Awaiting Trump, Community Clinics Plan for an Uncertain Future
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Uncertain Future","publishDate":1481590446,"format":"standard","headTitle":"KPCC | State of Health | KQED News","labelTerm":{},"content":"\u003cp>Chance Rearden used to get health insurance through his job in the entertainment industry. But when his hours fell off, he didn't qualify for coverage anymore.\u003c/p>\n\u003cp>At the time, Rearden wasn't old enough to get Medicare and he couldn't afford to pay out of pocket for treatment. So, he says, he often skipped going to the doctor.\u003c/p>\n\u003cp>Then the Affordable Care Act took effect, and under its expansion of Medicaid eligibility, Rearden was able to sign up for California's version of the program, Medi-Cal.\u003c/p>\n\u003cp>\"I've been able to get medical attention that I otherwise wouldn't be able to afford to get,\" he says.\u003c/p>\n\u003cp>Rearden, now 66, gets treated at the Saban Community Clinic near Los Angeles' Fairfax District, where he receives primary care and has seen specialists, including a dermatologist and a podiatrist.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>But with the incoming Trump administration looking to repeal the Affordable Care Act, he's scared his benefits will dry up. One key piece of the Republican plan is turning Medicaid into a block grant program, which could mean less money for California to run Medi-Cal.\u003c/p>\n\u003cp>A lot of people who have benefited from the Medi-Cal expansion are worried about losing their coverage, and the community clinics that serve many of them are concerned that they'll have to cut back on some of their services.\u003c/p>\n\u003cp>\u003cstrong>\"Most vulnerable and poorest patients\"\u003c/strong>\u003c/p>\n\u003cp>Saban Community Clinic nurse practitioner Stacy Nadler says her Medi-Cal patients are asking her all sorts of questions, like, \"Will their specialists still be covered? Do you think they'll still be able to see the chiropractor or the neurosurgeon? Or they're planning a surgery for next year. What do I think is going to happen?\"\u003c/p>\n\u003cp>Nadler doesn't have the answers. Neither does clinic CEO Julie Hudman. But she knows there's a lot at stake for her patients.\u003c/p>\n\u003cp>\"A lot of the folks that we see are single adults,\" Hudman says. \"They're maybe more transitional. They're homeless patients. They have behavioral health challenges. They're really, to be honest, some of the most vulnerable and poorest patients of all.\"\u003c/p>\n\u003cp>Before the Affordable Care Act, eligibility for Medicaid depended on a variety of factors, including income, household size, family status, disability and more. Under Obamacare, people can qualify on income alone if their household makes less than 138 percent of the federal poverty level - $16,395 for an individual and $33,534 for a family of four, according to the California Department of Health Care Services.\u003c/p>\n\u003cp>About half of the clinic's 18,000 patients were uninsured prior to the Affordable Care Act, says Hudman. They paid very little for treatment – maybe a co-pay of $5 or $10. Almost all of those patients qualified for Medi-Cal after the health law expanded eligibility, she says. \u003c/p>\n\u003cp>That's made a big difference for the bottom line, Hudman says, explaining that Medi-Cal pays the clinic around $200 per patient visit.\u003c/p>\n\u003cp>These days, more than half of Saban's revenue comes from health insurance programs. The possibility of losing some of that money is forcing Hudman to make some hard decisions.\u003c/p>\n\u003cp>She says she was looking to lease or buy a fourth facility, but with Trump's election that plan is on hold.\u003c/p>\n\u003cp>\"We had a lot of momentum moving forward and now we've just sort of … stalled,\" she says.\u003c/p>\n\u003cp>Hudman has also decided to freeze her plans to expand free services, like help for the homeless.\u003c/p>\n\u003cp>\"I'm not willing to move forward and take some of those risks that I think are what our community and our patients need,\" she says. \"I need to make sure that we're able to pay our bills and pay our staff.\"\u003c/p>\n\u003cfigure id=\"attachment_271077\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/12/KPCC-Community-Clinic-CEO-800x534.jpg\" alt=\"Saban Community Clinic CEO Julie Hudman says she's placed expansion plans on hold amidst the uncertainty over the future of Obamacare.