Kimberly Shanklin drives slowly through the narrow residential streets of East Oakland in her gray van. When she spots a goateed, dreadlocked young man crossing the street, Shanklin stops the car and calls out to him. "Excuse me! I just wanna give you some information. About a free community health fair." She digs around in her green tote bag for a flyer, while the man shakes his head and keeps walking. "You can sign up for health insurance!"
He changes his mind and turns around, taking a flyer and nodding wordlessly at her before walking away. Undeterred, Shanklin starts driving again. "Sometimes, some people think we might be undercovers out here," she says, laughing cheerfully. With her effervescent smile, big white hoop earrings and bedazzled nails dressing up her red t-shirt and black jeans, Shanklin doesn't look like the 42-year-old mom that she is.
For the past six weeks, the groups Causa Justa:Just Cause, Communities for a Better Environment, Oakland Community Organizations, and Alliance of Californians for Community Empowerment have sent teams of workers like Shanklin out to knock on doors every day talking to Oakland residents about healthcare and an upcoming community fair being held at Laney College. Their goal is to enroll poor and working-class people in healthcare coverage that's newly available to them under the Affordable Care Act (ACA), the Obama Administration healthcare law passed in 2009.
After visiting a house with an elderly couple who are undecided about whether they'll make it to the health fair, Shanklin walks up to Tiffany Darnell's house.
"Hi, how ya doin'? I'm Kimberly from Causa Justa:Just Cause, and we're giving out information for a free community health fair this May 19. We're trying to focus on people who don't have healthcare."
Darnell cuts her off there. "Are they gonna be working on your teeth? 'Cause I can see the doctor sort of, but I don't have dental."
"They're doing screenings, and LifeLong's gonna be there and they have dental," Shanklin tells her. After chatting a bit, she finds out that Darnell worked at Highland Hospital as a housekeeper for 10 years before getting laid off recently. She still has Medi-Cal, California's version of the federal low-income program Medicaid, but the state cut coverage for dental care in 2009.
"I chipped a back part of my teeth," Darnell says. "They still give the children dental, so my daughter at least is not gonna walk around like her mama here." Back in the van, Shanklin sympathizes. She doesn't have dental coverage either. And now that she's been laid off from her job of 12 years, working at a homeless shelter, she's falling behind on rent too. "I'm not worried," she says stoically. "Something will come up, it has to."
While health reform faces a Supreme Court ruling this June on its constitutionality, California has pledged to move forward in implementing the ACA at the state level. Massive preparations have been underway to expand Medi-Cal coverage and roll out in 2013 the Health Benefits Exchange, a new market for affordable insurance plans.
Despite being seen by many progressives as modest reform that didn't go far enough, the ACA has some big implications for uninsured people and people of color. Its expansion of Medicaid eligibility to everyone under 133 percent of the poverty level is hugely important for low-income people who didn't meet the program's categorical as well as income requirements (Medicaid largely serves poor families with young children, pregnant women, and disabled people). Twenty-seven percent of African Americans and Latinos receive health coverage through Medicaid, compared to 11 percent of white people, according to a report from the Alliance for a Just Society.
The ACA also entails a large shift of resources toward expanding health infrastructure and services, with $9.5 billion allocated over five years and $1.5 billion for community health centers, which disproportionately serve people of color and uninsured or underinsured patients.
But one of the biggest challenges, advocates say, will be educating the people who need it most about the ACA's benefits and laying the groundwork for their enrollment in health coverage.
"A lot of ACA is still up in the air, a lot is still to be determined at the state level. People really need to be involved in making their voices heard to make sure that it ends up serving communities," says Dr. Damon Francis, medical director of Alameda County. "If we can take this moment not just to expand coverage but to redefine what healthcare is from a community perspective, we can potentially make a lot of change."
Building Healthy Communities from the Ground Up
Through the East Oakland Building Healthy Communities project, part of an initiative funded in 14 cities by The California Endowment, Oakland's health advocacy and social justice communities are working to harness ACA resources and direct attention toward the deep problems of East Oakland. It's a place where health outcomes leading to a life expectancy 10 years shorter than wealthier parts of the city are shaped by high unemployment, homicide rates, lack of grocery stores, chronic disease, and other forces. Once home to good manufacturing jobs with Mothers Cookies and General Motors as well as one of the nation's first urban malls, East Oakland today is a microcosm of the structural components of racial health disparities.
To be effective at both saving lives and holding down costs, healthcare must be accessible, consistent, and preventive -- elements emphasized in the ACA through provisions such as the Community Transformation Grants that focus on place-based social and environmental determinants of health. As it is, more than 40 million people a year do not get healthcare when they need it because they can't afford it, and thousands of deaths each year are attributable to lack of insurance, according to the Kaiser Family Foundation.
