National Physicians Alliance

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From Invisible to a Player: The Poor in the New Health Care System

Posted by Ricky Choi, MD, MPH, NPA Board Member July 22, 2011 at 1:20 PM

This article is cross-posted from San Francisco Chronicle Blog, originally published July 21, 2011.

37 years ago, at the very tail of the civil rights movement, my community health center (CHC) was established in Oakland to fill an unmet and urgent need. A growing population of immigrants were settling in downtown Oakland and had few choices for health care. Community surveys conducted by local leaders confirmed that residents received significantly less health care than the rest of the population largely due to a shortage of providers and limited English proficiency. And so a group of volunteers and students opened a make shift clinic with a volunteer doctor and an optometrist available for two days a week. As demand grew this little clinic expanded hours and added staff one at a time. Almost four decades later, the clinic has grown to 40+ doctors seeing 20,000 patients who speak any of 10 different languages.

Our clinic still keeps its doors open to everyone regardless of insurance status or ability to pay. The people who work here are amazing. Our staff is dedicated and hard working. Our clinic attracts prestigously educated and clinically astute doctors devoted to the care for underserved communities. In a sector that is notoriously under paid, under supported, and with few frills, my coworkers choose to work here because of it’s mission driven purpose.

But change is coming. As we march toward 2014, when the insurance expansion provisions of the Affordable Care Act (ACA) are fully implemented, it is apparent that clinics and CHCs will have to make adjustments. Studies show that community health centers are a great deal for the health care system by providing high quality care for the fraction of the cost. However, a recent report from the Blue Shield of California Foundation questions if this is enough. If their conclusions are correct, the ACA will change the landscape of health care to one where low income patients have the power to choose their provider. Clinics like mine have a challenge (or opportunity) to be their first choice.

The Blue Shield of California Foundation asked 1005 Californians

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