commercial coverage, whereas disparities were narrowest in rural and agricultural regions, but health and quality of care were lower overall in those regions, according to the new data.

The brief also explored the unique role CPEHN and other statewide advocacy groups have traditionally played in the advancement of state initiatives to address health equity; including through requirements on health plans to reduce health disparities, as well as broader system wide requirements on public and private entities to invest carbon cap-and-trade revenues in disadvantaged communities. 

The article was co-authored by Cary Sanders/Director Policy Analysis and Sarah de Guia/Executive Director of CPEHN in partnership with Ninez A. Ponce, professor in the Department of Health Policy and Management, director of the UCLA Center for Health Policy Research and principal investigator of the California Health Interview Survey and researchers Michelle Ko/assistant professor UC Davis and Riti Shimkhada/research scientist UCLA.


Despite rising uninsurance rates nationally, a new report from the U.S. Census Bureau shows that California continued to make historic gains in the effort to reduce the state’s uninsured rate. According to the data released, California’s uninsured rate fell to a new historic low of 7.2 percent in 2017, which represents a decline of 10 percentage points from the pre-Affordable Care Act rate of 17.2 percent. The report highlighted California and two other states, Louisiana and New York, as states that saw a reduction in their uninsured rate in 2017, while 34 other states had uninsured rates that remained unchanged. 
 
An analysis of the numbers by CPEHN showed California’s communities of color also continued to see gains in rates of health care coverage with a decline in uninsurance rates for Latinos, Asians, and Native Hawaiian Pacific Islanders, despite federal efforts to sabotage the ACA. These positive numbers are due in part to the proactive steps California has taken despite federal interference, to keep insurance premiums low and make consumers aware of their eligibility for low or no-cost health care coverage in Medi-Cal and Covered California. Covered California in particular was recognized nationally for its targeted outreach and media activities to reach Latinos, African Americans, Asian/Pacific Islanders and LGBTQ communities throughout the state. 

Percentage of Uninsured Californians by Race/Ethnicity: 2016 and 2017

Homelessness and Health

Mr. James was cold. An internal body temperature of 84.2 degrees Fahrenheit qualifies as severe hypothermia. When I first met him in the Emergency Department, his grey hair was poking out from under a warming blanket. Warm fluids were running through an IV into his veins and through a catheter into his bladder. He responded incoherently when I asked his name. His 67-year-old brain and body had frozen.

I ordered a battery of blood tests searching for the cause of Mr. James’ hypothermia. As I’d been taught in medical school, I considered infection, hypothyroidism, adrenal insufficiency, and carbon monoxide intoxication. All the tests came back normal. 

It turns out Mr. James was cold from sleeping outside. Someone stole his blankets and the temperature dropped, a simple formula for hypothermia. He’d had three identical hospital admissions in the last year, each of which involved the same process: We warmed him up, gave him a few hot meals and a warm bed for the night, and then discharged him to the street with a taxi voucher to a homeless shelter. He walked out of the hospital and right back into the cold.

Discharged to the Street

As a resident, or doctor in training, one of my key roles is coordinating discharges from the hospital. Every time I sign a discharge order, I must select the patient’s destination from a dropdown menu of options including home and other levels of care such as skilled nursing facility. “Street” is not an option and yet this is where patients like Mr. James end up. 

John testifying in front of the legislature in support of SB 1152

Treating and Streeting Vulnerable Patients - Inhumane and Ineffective

By: John Landefeld, MD MS

Healing is hard work for patients and clinicians, and leaving the hospital can be just the beginning of a long and complicated recovery process. As a physician, I care for many marginally-housed or homeless patients who struggle with managing antibiotics, wound care, physical therapy, or necessary follow-up appointments after they leave the hospital. Yet most hospitals discharge patients as soon as they are ‘medically clear’: when the wound is stitched, burn is treated, or heart stabilized after cardiac arrest. Homeless patients who still need care are often discharged to the streets or to waiting lines at shelters. A recent survey by the SF Homeless Coalition found that more than half of shelters reported hospitals routinely dropped off discharged patients who were still wearing hospital gowns, had open wounds, or injuries that were not fully treated. Some patients even had IV’s in their arms! Many of these people were confused, still in crisis, or in need of counseling.

The painful experience of my recent patient, Mr. “F”, illustrates this disturbing and increasingly common situation. Mr. “F”, a San Francisco native, is homeless. Due in part to the harsh reality of his life on the street, he developed a severe skin infection that required hospitalization, where I first met and cared for him. After several days, he no longer required IV antibiotics and had stabilized, but still needed several more days of oral antibiotics. To the health care system the hospital had done its job, and he was to be discharged in an all-too-familiar manner for many of our marginally-housed patients; dropped off to a line waiting for a jam-packed shelter, hoping to secure an open bed for the night.

