Will President Obama Defend Healthcare Reform?

 

St. John's Well Child and Family Center

Will President Obama Defend Healthcare Reform?
By Jim Mangia and Dave Regan
Estela Chavez is like many mothers in California. Her two kids want new bikes and the latest Xbox
video game. But what they need is healthcare.
She works more than 60 hours a week at two different jobs, but even so there is barely enough
money for bare necessities. For healthcare for her two children she depends on a statewide
program that covers preventive care for children.
“My son has autism and without healthcare assistance he has no access to a doctor,” Estela said
recently. “I could never afford the medication and behavioral health care he needs to function
without this program.”
While President Obama and Congress are jockeying over the federal budget in Washington, D.C.
people like Estela and her family hang in the balance.
President Obama is talking about closing corporate loopholes, taxing private jets and requiring
the upper echelon of society to pay its fair share, but he is also proposing significant cuts to
programs like Medicaid that if enacted would eliminate basic healthcare for kids. Estela’s
children depend on Medi-Cal, the California Medicaid program for children.
Funding for our nation’s healthcare safety net is most in danger in the recent round of hyperbolic
debate. Republicans are wielding a sledgehammer – demanding to gut the program and move on.
President Obama can stand up for healthcare funding for millions of children and people with
disabilities while protecting the success of his own historic healthcare law passed last year by
looking at states like California that have responsible and efficient programs that have reduced
costs while adding coverage to those in need.
The Affordable Care Act has already extended coverage to dependents up to age 26 and
prevented health insurance companies from denying care to children with pre-existing
conditions. In 2014 the law will dramatically expand coverage for most Americans. For lowincome
people who have no health insurance now, the law calls for more than 16 million to
become eligible for Medicaid.
The program serves 50 million people, the vast majority children and the rest people with
disabilities. Cut the program at the knees now and future benefits will never come to pass and the
effects now will also be catastrophic.
We already see more people delaying care until only a costly dramatic or emergency room
intervention can save them. We see more and more Californians out of work or without good
jobs with benefits. Cut more out of the safety net and we will see nonprofit community clinics,
long the only bastion for low cost preventive care, closing their doors in record numbers.
Hospitals, community health centers and doctors serving low-income Americans would be
disproportionately affected.
Additionally, California will suffer. If Medicaid is slashed, our state stands to lose as many as
28,440 more jobs, and up to $3.7 billion in related revenue according to a new report by the
nonprofit health-advocacy group Families USA.
California just enacted enormous and extraordinarily painful spending cuts to almost every
program, university, hospital, clinic and courthouse in our state and we cannot weather another
round of slashing.
It’s no mystery how important the safety net is for children and families like Estela’s.
We’ve become accustomed to the slow unraveling of the healthcare safety net, rising
unemployment and revenue losses. President Obama can stop these phenomena. California has
done a lot to control the cost of Medicaid and that should be recognized before implementing a
blunt instrument.
Do not betray Estela Chavez and millions more like her. President Obama can take leadership to
protect seniors, people with disabilities and children now.
____________________________________________
Jim Mangia is president & CEO of St. John’s Well Child and Family Centers, a network of
federally qualified health centers in South Los Angeles which serve more than 140,000 patient
visits each year.
Dave Regan is president United Healthcare Workers West, which represents 150,000 hospital,
nursing home and in-home care workers in California.

Lead Poisoning: Perhaps the Main Source Behind Chicago’s Youth Violence – Lessons for Los Angeles

Lessons For Los Angeles
By Jacqueline Jacobs Caster and Jim Mangia

 Last week, the 5^th and final youth was convicted of first degree murder of Derrion Albert, a 16 year old beaten by a student mob near a Chicago high school in 2009.

 During the last several years, there has been an epidemic of deadly violence amongChicago’s schoolchildren.  The crisis recently prompted National Public Radio to dedicate a 7 part series to the topic. Its report included the astonishing fact that nearly 700 children in the city were hit by gunfire last year – an average of almost two a day, with 66 fatalities – and that the number is up over the prior year despite an overall decline ofChicagohomicides to a 45 year low.

