California must transform health insurance. Here’s how

By Hector De La Torre and John Baackes, Special to CalMatters

Life packed a lot of hardship into Ma’Lissa Simon’s 24 years. Bullied by schoolmates and siblings about her weight, anger drove her into gangs, drugs and even prostitution before the age of 18.  

She spent some time in prison. Once she got out, transitional programs did not work and she ended up on the streets. It was not until she was six months pregnant with twins, in the hospital for gestational diabetes and kidney problems, that things started to change.  

She learned about Housing for Health, an L.A. County program designed to improve health outcomes by helping individuals experiencing homelessness to move into permanent housing.

In 2017, L.A. Care Health Plan committed $20 million over five years to Brilliant Corners, the agency that finds locations for the Housing for Health program.  

The goal was to house 300 individuals experiencing homelessness – 291 individuals have been placed in housing so far. Ma’Lissa was the first. 

This commitment represents just one of the steps L.A. Care has taken to address social factors that impact health.

Researchers maintain that medical care accounts for only 10-20% of all health outcomes. The other 80-90% is dependent on a variety of social factors such as housing, transportation, income and food security, and education.

It is clear that California needs to reevaluate how health insurance plans operate, especially Medicaid plans, the state and federal government-funded safety net plans serving the most vulnerable in every community.

For L.A. Care, the largest publicly-operated health plan in the country, health insurance has to be more than a plastic card in our member’s wallet. 

As a health plan serving nearly 2.2 million people, the vast majority of them Medi-Cal beneficiaries, we have taken numerous steps to address the various social factors that threaten our members’ health. We are accountable and responsive to the communities we serve and in recent years, that has meant moving beyond clinical care.

While L.A. Care is committed to using reserve funding for grants to outside organizations that can address a wide variety of social factors, the health plan also operates six Resource Centers across Los Angeles County where many social factors can be addressed.

Each center is a safe, fun, and inclusive space where plan members and the wider community can access free health screenings and a range of fitness and nutrition classes. The centers enhance community connections and some care coordination, while offering access to agencies and organizations that can address social needs. L.A. Care recently announced a new $146 million collaboration with the Promise Health Plan to expand and jointly operate the centers over the next five years.  

Eventually, there will be 14 Community Resource Centers across L.A. County, offering even more services for members and non-members in the broader community.

These are just a few of the steps L.A. Care has taken to address the social factors that are impacting health outcomes in the region, certainly not all. 

Our hope is that state and local government leaders will acknowledge what researchers have been saying for some time: medicine alone cannot cure what is ailing us. 

We must treat the whole person, and address issues that may drag them and their physical and mental health down. To truly keep our communities healthy, we must go beyond clinical care and address the social needs that will make clinical care more effective.

It is working for Ma’Lissa Simon. She is in the apartment that L.A. Care’s commitment helped to provide. She is healthy and plans to start looking for a job very soon. Her twins just turned 2, and keep mom on her toes. And they have a place to call home.

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Hector De La Torre, a former California legislator, is chair of the L.A. Care Board of Governors, [email protected] John Baackes is chief executive officer of L.A. Care Health Plan, [email protected]. They co-authored this commentary for CalMatters.

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