With the recession still in full-gear, community health clinics are seeing interesting turns on their roads to survival.

They’re seeing major cuts to the health programs with the passing of California’s fiscal budget in July but they’re also seeing stimulus dollars come through.  At the same time, clinics are seeing a rise in patients and a different demand in services due to layoffs.

“It’s an interesting time right now,” said director for Community Clinics Health Network Christy Rosenberg. “We’re seeing clinics expanding or opening new sites because of the stimulus dollars — which is great because it provides more access to the community but at the same time — with the state budget challenges — we’re also starting to see some clinics cut back on their hours and we have seen a couple closures.”

About 102 clinics spread throughout the San Diego, Imperial and Riverside Counties and are joined together by the umbrella organization, Council of Community Clinics (CCC).In 2008, the clinics had 550,714 patients who visited the clinics 1.6 million times. Of those patients, 69 percent were female, 60 percent were below the federal poverty line, 76 percent were Caucasian and 69 percent were between the ages of 20 and 64.

Data collected by CCC notes that 42 percent of patients were underinsured and 39 percent were uninsured. Because San Diego County doesn’t provide its own government-assisted clinics like many other jurisdictions, these clinics have more patients, said director of health policy and fund development Gary Rotto.

“Other counties have public hospitals or government-run clinics, we don’t,” Rotto said. “We’re very dependent upon private, non-profit clinics.”

Budget cuts taking its toll on patients

The state budget cuts made to health services in July are estimated to be about $2 billion. Although the amount of cuts taken to clinics under CCC hasn’t been tallied yet, the cuts made to four different state programs will affect San Diegans. The four programs are: Expanded Access Primary Care, Indian Health, Healthy Families and Medi-Cal Dental. Among those programs, Gov. Arnold Schwarzenegger cut programs he did not consider necessary, such as podiatry and optometry services.

“The budget cuts have been absolutely devastating,” said La Maestra Community Health Centers CEO Zara Marselian. “Certain programs have been disseminated or totally frozen. It’s been really, really rough and really hard to deal with.”

Marselian said that many patients will visit her clinics for what may seem to be minor injuries but later, they become severe. She told the story of a man who loss his insurance after losing his job and who came to the Fairmount location with a broken ankle. The man was advised by a doctor to see a specialist but couldn’t because of the lack of funds and the recent budget cuts to podiatry services, she said.

“He told the doctor, ‘Whatever you can do for me, do it for me here. I cannot afford anything else,’” said Marselian. “What a shame. He was born here, he’s a citizen who has paid taxes and he’s been struggling and will probably be crippled for the rest of his life. It’s not enough that all his life he had to work for health insurance and pay for it out of his own pocket and now when he needs his government most, they’re ignoring him.”

Clinics seek recovery with Reinvestment Act

Under President Barack Obama’s American Recovery and Reinvestment Act of 2009 (ARRA), $5.6 billion has been made available to health services in California with $3.8 billion already rewarded. Of the $3.8 billion, $18.5 million has come to San Diego County.

Rosenberg said the funds coming from ARRA are assisting many clinics, who qualified for funding. She said many of the clinics have been able to “upgrade their technology and hardware,” which makes the process of seeing patients and keeping their files more efficient.

Thus far, 11 clinics within San Diego County have been able to obtain stimulus funds (see chart). Despite the extra funding from the federal government though, Rosenberg said many clinics are not filling positions because of fear of the recession lasting longer than expected or because of California’s budget dilemma and its ongoing problems.

‘A lot more patients’

Although both the state’s budget cuts and the federal stimulus are affecting the clinics in different ways – the affect the overall recession is taking on Americans is clear and clinics are definitely seeing a rise in patients, said O’Kane.

“The number of uninsured patients has increased,” he said.

The uninsured rate in San Diego County is 17.4 percent, two percent higher than the national average at 15.1 percent – according to a policy brief by the Center on Policy Initiatives. Out of the 3 million people residing in the region, 503,385 people are uninsured.

“If 20 percent of working-age San Diegans have no health insurance, it’s not just those individuals who are suffering– it’s families and children,” said Corinne Wilson, CPI research analyst. “When people who are woefully under insured are included, the picture is even more dismal.”

CPI also finds that “job loss and wage stagnation lead to lower incomes and more people without health insurance.”

At the La Maestra health clinic off Fairmount Ave., not only is the number of patients rising but more patients are coming in because of stress from the recession.

Marselian, whose clinics provide services in 20 different languages, said the recession’s toll has been clear.

“A lot of people are coming in for depression, stress and anxiety,” she said.

In addition, La Maestra nurse Alicia Perez, said with the start of the school year they saw “a lot more patients” bringing in their children for their yearly check-ups. And with the rise of school children visiting the clinics, parents also asked doctors to do full check-ups all during one visit, to save on costs.

“They come in with a little bit of money and try to do everything at once.”

Other patients are also referring their family members to the clinics.

Boony, a San Diego resident who has been visiting La Maestra for 10 years and did not want to reveal her last name, now visits the clinic more often and refers her family too. She lives near Fairmount Avenue with her husband, son, daughter-in-law and four grandchildren in one house. The family lost a house after her son lost his job. Now she and her daughter-in-law support the family of eight on one full-time job (how much? If you are going to name Boony’s salary then we should have the full time income too. If not, then delete Boony’s salary) and Boony’s part-time job that pays $400 a week.

“It doesn’t feel good but we have to stick together,” she said. “We have no choice. We have no health insurance.”