 A recent analysis of over 500 children touched by this violence indicated that those most at risk tend to be youth lacking a stable home environment, enrolled in special-ed, skipping school an average of 42 days annually and having behavioral flare-ups at 8 times the rate of a typical student.  The proposed solution was to provide paid after-school jobs and adult attention to those at-risk in order to deprive them of the opportunity to stray. The NPR report also spotlighted other useful strategies such as pairing youth with mentors and initiating programs that create a “culture of calm”.

 While we are not disputing the value of these approaches, there may be another underlying problem – huge unnoticed red flags being vigorously waved:  far higher than average rates at which 1) these children are enrolled in special education and 2) exhibit behavioral flare-ups – both possible indicators of lead poisoning.

 The primary culprit of lead poisoning is substandard housing conditions. Though federal, state and local governments were aware that exposure to lead was directly damaging to children as early as the 1930s, legal bans on lead paint were not passed until 1978.  Most ofChicago’s inner-city children live in pre-World War II housing with limited money available for housing maintenance – a situation that also exists in low-income neighborhoods ofLos Angeles. 

 Multiple studies in leading medical journals reveal that blood lead levels in children as low as 3 micrograms per deciliter can cause serious developmental disabilities and dramatically lowered IQs – perhaps causing the higher than normal rates of special-ed enrollment in this Chicago neighborhood.  Additionally, numerous studies, some dating as far back as 1979, show a strong link between anti-social and impulsive violent behavior in those with childhood lead poisoning. 

 In 1998, Dr. Herbert Needleman compared a group ofPennsylvaniachildren in the juvenile justice system against those with no criminal behavior.  He found that the convicted children had bone lead levels 10 to 11 times higher than their non-offending counterparts.  In the first longitudinal study of the issue, Professor Deborah Denno weighed more than 3,000 factors to see what correlated with incarceration and criminality.   She discovered that an elevated lead level in blood was the single highest predictor of school behavioral problems and the third highest predictor of juvenile crime.

 Currently, the Centers for Disease Control classifies 10 micromoles of lead per deciliter of blood as a dangerous blood lead level – more than three times the level that causes decreased brain function in children.  As a result, most government health agencies will not intervene until a child is severely poisoned, often with levels as high as 30 and has severe irreversible brain damage.  The CDC needs to change its standards.

 InCalifornia, even with the recent passage of SB 460 that empowers government agencies involved to enforce lead safe practices in housing and construction, state and local government has been slow to protect our children.  In response, St. John’s Well Child and Family Center (and a coalition of nonprofit organizations including Strategic Actions for a Just Economy and Esperanza Community Housing Corporation), supported by a $1 million grant from The Everychild Foundation, has created the innovative pilot demonstration project, Healthy Homes Healthy Kids, to dramatically reduce lead exposure in 4,000 children here in South Los Angeles.  The program provides staff to help safely mitigate lead hazards in dwelling spaces of children and, if needed, facilitate legal advocacy.

 The public must demand that government take its lead from such foundation-supported, community-based strategies, and that the CDC revise its acceptable standard for blood lead levels.  Otherwise, our urban communities are likely to see the continued tragedy resulting from youth violence as well as the concomitant problems a concentrated population of brain-damaged individuals will bring to their communities as they age.

________________________________________________________________________

 Jacqueline Jacobs Caster is the Founder and President of The Everychild Foundation, a grant-making organization comprised of over 200 local women which has filled critical unmet needs of over 400,000 Los Angeles area children since its founding in 1999.

 Jim Mangia is President & CEO of St. John’s Well Child and Family Centers, a network of federally qualified health centers in south Los Angeles providing medical, dental and mental health services to more than 120,000 patient visits each year.  He is also the founder of the South Los Angeles Health & Human Rights Conference.

 

 

A Tale Of Two Cities

By Jim Mangia and Bob Schoonover

 Miguel Chaves works at a health care clinic in Compton.

