This is one in a series of year-end stories that look back at the most memorable pieces KPCC reporters worked on in 2012 and look ahead at a key issue that will be the focus of coverage in the coming year.
Few topics in 2012 seemed as tailor-made for OnCentral – a blog that focuses on issues of health and quality of life in South Los Angeles – as the Supreme Court's ruling on the Patient Protection and Affordable Care Act (ACA).
President Barack Obama's landmark legislation that would overhaul many aspects of the health care industry was, to oversimplify, geared toward making medical care more affordable. The health of communities in South L.A., like many that are low-income, are shaped by social determinants: Do they have access to healthy housing and healthy food? Are there places for people to exercise? Are they employed, and if they are, does their employer provide health insurance at a radically reduced cost? For many southsiders, the answers to a lot of those questions is no – and so chronic conditions like obesity, diabetes, asthma and high blood pressure are present at disparately high rates. Those, in turn, contribute to a more dangerous, potentially fatal array of problems, including heart disease and respiratory complications.
But even though many can't afford it, there are still places that try to provide the community with low-cost or free health care – federally-qualified community health clinics, which often provide better care than their private counterparts. These clinics face a chronic limit on resources, and can only do so much to meet the deep need. That's why clinic leaders and staffers were holding their breath on the morning of June 28, when the Supreme Court announced its verdict: The Affordable Care Act was indeed constitutional, and for the most part, would continue to roll out as planned.
I felt overwhelmed reading the initial reports of the court's opinion, because I knew what this meant for the community. I knew, from conversations with South L.A. health workers, that the ACA's provision that expanded Medicaid would be invaluable to extending care to tens of thousands of people in Los Angeles, where more than 2 million are uninsured.
I was moved as I spoke to these clinic leaders on the phone, gathering reactions for this OnCentral story I've chosen as the reporting highlight of my year. I heard their voices quiver with disbelief, with joy, with hope. And when I met with them and their patients later that day, I saw their smiles and their relief that their work and their source of care would not only continue unimpeded, but would probably be bolstered.
That was the day that I truly began feeling invested in my beat. I'd learned so much about the mechanics of this legislation, and I'd learned so much about the health struggles facing communities in South Los Angeles. To see so much joy and hope result from a court decision was truly remarkable.
But of course, this comes with challenges. A key issue in 2013 will be making sure there are enough health providers – doctors, nurses, physician's assistants – to take care of all the people who will gain health coverage. By 2015, the Association of American Medical Colleges estimates the country will be short nearly 63,000 doctors; by 2025, that shortage is expected to more than double.
Combine that with a declining number of medical students choosing to go into primary care – which will comprise the bulk of the need once the Medicaid expansion is implemented – and it's unclear how the country will meet the needs of the millions who will gain coverage.
In 2013, preparations to set up affordable health insurance markets in each state will reach a fever pitch, and Medicaid expansion plans will need to be completed. One question is central to both of those efforts: Where will all those health providers come from?