By Dr. Jack Donaldson for VC Star
Angélica is a 44-year-old, undocumented, transgender woman who I have only seen a handful of times. In 2017, she qualified for one month of care under emergency Medi-Cal, after a visit to the emergency room. I was able to start her on gender-affirming hormones, but shortly thereafter she disappeared.
Then again in late 2018, she came to my clinic, hoping to proceed with breast augmentation so that she could move about in society more easily as a woman and would be less likely to be a target of transphobic harassment, abuse and violence. These surgeries can literally be life-saving for transgender patients. But as before, her emergency Medi-Cal expired after a month and she could no longer afford health care.
When I began medical school, my cohort and I swore the ancient Hippocratic Oath, which is not just a declaration of ethics, but also vow to remember the human being holistically, including their social and financial well-being. The principles underlying this oath are the reasons I went into medicine, a career choice that eventually brought me here, to Ventura County, in 2009. In recent years, I have had the privilege of serving marginalized communities in two roles: as President of the Board of Directors of the Mixteco Indigena Community Organizing Project (MICOP) and as a doctor treating patients like Angélica who have few other places to turn for help.
It is my hope that all medical providers approach patients with a holistic analysis in mind. If we want our patients, and our communities, to thrive, we need to ensure that health care is both accessible and affordable, regardless of socioeconomic standing. Access to affordable health care changes lives and has ripple effects that go far beyond the individual level.
Every week I care for patients who avoid needed medical care because they cannot afford deductibles or co-pays on their insurance. Every week, I also am in touch with patients who cannot see me because they cannot afford insurance, even though they are working 40 hours (or more) per week.
The various layers of marginalization that my patients face also make it difficult for them to be able to afford the care they need. Communities of color, LGBTQ+ communities, and the undocumented all face higher rates of poverty, homelessness, and mental illness. The more layers of marginalization, the more barriers they face.
Public health care programs and systems, such as Medi-Cal, are critical for patients who would have never been able to afford medical treatment. The latest expansion of Medi-Cal, giving access to undocumented people up to age 26, has and will continue to make a critical difference for many of the patients I see.
But we need more comprehensive coverage. The rapidly rising costs of life-saving medications, medical care and health insurance are all signs that our health care system needs fixing. Nearly three million Californians remain uninsured. Of those, nearly a third are undocumented and don’t have access at all.
For a state with one of the largest economies in the world, I believe we have no excuse for not guaranteeing comprehensive health care coverage for everyone who lives here. By far the simplest way to achieve this goal would be to strengthen and expand Medicare — already America’s most popular form of health insurance — to include everyone. We need to challenge/support our elected officials in pushing for a goal like this one.
Angélica is just one of the many patients I care for who face terrible situations due either to lack of health insurance or incomplete/inconsistent coverage. The Hippocratic Oath calls me “not to discriminate against any person” in the decisions I make. Sadly, such discrimination still exists for many, even more so in undocumented, people of color, and LGBTQ+ communities.
Access to health care is a human right, and it should be reflected in our policy framework.