Health & Spirit

Upsurge of suburban poor discover health care's nowhere land

Elaine Korry, Kaiser Health News on

Published in Health & Fitness

The promise of cheaper housing brought Shari Castaneda to Palmdale, Calif., in northern Los Angeles County, about nine years ago.

The single mom with five kids had been struggling to pay the bills. "I kept hearing that the rent was a lot cheaper out here, so I moved," she said.

But when she developed health problems -- losing her balance and falling -- Castaneda found fewer care options in her new town. Unable to find local specialty care, she traveled nearly 65 miles to a public hospital in Los Angeles, where doctors discovered a tumor on her spine.

Then she had to drive nearly 75 miles to the City of Hope cancer center in Duarte, Calif., for an operation to remove the growth. The procedure left her partially paralyzed. "I walked into the hospital and I never really walked again."

Castaneda, 58, receives Social Security disability payments and is enrolled in Medi-Cal, the state's Medicaid program for low-income people. "There are no doctors available here," said Castaneda. "I called every single one of them in the book, and nobody takes Medi-Cal out here." Instead, Castaneda now sees doctors nearly 50 miles away in Northridge.

Suburbs in the United States, often perceived as enclaves of the affluent, are home to nearly 17 million Americans who live in poverty -- more than in cities or rural areas -- and growing demand for care strains the capacity of suburban health services to provide for them, according to a recent study in Health Affairs. Suburban areas have historically received a fraction of health funding that cities have, leaving them with inadequate infrastructure and forcing people like Castaneda to scramble for the medical attention they need.

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The Health Affairs study found that about a fifth of the suburban poor are uninsured, and many who do have health insurance -- especially people on Medi-Cal -- either can't find providers or must travel far for appointments.

The Affordable Care Act cut California's uninsured rate from 17 percent in 2013 to about 7 percent last year due largely to the Medicaid expansion, which added more than 3.7 million adults to the state's Medi-Cal rolls. But that has not ensured access to health care for millions of suburbanites, said Alina Schnake-Mahl, a doctoral candidate at the Harvard T.H. Chan School of Public Health in Boston, who was lead author of the Health Affairs study.

"That really goes against the idea that everyone in the suburbs is insured because everyone has a white-collar job with coverage," she said.

Coverage doesn't equate to care even for patients with Medi-Cal, as Castaneda can attest. Before the health law, they had trouble finding doctors who would see them because of Medi-Cal's low payment rates. That problem intensified as millions more signed up for Medi-Cal, driving many enrollees to seek services at safety-net care facilities.


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