\" width=\"800\" height=\"534\" class=\"size-medium wp-image-271077\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/12/KPCC-Community-Clinic-CEO-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/12/KPCC-Community-Clinic-CEO-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2016/12/KPCC-Community-Clinic-CEO-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/12/KPCC-Community-Clinic-CEO-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2016/12/KPCC-Community-Clinic-CEO-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2016/12/KPCC-Community-Clinic-CEO-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2016/12/KPCC-Community-Clinic-CEO-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2016/12/KPCC-Community-Clinic-CEO-520x347.jpg 520w, https://ww2.kqed.org/app/uploads/sites/27/2016/12/KPCC-Community-Clinic-CEO.jpg 1024w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Saban Community Clinic CEO Julie Hudman says she's placed expansion plans on hold amidst the uncertainty over the future of Obamacare. \u003ccite>( Maya Sugarman/KPCC)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>A lot of health centers are in a similar situation, according to Louise McCarthy, president and CEO of the Community Clinic Association of Los Angeles County. She says it's frustrating not knowing exactly what Trump and the Republican-led Congress will do.\u003c/p>\n\u003cp>In the end, though, \"the populations [the clinics] serve are there and are going to stay there,\" she says. \"So the question is, how do you broker the resources to do it?\"\u003c/p>\n\u003cp>\u003cstrong>Paul Ryan's \"A Better Way\" proposal\u003c/strong>\u003c/p>\n\u003cp>The most detailed Republican plan for repealing and replacing the Affordable Care Act is House Speaker Paul Ryan's (R-Wisconsin) \u003ca href=\"http://abetterway.speaker.gov/_assets/pdf/ABetterWay-HealthCare-PolicyPaper.pdf\" target=\"_blank\">\"A Better Way\"\u003c/a> proposal.\u003c/p>\n\u003cp>It argues that Medicaid's structure is financially unsustainable over the long term and is unfair to states, whose governors and legislatures \"know better than Washington bureaucrats where there are unmet needs and opportunities to cut down on waste, fraud, and abuse.\"\u003c/p>\n\u003cp>The Affordable Care Act's Medicaid expansion unfairly dedicates a greater share of federal dollars to people who make more than the poorest program participants, according to Ryan's plan. \u003c/p>\n\u003cp>The proposal suggests Medicaid be transformed to either provide states with a fixed block grant or a set allotment for each patient, along with the authority to adjust eligibility and benefits \"in a way that better meets the needs of their state populations, promotes personal responsibility and healthy behaviors, and encourages a more holistic approach to care.\"\u003c/p>\n\u003cp>The blueprint proposes that states could base eligibility on requiring \"able-bodied individuals to seek a job, be employed, or participate in a training or educational program,\" as some states have done under a 2012 Supreme Court ruling that gave them the choice of opting out of the Medicaid expansion. \u003c/p>\n\u003cp>The ultimate goal, according to Ryan's plan, is to help Medicaid recipients get off of the program and onto private health coverage. \u003c/p>\n\u003cp>\"As state reforms reduce dependence on government assistance, the people helped would enter the workforce, have insurance, and be able to lift themselves up the economic ladder,\" it says.\u003c/p>\n\u003cp>Meanwhile, community clinics are seeking to reassure Medi-Cal patients nervous about the future. Saban nurse practitioner Nadler says she recently saw a man who wanted to get his high blood pressure under control. He got Medi-Cal through the Obamacare expansion and she says he's worried that if the law is repealed, he might not get his medications anymore.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>She recalls telling him, \"we're not going to treat you any differently than we did before. We need to stabilize your blood pressure no matter what, whether you have health insurance or not. Even if you don't have health insurance, I'm sure we're going to still take care of you.\"\u003c/p>\n\n","blocks":[],"excerpt":null,"status":"publish","parent":0,"modified":1481590446,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":33,"wordCount":1112},"headData":{"title":"Awaiting Trump, Community Clinics Plan for an Uncertain Future | KQED","description":"Chance Rearden used to get health insurance through his job in the entertainment industry. But when his hours fell off, he didn't qualify for coverage anymore. At the time, Rearden wasn't old enough to get Medicare and he couldn't afford to pay out of pocket for treatment. So, he says, he often skipped going to","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Awaiting Trump, Community Clinics Plan for an Uncertain Future","datePublished":"2016-12-13T00:54:06.000Z","dateModified":"2016-12-13T00:54:06.