Archived: One Decision’s Impact on My Community


The U.S. Supreme Court could decide as soon as today the fate of the Affordable Care Act (ACA), the most sweeping health care overhaul since the arrival of federal Medicare and Medicaid in 1965.

And while the stakes are high both for our country and our state, the outcome of the Supreme Court’s decision will likely be most noticeable to communities like the one I work in every day– South Los Angeles.

The promise of affordable and quality health care is critical to a community where nearly 34 percent of residents are uninsured, one of the highest rates in the state. Why, because as it stands our neighborhoods in South Los Angeles have LA County’s highest rates of disease and premature deaths from preventable conditions like diabetes, lung cancer and heart disease.

My neighborhood is not unlike many other communities across Southern California with high rates of uninsured and people in need of preventative care services.

With the Affordable Care Act in place, nine out of ten Californians will have access to insurance in 2019, and it is very likely that those rates of premature and preventable illness will decline. Without the law, it is likely that those preventable conditions will persist, that people will continue to flood emergency rooms for basic care, and that costs will continue to escalate for many of the city’s poorest residents.

Even with the law, there are two pressing issues facing the people I work with on a daily basis: coverage for undocumented residents and the primary care physician shortage. Only if we address these two issues do we ensure health care access for all.

Undocumented residents are not eligible for health insurance under the Act. They are not offered Medicaid and denied low-income subsidies to purchase entry into state health exchanges. As a result, they will continue to seek care in safety net healthcare systems for the uninsured. Without coverage, these individuals, who constitute a growing percentage of our population and who are part of the fabric of our community, greatly impact our health care system. In any of the post-ACA decision scenarios, we need to have comprehensive and honest conversations to provide community-based, culturally competent solutions.

And after we fight to expand coverage for all we are left with a profound primary care shortage. The Association of American Medical Colleges estimates a shortage of approximately 21,000 primary care physicians in 2015, and South Los Angeles already has one of the highest shortages of health care professionals. An increase in the number of insured and the growing elderly population places a burden on the workforce.

An essential solution to the shortage is to expand medical education in underserved communities. After all, key determinants of where physicians practice include where they are from and where they obtain their medical training. We need to incentivize them with expanded scholarship and loan repayment programs for those that choose to serve in primary care.

Other solutions include the creation of new practice models, such as patient-centered medical homes, technology improvements, adding additional primary care residency training slots, as well as a greater reliance on nurse practitioners and physician assistants who provide significant access to primary health care services, particularly in underserved communities.

No matter the Court’s decision, South Los Angelenos, and all underserved communities, should have quality care by a workforce that is trained and employed to help all of our residents. I urge California to push ahead to implement elements of the Affordable Care Act to bring coverage to millions more people and curb skyrocketing health costs.

The problems faced by the underserved don’t go away, so let’s not ignore them, let’s do something about it.

Dr. David M. Carlisle is President of Charles R. Drew University of Medicine and Science, a private, nonprofit, nonsectarian, medical and health sciences institution in the Watts-Willowbrook area of South Los Angeles.

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