Kevin McWhorter hoists himself onto an exam room table and begins untying his shoes.
“And go ahead and take your socks off for me too,” Dr. Lisa Abdishoo tells him.
McWhorter is getting a foot exam from Abdishoo, who runs the Los Angeles Christian Health Centers clinic on Skid Row.
“I want you to close your eyes and tell me if I’m moving your feet up or down,” Abdishoo says, as she begins wiggling McWhorter’s toes, checking for signs of nerve damage.
McWhorter has Type 2 Diabetes. He’s also homeless, living in a nearby shelter.
While diabetes is a manageable disease, if left untreated, then cuts and scrapes can go unnoticed. That could lead to infections, and even amputations.
“There are so many people out here with amputated limbs because they didn’t get the proper care,” McWhorter tells Abdishoo after she congratulates him on a good checkup. “I want to keep mine.”
Getting the proper care has been easier for McWhorter since he enrolled in Medi-Cal, the state’s version of Medicaid, three years ago.
He’s one of the 3.5 million Californians and thousands of homeless individuals who benefited when the state expanded Medi-Cal under the Affordable Care Act, or Obamacare, to everyone living near or below poverty.
“When I received the card, it was like bam. I can go to the doctor,” McWhorter says. “It really feels good to know that if there’s something wrong, I can go get it taken care of.”
Before Obamacare, someone like McWhorter would have struggled to qualify for Medi-Cal.
Being poor wasn’t enough. A person needed to have either young children or a disability. The latter category might have covered McWhorter, but he would have needed to prove not just his diagnosis, but also a progression of the disease, likely with detailed medical records — not an easy feat for for someone who’s homeless and uninsured.
Now, with those barriers removed, McWhorter is able to keep his insulin prescriptions filled, see specialists as needed and keep his diabetes under control.
“Diabetes is rocking,” McWhorter says with a broad smile. “My blood pressure is 127 over 63. I’m just fat. But um, I’m eating differently. They gave me a whole booklet on eating rabbit food, but you know, it’s healthy. And I want to live today.”
When Obamacare rolled out in 2014, many of the nation’s homeless became newly eligible for health coverage. On LA’s Skid Row, around a half-dozen free clinics joined forces to get the thousands of people living on the streets and in shelters there enrolled in Medi-Cal.
Three years later, clinic staff say the outreach has reshaped how healthcare works for those living on Skid Row.
At LA Christian Health Centers alone, the clinic signed up nearly 2,500 for Medi-Cal. Its insured rate, which previously hovered around a dismal 28 percent, jumped to nearly 70 percent. Newly covered services like optometry increased tenfold. Dental and mental health care visits both doubled.
About a block away from LA Christian Health Centers at another Skid Row clinic, dental hygienists crouch over their patients’ faces with drills and picks, leaving only their feet visible.
John Wesley Health Center is the largest provider of homeless health care services in Los Angeles, serving more than 8,000 homeless people last year.
Between 2013 and 2014, the clinic helped enroll another nearly 4,400 people in Medi-Cal. With the expansion of coverage, came the expansion of services.
“This was only open one day a week because there was nothing to cover it,” says JWCH’s CEO Al Ballesteros of the dental clinic. “There was no insurance. Medicaid didn’t cover dental care. People didn’t have Medicaid, so we had these beautiful seven chairs and we were only able to operate them one day a week.”
Ballesteros says JWCH’s Skid Row clinic also saw a big uptick in its insured rate, from 17 percent to about 60 percent. He says without Obamacare, most of the clinic’s patients would go back to not having their health care, dental care, eye care, mental health care and addiction treatment guaranteed.
It’s a prospect the patients and the clinics may soon face.
Though Republicans in Washington failed to repeal and replace Obamacare last month amid party infighting, those efforts are far from dead.
Speaking just a few days after the Republican healthcare bill failed, House Majority Leader Kevin McCarthy, who represents Bakersfield, said as much in a press conference.
“We promised that we would repeal and replace Obamacare,” McCarthy said. “The timeline wasn’t there. The votes were not there yet. That doesn’t mean we’re not going to get there.
Even if the health law doesn’t change, Medi-Cal still faces problems.
Right now the federal government is covering all of the expansion costs, but starting this year, the state will have to start picking up more of the tab. Meanwhile, the number of people enrolling in the program is only expected to grow.
Without the Medi-Cal expansion, though, the Skid Row clinics say their services and the trust they’ve built with their patients could fall apart.
JWCH’s chief medical officer, Dr. Paul Gregerson, says that would mean reverting back to relying on the overburdened county system for anything beyond basic primary care.
“Somebody that came in with hernia would wait a year or more for surgery. Somebody that had a gallbladder that needed to be removed, same thing, it would take a long time. Eye appointments, eight, nine months out,” Gregerson says. “So many of things that needed to be addressed in terms of specialty care, we ended up sending people to the emergency room.”
At LA County+USC Medical Center near downtown, ER visits that didn’t require a hospital admittance dropped 11 percent after the health law’s rollout.
Michael Cousineau, a public health professor at the University of Southern California, says what the health law gave homeless individuals more options.
“If a person – let’s say they needed to see a cardiologist or they needed to see an ophthalmologist to have their annual eye check, then the panel of doctors that were available – are available — is much larger,” Cousineau says.
That was the case for 50-year-old Mary Morgan, a patient at JWCH who newly qualified for Medi-Cal under Obamacare. In November, Morgan had back surgery to fix critical damage to her lower spine. She says she’d been dealing with excruciating pain for years. For four them, she was homelessness.
“Sleeping on the concrete bears your back even more,” Morgan says. “So that really lead to more pressure more damaging to me because my mind was on trying to get myself together and keep myself alive. And, you know, we don’t think about that sometimes, that our body talks to us, but we don’t listen.”
Morgan currently lives in a shelter on Skid Row. She says right now she’s getting physical therapy, but will need another surgery to address more spinal damage.
Morgan is relying on Medi-Cal to pick up the bill.
“I won’t have anything to insure myself or go to the doctor’s with,” says Morgan when asked what would happen to her if her coverage ended or changed significantly. “Because we don’t have the funds to pay for anything right now. We’re living out here with nothing. You know? And without funding for that, what are we going to have? We’re going to get sick, and keel over and die, when we could be saved? You know? That little medical thing helps a lot of people, little that they know, it does. Because a lot of us can’t afford it, and we need it.”
Republicans aren’t putting a timeline on a new replacement plan this time around.
So at least for now, Morgan can keep her coverage.