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"271075 http://ww2.kqed.org/stateofhealth/?p=271075","disqusUrl":"https://ww2.kqed.org/stateofhealth/2016/12/12/awaiting-trump-community-clinics-plan-for-an-uncertain-future/","disqusTitle":"Awaiting Trump, Community Clinics Plan for an Uncertain Future","source":"KPCC","sourceUrl":"http://www.scpr.org/","nprByline":"\u003cstrong>Rebecca Plevin\u003c/strong>","path":"/stateofhealth/271075/awaiting-trump-community-clinics-plan-for-an-uncertain-future","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Chance Rearden used to get health insurance through his job in the entertainment industry. But when his hours fell off, he didn't qualify for coverage anymore.\u003c/p>\n\u003cp>At the time, Rearden wasn't old enough to get Medicare and he couldn't afford to pay out of pocket for treatment. So, he says, he often skipped going to the doctor.\u003c/p>\n\u003cp>Then the Affordable Care Act took effect, and under its expansion of Medicaid eligibility, Rearden was able to sign up for California's version of the program, Medi-Cal.\u003c/p>\n\u003cp>\"I've been able to get medical attention that I otherwise wouldn't be able to afford to get,\" he says.\u003c/p>\n\u003cp>Rearden, now 66, gets treated at the Saban Community Clinic near Los Angeles' Fairfax District, where he receives primary care and has seen specialists, including a dermatologist and a podiatrist.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>But with the incoming Trump administration looking to repeal the Affordable Care Act, he's scared his benefits will dry up. One key piece of the Republican plan is turning Medicaid into a block grant program, which could mean less money for California to run Medi-Cal.\u003c/p>\n\u003cp>A lot of people who have benefited from the Medi-Cal expansion are worried about losing their coverage, and the community clinics that serve many of them are concerned that they'll have to cut back on some of their services.\u003c/p>\n\u003cp>\u003cstrong>\"Most vulnerable and poorest patients\"\u003c/strong>\u003c/p>\n\u003cp>Saban Community Clinic nurse practitioner Stacy Nadler says her Medi-Cal patients are asking her all sorts of questions, like, \"Will their specialists still be covered? Do you think they'll still be able to see the chiropractor or the neurosurgeon? Or they're planning a surgery for next year. What do I think is going to happen?\"\u003c/p>\n\u003cp>Nadler doesn't have the answers. Neither does clinic CEO Julie Hudman. But she knows there's a lot at stake for her patients.\u003c/p>\n\u003cp>\"A lot of the folks that we see are single adults,\" Hudman says. \"They're maybe more transitional. They're homeless patients. They have behavioral health challenges. They're really, to be honest, some of the most vulnerable and poorest patients of all.\"\u003c/p>\n\u003cp>Before the Affordable Care Act, eligibility for Medicaid depended on a variety of factors, including income, household size, family status, disability and more. Under Obamacare, people can qualify on income alone if their household makes less than 138 percent of the federal poverty level - $16,395 for an individual and $33,534 for a family of four, according to the California Department of Health Care Services.\u003c/p>\n\u003cp>About half of the clinic's 18,000 patients were uninsured prior to the Affordable Care Act, says Hudman. They paid very little for treatment – maybe a co-pay of $5 or $10. Almost all of those patients qualified for Medi-Cal after the health law expanded eligibility, she says. \u003c/p>\n\u003cp>That's made a big difference for the bottom line, Hudman says, explaining that Medi-Cal pays the clinic around $200 per patient visit.\u003c/p>\n\u003cp>These days, more than half of Saban's revenue comes from health insurance programs. The possibility of losing some of that money is forcing Hudman to make some hard decisions.\u003c/p>\n\u003cp>She says she was looking to lease or buy a fourth facility, but with Trump's election that plan is on hold.\u003c/p>\n\u003cp>\"We had a lot of momentum moving forward and now we've just sort of … stalled,\" she says.\u003c/p>\n\u003cp>Hudman has also decided to freeze her plans to expand free services, like help for the homeless.\u003c/p>\n\u003cp>\"I'm not willing to move forward and take some of those risks that I think are what our community and our patients need,\" she says. \"I need to make sure that we're able to pay our bills and pay our staff.