 While tens of thousands of working Americans are in the streets in Madison, Wisconsin battling to keep basic rights as Gov. Scott Walker attempts to usurp collective bargaining and rollback benefits and wages for fire fighters, police officers, teachers, health care workers and others, Chaves has been working with his boss to make his job and the care he provides better.

 Here in Los Angeles, employees like Chaves through their union and in partnership with one of the largest nonprofit community health centers are a critical ingredient for positive change.

 Is this America’s post-modern “tale of two cities?”

 The new partnership between St. John’s Well Child and Family Center and SEIU Local 721, the union that represents clinic workers and thousands of other Southern California workers, will dramatically improve the quality of patient care, enhance worker morale and ensure the stability and growth of the organization.  Our two groups are hammering out the antidote to unchecked corporate influence that is lessening the quality of life for working Americans and their families. We are creating the partnership and the focus that America needs to improve the experience of workers and the quality of goods and services we produce and provide. It’s our future. 

 St. John’s Well Child and Family Center is a network of a dozen federally qualified health centers located in the poorest neighborhoods of South Los Angeles. We provide medical, dental and mental health serves to more than 125,000 patient visits each year.  SEIU, one of the largest unions in the country, is committed to uniting community health care workers, to improving the lives of working people and increasing access to quality patient care.

To St. John’s, an organization steeped in providing the highest quality medical care to L.A. poorest children and families, it seemed right to create a formal partnership with clinic employees. To SEIU and its membership, it seemed necessary to use our collective strength to promote quality health care and a stronger voice for workers.

 At first there were concerns on both sides. Would we be able to create a positive relationship rather than an adversarial one like we are seeing in Wisconsin? Would a union contract create animosity in the workplace? Would management really listen to its employees?

Clinic leadership and the Board of Directors of St. John’s decided to work with the union and proceed “shoulder-to-shoulder” in an innovative unionization process.  SEIU worked in the open and in the end an overwhelming majority of employees joined the union. Frontline healthcare workers, who are those most engaged in providing the direct patient care to tens of thousands of families in need, saw the benefit to our patients of an empowered and enhanced workforce.

For example, Miguel Chaves, who is a case worker at the clinic, now has a clear path to work with management to ensure that the clinic is prepared for the changes new health care reform laws will bring. Chaves, for one, is eager to take advantage of his new contract’s provisions for education and training.   “Training and new skills will help us make sure we’re ready for health care reform before it happens, instead of trying to adapt later on,” he said.

Patient “right-to-health” committees serve to build a unique alliance where the patients can inform healthcare workers of what their needs and desires are as well.  In this model there is one city, not two, united to improve health outcomes.

While Gov. Walker is leading the charge to expand corporate tax breaks and giveaways almost equal to the concessions he is seeking to extract from public employees and Americans for Prosperity, a front group for the billionaire Koch brothers, is working behind the scenes to fund and to foment the destruction of worker rights in Wisconsin; in LA our unique partnership at a South Los Angeles clinic is a model for fairness and social harmony across America. 

While some around the country seek to divide Americans once again by class and work, St. John’s stands proud as a union shop.  With joint employee/management quality of care committees a key part of the union contract we know healthcare services will improve for our county’s most vulnerable residents. 

______________________________

Jim Mangia is President & CEO of St. John’s Well Child and Family Center.

Bob Schoonover is the president of SEIU Local 721, which represents 80,000 workers in Southern California.

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Proper diagnosis and treatment makes all the difference

A man in his late-twenties arrived at one of St. John’s Well Child and Family Center’s clinics complaining of major weight loss, intense thirst and fatigue. The staff was shocked to find that his blood glucose level was 622, far above the threshold considered diabetic (which is anything over 125); his hemoglobin A1C level was 17 (the normal level is 6), which is a general measure of glycemic control over a three-month period. This was the highest such level that the clinician had ever seen. The patient was immediately placed on medications, and came frequently to the clinic for hydration and insulin treatment. He also received intensive nutrition and lifestyle education, and as a result radically changed his entire diet. After three months of this clinical and nutrition regimen, his hemoglobin A1C level was reduced to 6.5, an enormous improvement in glycemic control. St. John’s interventions and the patient’s own determination kept him out of the hospital. His blood sugars are now stable. He is on oral diabetes medication and now needs to come to the clinic just once every three months for a check-up.