The latest issue of our Health Equity Forum newsletter came out today and it includes several great articles and dozens of resources!

CPEHN’s Executive Director, Sarah de Guia, opens the newsletter affirms CPEHN's commitment to mobilize and unite our communities for better health for all. 

Our newsletter features an article from the California Black Health Network (CBHN) that spotlights their recent town hall events, 40th anniversary celebration and new report--The California Black Health Agenda. We also highlight Alameda County's pilot program to improve dental care for children, a re-cap of the California Oral Health Convenings in Fresno and Oakland, and welcome new CPEHN staff to our team! Finally we have a federal and state legislative updates. 

Updated on January 8, 2018 to include recommendations made by Maternal and Child Health Access

We are excited to announce, in a joint statement with Asian Americans Advancing Justice-Los Angeles and Justice in Aging, that beginning January 1, 2018, adults with full-scope Medi-Cal have many dental benefits restored through Denti-Cal. This includes all pregnant women, regardless of immigration status, who are eligible for pregnancy-related Medi-Cal with full benefits.

The full restoration provides an important opportunity to educate California residents, especially Medi-Cal beneficiaries, about the additional dental benefits to ensure that beneficiaries are able to seek needed dental services.

Here are the major dental services available to adults through Medi-Cal, as of January 1, 2018. However, Denti-Cal continues to have a cap of $1,800 for covered services per year, although some services do not count towards the $1,800 cap and additional services can be covered if shown to be medically necessary. Adults with full-scope Medi-Cal can expect to receive a letter in the mail notifying them of these new benefits.

Major services covered as of January 1st, 2018:

Tomorrow kicks-off the fifth year of open enrollment for coverage under the Affordable Care Act (ACA). In past years, the beginning of open enrollment coincided with a groundswell of digital, TV, radio, and in-person outreach. Instead, a few weeks ago the Trump administration announced a 90 percent cut in funds for open enrollment advertising and a 40 percent cut in grants for navigators who provide in-person enrollment assistance. We know that applying and selecting a health plan is a big decision for people. And this year—with all the attempts to repeal the ACA, cuts to subsidies paid to insurers, shorter enrollment period in many states, and the many insurers that have left ACA exchanges—the confusion is at an all-time high. CPEHN has created a fact sheet with some frequently asked questions that we've heard. Check it out here!

Yesterday, the GOP took the first step towards slashing health care from millions of people to fund a trillion dollar tax break for the wealthy. The House voted 216 to 212 to pass the Senate’s federal budget resolution with all 14 House Republicans from California supporting the plan despite a provision that will result in higher taxes on middle income earners in the state. That provision prompted 20 Republicans, primarily from New York and New Jersey to vote against their own party’s resolution. This latest vote clears the way for reconciliation, which replaces the Senate’s 60 vote threshold with a simple majority of 51 votes.

While yesterday's vote is disappointing, it is unfortunately not surprising.  Despite the harm it will cause to their own constituents, California’s Congressional GOP delegation has voted again and again for massive cuts to Medicaid and this vote is no different. The latest tax proposal is actually a double whammy for Californians who will see their taxes increase due to the elimination of the state and local tax deduction (SALT) at the same time while their health care is threatened. In 2015, more than 6 million California taxpayers claimed the SALT deduction, which was worth $112.5 billion.

Proposed GOP Cuts to our Care
The GOP’s health care attack list is long. Here are some of the ways the GOP budget will use health care to pay for a $1.5 trillion tax cut for the rich:

Medi-Cal, Medicare and Children’s Health Care Slashed

Over the past two days, California’s “Assembly Select Committee on Health Care Delivery Systems and Universal Coverage” heard testimony from key policy experts summarizing the state’s current health care delivery system and universal coverage systems around the world. Sarah de Guia, the California Pan Ethnic Health Network’s Executive Director issued this statement:

“California is closer to achieving universal coverage than ever before. Thanks to the Affordable Care Act (ACA), nearly 14 million Californians are enrolled in Medi-Cal and able to access preventive services, primary care, mental health, substance use treatment, and oral health care. Another 1.3 million Californians receive health care coverage including financial assistance through Covered California, our state’s ACA marketplace. More than 5 million Californians who were previously uninsured now have access to care thanks to the Affordable Care Act.

While we have made progress, our work is not done. 3 million Californians, a majority of whom are people of color and low-income, still lack health care coverage. In addition, stark disparities in health outcomes remain. For example, Black and Latino communities are more likely to have diabetes and to report poor mental health than White communities.  CPEHN remains committed to achieving universal coverage and eliminating health disparities. We look forward to working with the Legislature to explore all options to achieve universal coverage and to make meaningful strides towards eliminating disparities in access to care and health outcomes in our state.”

The California Pan-Ethnic Health Network (CPEHN) is a statewide multicultural advocacy organization that works to improve the health of communities of color. Visit www.cpehn.org for more information. 

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