\"\u003c/p>\n\u003cfigure id=\"attachment_271077\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/12/KPCC-Community-Clinic-CEO-800x534.jpg\" alt=\"Saban Community Clinic CEO Julie Hudman says she's placed expansion plans on hold amidst the uncertainty over the future of Obamacare.\" width=\"800\" height=\"534\" class=\"size-medium wp-image-271077\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/12/KPCC-Community-Clinic-CEO-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/12/KPCC-Community-Clinic-CEO-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2016/12/KPCC-Community-Clinic-CEO-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/12/KPCC-Community-Clinic-CEO-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2016/12/KPCC-Community-Clinic-CEO-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2016/12/KPCC-Community-Clinic-CEO-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2016/12/KPCC-Community-Clinic-CEO-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2016/12/KPCC-Community-Clinic-CEO-520x347.jpg 520w, https://ww2.kqed.org/app/uploads/sites/27/2016/12/KPCC-Community-Clinic-CEO.jpg 1024w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Saban Community Clinic CEO Julie Hudman says she's placed expansion plans on hold amidst the uncertainty over the future of Obamacare. \u003ccite>( Maya Sugarman/KPCC)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>A lot of health centers are in a similar situation, according to Louise McCarthy, president and CEO of the Community Clinic Association of Los Angeles County. She says it's frustrating not knowing exactly what Trump and the Republican-led Congress will do.\u003c/p>\n\u003cp>In the end, though, \"the populations [the clinics] serve are there and are going to stay there,\" she says. \"So the question is, how do you broker the resources to do it?\"\u003c/p>\n\u003cp>\u003cstrong>Paul Ryan's \"A Better Way\" proposal\u003c/strong>\u003c/p>\n\u003cp>The most detailed Republican plan for repealing and replacing the Affordable Care Act is House Speaker Paul Ryan's (R-Wisconsin) \u003ca href=\"http://abetterway.speaker.gov/_assets/pdf/ABetterWay-HealthCare-PolicyPaper.pdf\" target=\"_blank\">\"A Better Way\"\u003c/a> proposal.\u003c/p>\n\u003cp>It argues that Medicaid's structure is financially unsustainable over the long term and is unfair to states, whose governors and legislatures \"know better than Washington bureaucrats where there are unmet needs and opportunities to cut down on waste, fraud, and abuse.\"\u003c/p>\n\u003cp>The Affordable Care Act's Medicaid expansion unfairly dedicates a greater share of federal dollars to people who make more than the poorest program participants, according to Ryan's plan. \u003c/p>\n\u003cp>The proposal suggests Medicaid be transformed to either provide states with a fixed block grant or a set allotment for each patient, along with the authority to adjust eligibility and benefits \"in a way that better meets the needs of their state populations, promotes personal responsibility and healthy behaviors, and encourages a more holistic approach to care.\"\u003c/p>\n\u003cp>The blueprint proposes that states could base eligibility on requiring \"able-bodied individuals to seek a job, be employed, or participate in a training or educational program,\" as some states have done under a 2012 Supreme Court ruling that gave them the choice of opting out of the Medicaid expansion. \u003c/p>\n\u003cp>The ultimate goal, according to Ryan's plan, is to help Medicaid recipients get off of the program and onto private health coverage. \u003c/p>\n\u003cp>\"As state reforms reduce dependence on government assistance, the people helped would enter the workforce, have insurance, and be able to lift themselves up the economic ladder,\" it says.\u003c/p>\n\u003cp>Meanwhile, community clinics are seeking to reassure Medi-Cal patients nervous about the future. Saban nurse practitioner Nadler says she recently saw a man who wanted to get his high blood pressure under control. He got Medi-Cal through the Obamacare expansion and she says he's worried that if the law is repealed, he might not get his medications anymore.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>She recalls telling him, \"we're not going to treat you any differently than we did before. We need to stabilize your blood pressure no matter what, whether you have health insurance or not. Even if you don't have health insurance, I'm sure we're going to still take care of you.