Silicon Valley Wrestles With Reform Implications

SANTA CLARA — This county of more than a million people is one of relative affluence and high education levels — which, according to the county public health department, allows residents, as a whole, to enjoy better health than most of California and the U.S. But that’s only part of the picture. The Silicon Valley also has one of the most diverse populations in the state, with a rising number of uninsured. A recent UCLA study put the number at about 314,000 —  or almost one of every three residents.

“Our board of supervisors has emphasized this issue for some time. Since we have such a diverse population to reach out to, it only intensifies our need to look at how reform impacts our county,” said Santa Clara Supervisor Liz Kniss, who moderated a special forum last month on the subject at Santa Clara University. The session was sponsored by the Health Trust, the California Public Health Association-North  and the EQUAL Health Network. The panelists covered such issues as how the health reform law affects public health, children, seniors and the health care work force.

“We need to move forward with reform because people are suffering. There are 47,000 deaths a year in this country due to a lack of insurance,” said Ellen Shaffer, co-director of the EQUAL Health Network, which sponsors online advocacy for health care reform. “The more people we cover the better we can control costs,” she said.

‘We Need To Get Ready’

Sarah Muller of the San Jose public policy group Working Partnerships USA pointed out that 71% of uninsured people in Santa Clara County are employed and work 20 hours a week or more. “The number of uninsured is increasing for several reasons,” she said. “Between 2000 and 2009, premiums rose 130%. As a result, fewer employers are offering affordable employer-based health insurance and individual health insurance is often too expensive for low- and middle-income families.”

She said her group wants to make sure that when mandatory health coverage kicks in through national health reform, the necessary resources — including doctors — are available. “We need to get ready to make sure people know what they qualify for so they can get into the right program and not be penalized,” Muller said.    

According to Muller, it’s going to take extensive outreach and community education. Muller added that even under reform there’s still a concern about finding affordable health insurance products, some of which will still be too expensive for many people. Working Partnerships is joining forces with health care experts throughout the county to find ways to expand health coverage to low-income adults employed by small businesses.

Efforts are also under way in Santa Clara County to expand the “safety net” for those residents who don’t have coverage or the ability to pay. Traditionally, Valley Medical Center, the largest and busiest hospital in the region, has handled those patients. To ease its overcrowded emergency room, the county is setting up additional urgent care clinics to more rapidly screen patients and handle those who don’t need a hospital bed.

“There’s going to be a group of newly insured people who haven’t been to a doctor in a long time,” said Chris Wilder, executive director of VMC Foundation. “These people will have a laundry list of problems, so the county is working to add more primary care physicians to meet the greater demand.”

Access as Important as Coverage

Conference panelists pointed out that health care reform is as much about access as it is about coverage. “Having a relationship with a doctor you can call anytime, even for something that may turn out to be small keeps us healthier and holds costs down in the long run,” said Supervisor Kniss, who also sits on the Health Steering Committee for the National Association of Counties.

Access to health coverage for children is something Santa Clara is aggressively trying to maintain. In 2001, the county launched the nation’s first universal health insurance program for children. However, it may be dismantled after nearly a decade of surviving on a patchwork of funding sources. To save the program, a coalition of health, business and community leaders qualified an initiative on the November ballot that calls for a county parcel tax. “This is one of the most proactive children’s health initiatives ever, focusing on kids who are under the national poverty level. Our program is being copied in 27 other counties,” said Kathleen King, executive director of Santa Clara County Family Health Foundation.

On the other end of the spectrum, senior health issues are getting attention in Santa Clara County. Sarah Steenhausen of the SCAN Foundation, a senior health care policy organization, told the audience that the new law lays the foundation for a much improved system of long-term care. “At the same time, it takes steps to bolster the Medicare system to make sure it doesn’t go bankrupt in seven years as some have predicted,” Steenhausen said.

Moving From ‘Sick-Care to Wellness-Based’ System

Rounding out the conference, Marty Fenstersheib, Santa Clara public health officer, said his department’s health reform focus is an ongoing investment in prevention. “We need to move from a sick care system to a wellness-based system,” Fenstersheib urged. “There’s too much emphasis on the medical care side and prevention is secondary.”

He said one of the challenges to public health is to expand partnerships with the medical care community to promote a full spectrum of prevention. That includes collaborating with schools, businesses, cities and transportation agencies to create a healthier environment. “The health of the individual is inseparable from the health of the community,” Fenstersheib said. 

Santa Clara County expects to have more of these conferences as additional parts of the Affordable Health Act take effect over the next several years.   

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