Progress, Challenges Ahead For Women’s Healthcare

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On an unseasonably warm June day in San Francisco the Women’s Community Clinic was quiet.  It’s a tidy place, with walls painted bright muted colors. The space sends a message that regardless of a person’s income or insurance status, everyone deserves great healthcare in an environment where they feel safe and respected. 

The clinic has been located on Fillmore Street for about four years.  It serves more than 4,000 women, scheduling 7,000 clinical appointments annually. Carlina Hansen directs the facility, with support from about ten staff members.  There’s six exam and three counseling rooms. It’s open three days a week until 9 p.m., two days until 5 p.m. and Saturday until 1 p.m.   

Historically most of the clinic’s clients have been uninsured. But that’s changed with the Affordable Care Act. “The ACA had a huge impact on our clients and has enabled many of them to gain coverage through Medi-Cal,” Hansen said. ACA mandates insurance coverage that includes, among other care, birth control, domestic violence counseling and mammograms, without any out-of-pocket costs.

“This has been a very revolutionary time,” said Dr. Claire Brindis, a professor of pediatrics and obstetrics at the University of California, San Francisco. Nearly 50 million people were without health insurance before the ACA, she said. Since then significant progress has been made in providing women’s preventative care that doesn’t require a co-payment. According to Brindis, annual wellness visits and screenings for diabetes are also covered under the ACA. 

Hansen said the Women’s Community Clinic started offering a full scope of primary care last year. The clinic also provides mental health services, either through referrals or on-site counseling. As many as one-quarter of the clinic’s clients report dealing with depression, anxiety, sexual abuse or trauma. “Our expanded scope of services is an essential part of our coordinated holistic approach to total wellness for our clients,” Hansen said.  

The clinic provides accessible and affordable services to women and girls – anyone female-identified or female-bodied – 12 years and older who live in San Francisco, San Mateo, Alameda or Marin counties. No one is turned away due to an inability to pay, Hansen said. About 10 percent of the facility’s clients live in zip codes 94110 and 94107.

Women tend to need healthcare services earlier in their lives than men, and they access care more frequently because of their reproductive system, Hansen said. Under the ACA, according to Hansen, insurers can no longer put a lifetime cap on care because a person goes into the hospital for a major illness. But “there’s still incredible barriers to sexual and reproductive healthcare access nationwide,” she said. California residents are fortunate, she said, but even in the Golden State barriers exist to abortion access in the Central Valley and rural areas of Northern California. 

The wage gap between men and women is another challenge, as is lack of access to childcare. Nationwide women earn $.75 on the dollar compared to men. “There’s some pretty huge challenges right from the get go,” Hansen said.   

The clinic generally serves women who have complex healthcare needs, including related to mental health and dental issues. Medi-Cal reimbursement rates pay less than it costs to provide services, Hansen said. As a result, few providers are willing to accept Medi-Cal. Those that do have to be creative in covering costs, she said. That means a lot of fundraising. 

According to Brindis, patients’ understanding of the insurance system is also a barrier. They often don’t know what a premium is, or how to use their insurance rather than the emergency room. Switching doctors is a problem for some.  

Amy Moy, a spokeswoman for the California Family Health Council, which advocates for quality sexual and reproductive healthcare, said as more women gain comprehensive coverage healthcare professionals have to ensure that they don’t lose access to quality family planning care. And they must ensure women get timely access to care through a robust provider network. “We have a lot to be proud of in California,” Moy said. “Now we have to make the promise of that coverage a reality.” 

“We’re a great place to access healthcare services and support,” Hansen said.