\"\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/271075/awaiting-trump-community-clinics-plan-for-an-uncertain-future","authors":["byline_stateofhealth_271075"],"categories":["stateofhealth_15"],"tags":["stateofhealth_294","stateofhealth_99","stateofhealth_2846"],"affiliates":["stateofhealth_2353"],"featImg":"stateofhealth_271076","label":"source_stateofhealth_271075"},"stateofhealth_228633":{"type":"posts","id":"stateofhealth_228633","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"228633","score":null,"sort":[1472062466000]},"guestAuthors":[],"slug":"l-a-county-treating-few-people-for-hepatitis-c","title":"L.A. County Treating Few People for Hepatitis C","publishDate":1472062466,"format":"standard","headTitle":"KPCC | State of Health | KQED News","labelTerm":{"term":2353,"site":"stateofhealth"},"content":"\u003cp>\"Adolfo\" was addicted to cocaine and heroin for 15 years.\u003c/p>\n\u003cp>\"Drugs are really horrible things,\" says Adolfo, who asked that his real name not be used. \"At the beginning, you do it to have fun but then it turns into a hell.\"\u003c/p>\n\u003cp>Although Adolfo eventually kicked his habit, he's left with the consequences of his IV drug use. He learned about 10 years ago that he has hepatitis C.\u003c/p>\n\u003cp>Today, Adolfo is one of the few patients that the Los Angeles County Department of Health Services has approved to receive powerful new drugs that effectively cure the virus.\u003c/p>\n\u003cp>Health Services, which provides health care for about half a million low-income people, started dispensing these drugs a little over a year ago. As of the beginning of this month, the department had approved hepatitis C treatment for a total of 160 people; 81 have completed or begun treatment.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Compare that with the San Francisco Health Network, which serves about 65,000 people overall. It began treating patients for hepatitis C a little less than two years ago. As of late June, it had treated 631 people for hepatitis C.\u003c/p>\n\u003cp>Dr. Hal Yee, L.A. County Health Services' chief medical officer and a liver specialist, personally reviews every treatment request. He defends his approach.\u003c/p>\n\u003cp>\"It's our obligation to offer treatment in a manner that's rational and logical,\" Yee says. \"We identify the individuals for initial treatment right now, based on how we can offer the most care to the most people, who are going to benefit from it the most now.\"\u003c/p>\n\u003cp>Yee has developed a checklist of criteria to determine if patients are eligible for treatment. His guidelines say patients should be drug-free for at least six months before getting hepatitis C medications.\u003c/p>\n\u003cp>\"We believe it is likely that patients who are not using drugs are more likely to complete the treatment than people who are actively using illicit drugs,\" Yee explains.\u003c/p>\n\u003cp>His approach differs from Medi-Cal's; the state Medicaid program expanded its guidelines last year to say active IV drug users should be treated for hepatitis C.\u003c/p>\n\u003cfigure id=\"attachment_228639\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-228639\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/08/RS11986_137165920-800x537.jpg\" alt=\"pills\" width=\"800\" height=\"537\">\u003cfigcaption class=\"wp-caption-text\">Pills \u003ccite>(Philippe Hugue/AFP/Getty Images)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\"There' a lot of evidence to support treating people who inject drugs, because there's a very likely possibility that they will transmit the virus to someone else if they're sharing equipment for injecting drugs,\" says Emalie Huriaux, director of federal and state affairs for Project Inform, which advocates on behalf of people with hepatitis C.\u003c/p>\n\u003cp>\"One estimate I've seen is that one person with [hepatitis C] who's injecting drugs will transmit the virus to 20 other people,\" she adds.\u003c/p>\n\u003cp>Dr. Yee says he is willing to consider changing his six-month drug-free rule. But he also says that so far, he's had very few IV drug users requesting treatment.\u003c/p>\n\u003cp>Beyond this issue, Yee's general approach to treatment requests is more conservative than most. He doesn't believe everyone with the disease should be treated.\u003c/p>\n\u003cp>The Centers for Disease Control and Prevention says only a relatively small percentage of people with chronic hepatitis C will develop serious complications, such as liver cancer.\u003c/p>\n\u003cp>\"If 70 percent of individuals would live out their lives without any consequences of their hepatitis C infection, none of those people will benefit from treatment,\" Yee says.\u003c/p>\n\u003cp>Here, too, Yee is somewhat of an outlier: The American Association for the Study of Liver Diseases recommends treating all patients with chronic hepatitis C. It says beyond liver problems, these patients are also at higher risk of developing heart and kidney disease.