Right to Health – Community Clinics On The Front Lines

Health Reform, Community Organizing and Social Change

By Jim Mangia, President & CEO, St. John’s Well Child and Family Centers

The health reform debate is the health and human rights question of the 21st century for our nation. Do Americans have a fundamental right to health? Is it the American people, or the health insurance industry, that will set the agenda and the plan for health reform and universal coverage?

As the struggle for health reform intensifies, its seems inherently clear that nonprofit community health centers have a critical role to play in organizing their patients and community members to have a seat at the table and play a role in the debate for health reform on the local and national level. Community health centers grew directly out of the war on poverty in the 1960s. As centers for community health, clinics have, for more than four decades, been at the center of the effort for social change.

As a member of President Obama’s Health Policy Committee during his presidential campaign, I participated in several conversations about various aspects of the agenda for health reform. As the CEO of a network of federally qualified health centers serving more than 100,000 patient visits each year in downtown and south Los Angeles, I have come to learn, on the front lines, that community health centers have a critical role to play in moving a progressive health reform agenda forward. In south Los Angeles, we have begun to organize and galvanize our patients and staff as community advocates for health as a basic human right. In June, St. John’s Well Child and Family Center, and a collaborative of community-based organizations convened the First Annual South Los Angeles Health & Human Rights conference. More than 700 people packed the conference center at the Natural History Museum in Exposition Park and began to craft a South Los Angeles Declaration for Health & Human Rights. More than 150 patients from St. John’s attended that convening.

On August 18, 2009 more than 200 patients of St. John’s joined other south Los Angeles community members and packed the chambers of the Board of Supervisors to support a proposal by Supervisor Mark Ridley-Thomas to allocate $350 million to reopen Martin Luther King Jr. Hospital in south Los Angeles. The hospital had been closed almost two years ago, shutting down the community’s only trauma center and emergency room and diverting patients in need of emergency care to hospitals five, ten and fifteen miles away. Anyone who knows the traffic in Los Angeles, knows that driving an extra five miles can determine whether a patient lives or dies. Many have died as a result of the closing of MLK Hospital. The reopening of the hospital is a critical human rights effort.

St. John’s patients took time out of their days, took off work and made the trek to downtown Los Angeles to have their voices heard: “…we want our hospital reopened as a high-quality, community-centered institution!” Patients testified and expressed their support for Supervisor Mark Ridley-Thomas’ motion to allocate the money necessary to reopen the hospital by 2012. The motion was passed unanimously by the Board of Supervisors.

St. John’s patients had an experience of victory in their fight for the right to health. And we have only just begun.

Earlier this month, several patients of St. John’s sued Governor Arnold Schwarzenegger in the Court of Appeals for his unconstitutional line-item cuts which eliminated health care benefits and services to millions of Californian’s children and families. A judge ruled earlier this week, that the Governor is mandated to respond to the lawsuit.

On Saturday, August 22, close to three dozen patients attended a convening to develop the South Los Angeles Declaration of Health and Human Rights; part of follow-up activities to the Health & Human Rights Conference. This work will continue over the next three months and will culminate in an event to present the South Los Angeles Health & Human Rights Declaration on December 10 – International Human Rights Day.

A key component of President Obama’s health reform initiative is a four-fold expansion of community health center sites across America. It is time for community clinics to regain the community organizing prominence which gave rise to the health care and anti-poverty movements of the last century. At St. John’s, we aim to continue our work on the front lines in the war on poverty. And we will continue to work as community organizers to partner with, empower and embolden health center patients as advocates and leaders for social change.

Join us in this historic effort for health and human rights by signing up on our website:

http://www.wellchild.org or www.southlahealthandhumanrights.org.