More than 20,000 uninsured Santa Clara County residents may become eligible for primary health care services through a resolution proposed by supervisors Joe Simitian and Otto Lee.
The duo wants to increase eligibility for the county-run Primary Care Access Program (PCAP), which essentially acts like a safety net for uninsured residents who do not qualify for insurance through the Affordable Care Act or other state and federal programs.
"(These are) folks who remain uninsured for whatever reason," Simitian said at a news conference Wednesday. "Maybe that they have seasonal work and just don't have the ability to access health insurance, maybe they're undocumented, it may be that they are that missing middle — folks who make what we thought was a decent middle-class wage back in the day, but who now discover in our high-cost Valley ... they can't access the help they need."
There are currently an estimated 80,000 uninsured residents in the county who fall into those categories, Simitian said.
Right now, about 8,000 of those people qualify for PCAP. The current requirement provides services to those making 200% of the federal poverty level — under $53,000 a year for a family of four.
For families making that much, "that leaves the family with about $13,000 to buy food, transportation, clothing, education costs, emergency expenses," said Dolores Alvarado, CEO of Community Health Partnership.
So, with such little money left for everything but rent, health care tends to fall on the back burner, Alvarado said.
Under the new proposal, those making 400% of the federal poverty level, or under $106,000 for a family of four, would qualify. For an individual, they would need to make less than $50,000 a year to qualify. It would more than triple the number of residents who could access the services to roughly 30,000 residents.
"If you have two kids, the health care costs plus your child care costs, your housing costs, $100,000 doesn't go very far in the Valley at all," Lee said. "So it's important to bridge this gap between the $53,000 and $106,000."
Lee, along with Alvarado and Simitian, also emphasized that access to quality health care was not a privilege, but rather a human right.
"This is not charity, this is social justice," Alvarado said. "And most importantly is what's good for the goose is good for the gander."
The expansion of eligibility would require a roughly $10 million investment, but it would save costs in the long run because residents wouldn't turn to the emergency room for health care, for example.
"The revenue from PCAP will help the clinics continue their service and be sustainable," Alvarado said. "It will help the families by not having to use 30-40% of their income for health care."
She said it would also allow families to seek preventative care instead of waiting until their health was seriously at risk.
And Simitian said it may even get more individuals insured, who may not know that they qualify for certain programs, because they would finally go to a county clinic because of PCAP expansion.
Alvarado, Lee and Simitian called it a "transformational" and "innovative" proposal.
"If we can get 20,000 of those 80,000 folks who are uninsured health care directly, without the intermediary as an insurance program, we'll make a big, big dent in getting to the folks who still don't have access to the health care they require," Simitian said.
He said the county Board of Supervisors will likely approve the proposal during the board meeting on Tuesday.
Even without a unanimous vote, the proposal will likely pass because Supervisor Cindy Chavez suggested making a similar pilot program about a month ago, so she will likely vote in favor. With her, Simitian and Lee, the motion has enough votes to go through.
"The world is upside down when you have to ask yourself, 'how poor do I have to be to get health care?'" Simitian said. "We're trying to create a different world here in Santa Clara County. That may seem a little aspirational, far reaching, but for the 20,000 folks we hope to include in the program, I think we can make that real."