\u003c/p>\n\u003cp>But Yee says that time will validate his approach.\u003c/p>\n\u003cp>\"I know that if you come talk to me in one year, in five years, in ten years, you're going to see these numbers climb, because we've put in infrastructure that I know allows us to provide the kind of care that other counties can't even begin to think about,\" he says.\u003c/p>\n\u003cp>As part of that infrastructure, patients like Adolfo receive an array of services from a team of providers.\u003c/p>\n\u003cp>At a recent class at County-USC Medical Center, Adolfo learns about his virus and the medication he'll be taking. The Department of Health Services requires patients to attend this class before beginning treatment.\u003c/p>\n\u003cp>\"This was a really, really good class that I never expected,\" Adolfo says. \"I was sleeping and the hepatitis is alive.\"\u003c/p>\n\u003cp>Afterward, a clinical pharmacist and a nurse practitioner escort him to the lab, where he undergoes blood and urine tests, and then walk him to the pharmacy, where he will pick up his medication every two weeks.\u003c/p>\n\u003cp>Adolfo is eager to begin his treatment: \"I think this is more important than anything.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>[contextly_auto_sidebar]\u003c/p>\n\n","blocks":[],"excerpt":"L.A. County says patients should be drug-free for at least six months before getting hepatitis C medication. Medi-Cal recommends treatment for IV drug users.","status":"publish","parent":0,"modified":1472067317,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":28,"wordCount":791},"headData":{"title":"L.A. County Treating Few People for Hepatitis C | KQED","description":"L.A. County says patients should be drug-free for at least six months before getting hepatitis C medication. Medi-Cal recommends treatment for IV drug users.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"L.A. County Treating Few People for Hepatitis C","datePublished":"2016-08-24T18:14:26.000Z","dateModified":"2016-08-24T19:35:17.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"228633 http://ww2.kqed.org/stateofhealth/?p=228633","disqusUrl":"https://ww2.kqed.org/stateofhealth/2016/08/24/l-a-county-treating-few-people-for-hepatitis-c/","disqusTitle":"L.A. County Treating Few People for Hepatitis C","nprByline":"\u003cstrong> Rebecca Plevin \u003c/br> KPCC \u003c/strong>","path":"/stateofhealth/228633/l-a-county-treating-few-people-for-hepatitis-c","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>\"Adolfo\" was addicted to cocaine and heroin for 15 years.\u003c/p>\n\u003cp>\"Drugs are really horrible things,\" says Adolfo, who asked that his real name not be used. \"At the beginning, you do it to have fun but then it turns into a hell.\"\u003c/p>\n\u003cp>Although Adolfo eventually kicked his habit, he's left with the consequences of his IV drug use. He learned about 10 years ago that he has hepatitis C.\u003c/p>\n\u003cp>Today, Adolfo is one of the few patients that the Los Angeles County Department of Health Services has approved to receive powerful new drugs that effectively cure the virus.\u003c/p>\n\u003cp>Health Services, which provides health care for about half a million low-income people, started dispensing these drugs a little over a year ago. As of the beginning of this month, the department had approved hepatitis C treatment for a total of 160 people; 81 have completed or begun treatment.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Compare that with the San Francisco Health Network, which serves about 65,000 people overall. It began treating patients for hepatitis C a little less than two years ago. As of late June, it had treated 631 people for hepatitis C.\u003c/p>\n\u003cp>Dr. Hal Yee, L.A. County Health Services' chief medical officer and a liver specialist, personally reviews every treatment request. He defends his approach.\u003c/p>\n\u003cp>\"It's our obligation to offer treatment in a manner that's rational and logical,\" Yee says. \"We identify the individuals for initial treatment right now, based on how we can offer the most care to the most people, who are going to benefit from it the most now.\"\u003c/p>\n\u003cp>Yee has developed a checklist of criteria to determine if patients are eligible for treatment. His guidelines say patients should be drug-free for at least six months before getting hepatitis C medications.\u003c/p>\n\u003cp>\"We believe it is likely that patients who are not using drugs are more likely to complete the treatment than people who are actively using illicit drugs,\" Yee explains.\u003c/p>\n\u003cp>His approach differs from Medi-Cal's; the state Medicaid program expanded its guidelines last year to say active IV drug users should be treated for hepatitis C.