On Precipice of Senate Vote, East Bay Health Clinic Fears for Thousands of Patients

U.S. senators voted 51-50 on Tuesday to begin debate on a controversial health care bill that could unwind the 7-year-old Affordable Care Act, and possibly revamp the way Medicaid has been funded for the past 52 years.

The GOP leaders have not determined exactly what version of the bill will be brought up for a vote after 20 hours of scheduled debate.

But two of the bills being considered would cut federal funding for Medicaid, the insurance program for low-income adults and children, pregnant women and people with disabilities. Since 1965, Medicaid has been administered by the states, but paid for through a combination of state and federal funds. 

In California, the program is called Medi-Cal, and it covers one in three Californians.

Doctors, nurses and staff members at Tiburcio Vasquez Health Center (TVHC) in Hayward have been speaking with KQED over the past month about how the proposed cuts of billions of dollars for Medi-Cal would affect the clinic's work as the safety-net provider of last resort for vulnerable patients.

“Both [bills] would be just terrible for our patients," said Chief Medical Officer Dr. Porshia Mack, after Tuesday's "motion to proceed" vote. "If it’s 'repeal and delay,' there’s no guarantee that they’d come up with a bill to cover those people that would lose insurance.”

'Less people will have coverage. Bottom line.' 

Recently, KQED health reporter Laura Klivans sat down with TVHC’s CEO to learn more about the day-to-day work of a large urban community health center and how potential cuts to Medi-Cal could affect that.

This interview was edited for brevity and clarity.

Name: David B. Vliet

Title: Chief executive officer at Tiburcio Vasquez Health Center, a federally supported clinic with locations in Hayward, Union City and Fremont. 

Q: Tell me a bit about the scope of the programs here.

A: We are pretty much a typical, run-of-the-mill community health center. We are federally qualified, which essentially compels us to take care of any member of the community that needs health care without regard to their ability to pay. We have pediatrics, internal medicine, family practice, women's health and dental. We also have a very large WIC — Women, Infants, and Children — program.

Q: Can you tell me a little bit about your own background and how you ended up as the CEO of Tiburcio Vasquez Health Center?

A: This is a movement that goes back to the civil rights movement. So we have a large number of people who have been in this work for a long time. I'm relatively new to the community health center world. I have about 16 years.

I got here because having lived in Mexico as a younger man, I saw a very desperate need for health care. I wanted to actually have my own mobile clinic that would go into the rural areas of Florida to deliver health care, like a bus that was outfitted. And very long story short, I decided that if I was going to raise money to do that I’d have to get an undergraduate degree in that area. I sort of slipstreamed into health administration in Florida. Then I moved to Texas, where I was introduced in 2002 to the community health center model, and fell in love with it.

In Austin, Texas, I ran the community health centers for about 10 years. I learned that this is really important, rewarding work because we get to impact the health outcomes of the community and see people be well. A lot of people will walk around with their diabetes out of control or slight depression or a toothache. And the fact that we're able to address that in a systematic way, to me is very exciting.

Q: Coming from Texas to a state like California, what are some of the things you've noticed about how health care is different at a community clinic level?

A: Similar to Travis County [where Austin, Texas, is located], Alameda County is also very progressive. And the community’s very committed to serving people even without documentation, because there is a return on investment when you do that. The overall cost of care longitudinally is reduced when you take care of people when they need to be taken care of. So I think there are a lot of similarities, but the political atmosphere certainly is much different in Texas.

Q: What do you find to be unique about Tiburcio Vasquez?

A: We began our health care journey back in the early '70s taking care of families that were busy making America great in agriculture, in the fields. As their families grew and they got ill, we were there in a very simple form.

[Community Health Centers] take care of around 24 million patients across the United States. We're a significant safety-net model and we've enjoyed bipartisan support for many years.

Q: How have the additional dollars from the Medi-Cal expansion helped Tiburcio Vasquez?

A: We opened up a new health center in San Leandro. We're able to add exam rooms, and add dental chairs, and hire staff, and then see more patients. But there were dollars that did other things, [for example], the conversion to the electronic health record so that we're no longer on paper charts.

If those [Medi-Cal dollars] go away, we will continue to have to take care of communities whether the funding is there or not. Those dollars really do have a return on investment, in that when we are able to make sure that Mr. Smith or Mrs. Rodriguez doesn't show up in the ER with tooth pain, everyone in the community enjoys lower costs because of that.

Q: If the ACA gets dismantled, what's the impact going to be for Tiburcio Vasquez?

A: Less people will have coverage. Bottom line.

Health centers are here, and have been for 50-odd years. We have funding from the federal government and have enjoyed bipartisan support. But that has not always been enough.

The Medicaid expansion assures -- particularly for adults who were not covered previously, working adults -- they're able to come in here and get preventive care. If there is a reduction in Medicaid, some of those folks in our county could be pushed off Medicaid and will probably go back on some sort of county plan.

At our health center, roughly 5,000 folks that did not have coverage before currently have Medicaid. That number will go away under the contraction of Medicaid under the proposed new bill.