Poor people frequently enter the health care system through a hospital emergency room. The hospital tries hard to qualify them for one of a patchwork of insurance programs: Medi-Cal, veteran's benefits, the Medically Indigent Adult program, Medicare, the State Children's Health Insurance Program.
Frequently, the patients are unaware of the programs available.
Mary Lou Porter of Oakdale is an example. She has suffered with leukemia and lymphoma for seven years and lost her insurance when she separated from her husband about two years ago. She was not eligible for Medi-Cal, and, at 63, is not old enough for Medicare.
Unaware of the Medically Indigent Adult program, Porter went most of the past two years without the blood tests that monitor her disease.
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She recently discovered she was eligible for the Medically Indigent Adult program and is being seen by the county's oncologist.
"It's scary not to have medical when you have a life-threatening disease," she said. "You can't get medicines, or a test. I was scared to death to get my first white blood cell test."
Porter is grateful for the care she is receiving through the county clinics, and says she is treated with respect. But the clinics are crowded, and wait times are about twice as long as a private care patient with insurance would experience, she said.
"There are only so many rooms at the inn," said Mary Ann Lee, managing director of the county Health Services Agency. "There are still only so many physicians, only so many exam rooms. We can only take care of so many patients."
Transportation often is an issue for clinic patients.
"I don't have a vehicle. I have to get a ride every time I go to the doctor," Porter said.
"I had to cancel my family physician (appointment) four times, I wasn't able to get there," she said. "I hate that. I like to be on time and early. But when you are in a situation where you don't have a way to get there ... "
A cab costs $10 for a round trip, a lot of money for Porter. She gets $654 a month in Social Security and pays $375 a month for rent. The Riverbank/Oakdale Transit Authority bus is just $1, but Porter uses a cane and worries about falling when she boards the bus. So she relies on rides from relatives, who have their own lives and health issues to deal with, she said.
Porter understands the stigma that often is attached to those on Medi-Cal or any of the other public programs. But she cautions those who are quick to judge.
She worked in retail and banking for 20 years, had insurance and a car. Her illness left her unable to work, and the stress of her cancer problems led to a separation from her husband of 14 years.
"It's not just people who haven't been productive. A lot of us out there paid taxes. These things just happen," she said.