\u003c/p>\n\u003cfigure id=\"attachment_228639\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-228639\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/08/RS11986_137165920-800x537.jpg\" alt=\"pills\" width=\"800\" height=\"537\">\u003cfigcaption class=\"wp-caption-text\">Pills \u003ccite>(Philippe Hugue/AFP/Getty Images)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\"There' a lot of evidence to support treating people who inject drugs, because there's a very likely possibility that they will transmit the virus to someone else if they're sharing equipment for injecting drugs,\" says Emalie Huriaux, director of federal and state affairs for Project Inform, which advocates on behalf of people with hepatitis C.\u003c/p>\n\u003cp>\"One estimate I've seen is that one person with [hepatitis C] who's injecting drugs will transmit the virus to 20 other people,\" she adds.\u003c/p>\n\u003cp>Dr. Yee says he is willing to consider changing his six-month drug-free rule. But he also says that so far, he's had very few IV drug users requesting treatment.\u003c/p>\n\u003cp>Beyond this issue, Yee's general approach to treatment requests is more conservative than most. He doesn't believe everyone with the disease should be treated.\u003c/p>\n\u003cp>The Centers for Disease Control and Prevention says only a relatively small percentage of people with chronic hepatitis C will develop serious complications, such as liver cancer.\u003c/p>\n\u003cp>\"If 70 percent of individuals would live out their lives without any consequences of their hepatitis C infection, none of those people will benefit from treatment,\" Yee says.\u003c/p>\n\u003cp>Here, too, Yee is somewhat of an outlier: The American Association for the Study of Liver Diseases recommends treating all patients with chronic hepatitis C. It says beyond liver problems, these patients are also at higher risk of developing heart and kidney disease.\u003c/p>\n\u003cp>But Yee says that time will validate his approach.\u003c/p>\n\u003cp>\"I know that if you come talk to me in one year, in five years, in ten years, you're going to see these numbers climb, because we've put in infrastructure that I know allows us to provide the kind of care that other counties can't even begin to think about,\" he says.\u003c/p>\n\u003cp>As part of that infrastructure, patients like Adolfo receive an array of services from a team of providers.\u003c/p>\n\u003cp>At a recent class at County-USC Medical Center, Adolfo learns about his virus and the medication he'll be taking. The Department of Health Services requires patients to attend this class before beginning treatment.\u003c/p>\n\u003cp>\"This was a really, really good class that I never expected,\" Adolfo says. \"I was sleeping and the hepatitis is alive.\"\u003c/p>\n\u003cp>Afterward, a clinical pharmacist and a nurse practitioner escort him to the lab, where he undergoes blood and urine tests, and then walk him to the pharmacy, where he will pick up his medication every two weeks.\u003c/p>\n\u003cp>Adolfo is eager to begin his treatment: \"I think this is more important than anything.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>[contextly_auto_sidebar]\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/228633/l-a-county-treating-few-people-for-hepatitis-c","authors":["byline_stateofhealth_228633"],"categories":["stateofhealth_11","stateofhealth_2746","stateofhealth_13"],"tags":["stateofhealth_2867","stateofhealth_2865"],"affiliates":["stateofhealth_2353"],"featImg":"stateofhealth_228636","label":"stateofhealth_2353"},"stateofhealth_25758":{"type":"posts","id":"stateofhealth_25758","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"25758","score":null,"sort":[1431380068000]},"guestAuthors":[],"slug":"terminally-ill-orange-county-mother-opposes-assisted-suicide","title":"Terminally Ill Orange County Mother Opposes Assisted Suicide","publishDate":1431380068,"format":"standard","headTitle":"KPCC | State of Health | KQED News","labelTerm":{"term":2353,"site":"stateofhealth"},"content":"\u003cp>It’s lunchtime on a recent spring break afternoon and Stephanie Packer is in her kitchen, preparing lunch with her four children.\u003c/p>\n\u003cp>\"Do you want to help?\" she asks the eager crowd of siblings gathered tightly around her at the stovetop.\u003c/p>\n\u003cp>\"Yeah!\" yells 5-year-0ld Savannah.\u003c/p>\n\u003cp>\"I do!\" says Jacob, 8.\u003c/p>\n\u003cp>Calmly managing four kids as each vies for the chance to help make chicken salad sandwiches can be trying. But for Packer, these are the moments she cherishes.