Getting and staying enrolled in low-income assistance programs poses a formidable challenge for many poor and working families. Lengthy applications, long wait times, and lost paperwork characterize most enrollment processes. Seventy percent of people enrolled in Medi-Cal or HealthPAC (Alameda County's program for those who don't qualify for Medi-Cal) get dropped from coverage, according to Amy Chen of Bay Area Legal Aid.
"Making sure people can keep their coverage is just as important once the pie gets expanded," Chen says.
Community Health Fair Day
The doors don't open at the WeConnect health fair being held at Laney College's gymnasium until 10 a.m., but Gregory Posey shows up at eight, knowing how crowded these events can get.
Posey, 52, has never had health coverage or been to a hospital in more than 30 years. Now though, his teeth have been bothering him, and the only option offered by basic dental services is to pull the tooth. He had an appointment at San Francisco General Hospital, but the bill would have been $169, and Posey kept putting it off to see if he could find a better deal.
He has worked odd jobs ever since his job at Oakland's Parks and Recreation department, funded by the federal stimulus, ended. Five years ago, Posey was released from prison, where he has bounced in and out of incarceration since the age of 26--due in large part to his alcohol addiction and the trouble he got in as a result.
"I know me, my weakness is alcohol. Whenever I got mad, I started drinking alcohol, and then I'd go smoking dope and it would be eff the world," he says. "So now I don't touch nothing. You gotta find out about you. Some people, they do it because they gave up on themselves--that's why they're out there. Do you love yourself or do you hate yourself? Look in the mirror."
With the help of a substance abuse program, Posey got clean and sober in prison.
"I've been blessed, I got another chance. Life is good," he says. "I just gotta get my mouth fixed."
Behind him, a long line starts to stretch down the breezeway, filling up with elderly people and families with strollers, most of them Asian, Latino or black. Inside the gymnasium, a team of multi-lingual workers are waiting to enroll as many people in health coverage as possible--if they can hit 150 enrollments, it will be a big success since, so far, only handfuls have been able to enroll out of the thousands of people who arrive without the documents needed. The weeks of grassroots outreach by organizers like Kimberly Shanklin have all led up to this day.
Community Needs, Community Strengths
East Oakland Building Healthy Communities has brought together organizations working on a range of issues from multiple disciplines, including the Ella Baker Center for Human Rights, Youth Uprising, Urban Peace Movement, TransForm, East Bay Alliance for a Sustainable Economy, First 5 Alameda County (a commission for children's health), the public health department, churches, and the school district, among others.
The groups and community members are working with a definition of health that revolves around priorities such as affordable housing, ending gun violence, access to fresh food, transit improvement, and jobs creation. It's a tall order for a collaboration, and when asked what he thinks will be most significant for the 10-year initiative to achieve, Dawn Phillips, a longtime Oakland organizer, says, "If we can make any concrete impact on the community-- strengthening health access in East Oakland--that would be significant. But it has to be measured around long-term institutional relationships built on a shared analysis of the problems, what's causing them, and the solutions--and that can only be done by building trust between organizations, having ongoing discussions, and working from a shared agenda."
The hard work of social change continues, one step at a time, one community leader at a time finding her voice.
Kimberly Shanklin remembers how stressful it was for her family, facing an illegal eviction when the bank foreclosed on the duplex she rented six years ago. The water got shut off, and mold in the walls was making her young children sick. "I just knew that it was wrong, and I had to fight it," she says, recalling the day Causa Justa:Just Cause held a press conference in front of her house. She was late, running to the rally, "and I turned the corner, and saw all these people. They started cheering for me, and I just started crying." She beams at the memory as she parks her van and gets out on the sidewalk.
On his porch sits an elderly man in a Costa Rica cap, with Wilson Pickett and Otis Redding cds playing on the boom box next to him. He looks to be in his 80s, and Shanklin, noticing his cap, asks if he was in the service. It turns out that he's a Korean War veteran. "I'm a vet, it's the best healthcare you can get," he says. "Don't have to worry about Medicare or any of that."
The screen door opens, and a heavy-set young man comes out. Shanklin immediately engages him, asking, "Do you have any health issues?"
"What do you mean 'health issues'?"
"Well, like some people have high blood pressure, or diabetes. Me, I have a problem with my thyroid, hypothyroidism. And I have arthritis in my back."
"Nah, I just have this weight I gotta lose. Been trying for years now."
Shanklin is already digging in her green tote for flyers and a newsletter to give him. "You can do it, you can do anything you set your mind to," she says encouragingly. "You should come out to a free community health fair, get you some health insurance."
Tram Quang Nguyen is an Oakland-based writer and former editor of Colorlines.