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>[contextly_sidebar id=\"o1k4flhCjxggFr6chb68MbeoTFxKuRK9\"]In 2012, after suffering a series of debilitating lung infections, she went to a doctor who diagnosed her with scleroderma. The autoimmune disease causes hardening of the skin and (in about one third of cases) other organs. The doctor told Packer that it had settled in her lungs.\u003c/p>\n\u003cp>\"And I said, 'OK, what does this mean for me?' \" she recalls. \"And he said, 'Well, with this condition...you have about three years left to live.' \"\u003c/p>\n\u003cp>Initially, Packer recalls, the news was just too overwhelming to talk about with anyone -- including her husband.\u003c/p>\n\u003cp>\"So we just … carried on,\" she says. \"And it took us about a month before my husband and I started discussing (the diagnosis). I think we both needed to process it separately and figure out what that really meant.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003ca title=\"http://www.scpr.org/blogs/health/2015/04/14/18020/terminally-ill-orange-county-mom-says-assisted-sui/\" href=\"http://www.scpr.org/blogs/health/2015/04/14/18020/terminally-ill-orange-county-mom-says-assisted-sui/\" target=\"_blank\">Read the full story via KPCC. \u003c/a>\u003c/p>\n\n","blocks":[],"excerpt":"Instead of fatal medication, Stephanie Packer hopes terminally ill people consider palliative medicine and hospice care. ","status":"publish","parent":0,"modified":1431465976,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":12,"wordCount":225},"headData":{"title":"Terminally Ill Orange County Mother Opposes Assisted Suicide | KQED","description":"Instead of fatal medication, Stephanie Packer hopes terminally ill people consider palliative medicine and hospice care. ","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Terminally Ill Orange County Mother Opposes Assisted Suicide","datePublished":"2015-05-11T21:34:28.000Z","dateModified":"2015-05-12T21:26:16.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"25758 http://ww2.kqed.org/stateofhealth/?p=25758","disqusUrl":"https://ww2.kqed.org/stateofhealth/2015/05/11/terminally-ill-orange-county-mother-opposes-assisted-suicide/","disqusTitle":"Terminally Ill Orange County Mother Opposes Assisted Suicide","nprByline":"Stephanie O'Neill, KPCC","path":"/stateofhealth/25758/terminally-ill-orange-county-mother-opposes-assisted-suicide","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>It’s lunchtime on a recent spring break afternoon and Stephanie Packer is in her kitchen, preparing lunch with her four children.\u003c/p>\n\u003cp>\"Do you want to help?\" she asks the eager crowd of siblings gathered tightly around her at the stovetop.\u003c/p>\n\u003cp>\"Yeah!\" yells 5-year-0ld Savannah.\u003c/p>\n\u003cp>\"I do!\" says Jacob, 8.\u003c/p>\n\u003cp>Calmly managing four kids as each vies for the chance to help make chicken salad sandwiches can be trying. But for Packer, these are the moments she cherishes.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>In 2012, after suffering a series of debilitating lung infections, she went to a doctor who diagnosed her with scleroderma. The autoimmune disease causes hardening of the skin and (in about one third of cases) other organs. The doctor told Packer that it had settled in her lungs.\u003c/p>\n\u003cp>\"And I said, 'OK, what does this mean for me?' \" she recalls. \"And he said, 'Well, with this condition...you have about three years left to live.' \"\u003c/p>\n\u003cp>Initially, Packer recalls, the news was just too overwhelming to talk about with anyone -- including her husband.\u003c/p>\n\u003cp>\"So we just … carried on,\" she says. \"And it took us about a month before my husband and I started discussing (the diagnosis). I think we both needed to process it separately and figure out what that really meant.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003ca title=\"http://www.scpr.org/blogs/health/2015/04/14/18020/terminally-ill-orange-county-mom-says-assisted-sui/\" href=\"http://www.scpr.org/blogs/health/2015/04/14/18020/terminally-ill-orange-county-mom-says-assisted-sui/\" target=\"_blank\">Read the full story via KPCC. \u003c/a>\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/25758/terminally-ill-orange-county-mother-opposes-assisted-suicide","authors":["byline_stateofhealth_25758"],"categories":["stateofhealth_14"],"tags":["stateofhealth_914","stateofhealth_40","stateofhealth_754"],"affiliates":["stateofhealth_2353"],"featImg":"stateofhealth_26539","label":"stateofhealth_2353"}},"programsReducer":{"possible":{"id":"possible","title":"Possible","info":"Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. 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