California’s massive Medicaid program works...

something inside her abdomen, she said.

Lammers, 53, has been suffering from frequent bouts of nausea, pain, and bloating for six months.

Her gastroenterologist wants to perform diagnostic procedures, including a colonoscopy and, if anything shows up, a biopsy. But Lammers, who lives in a motel with her boyfriend and teenage daughter in the Gold Rush town of San Andreas, doesn’t have a working car and can’t readily get to the clinic — which is 50 miles away.

For Lammers, like many MediCal enrollees who live in rural areas, lack of transportation is a major impediment to obtaining care. The problem is particularly acute for patients who need to see specialists.

Lammers’ dermatologist and eye doctor are over an hour away from San Andreas, the county seat of Calaveras County, about 125 miles northeast of San Francisco. She isn’t seeing a neurologist, despite a series of mini-strokes and stress-related seizures. And she hasn’t been to a podiatrist in two years, even though her toes are twisted over one another and hang down, causing her to trip. She’s often in excruciating pain when she walks.

Medi-Cal is supposed to provide free transportation to enrollees who can’t otherwise get to their appointments.

But Lammers, whose health plan is California Health & Wellness, owned by Centene, the nation’s largest commercial Medicaid insurer, stopped using its ride service nearly a year ago, after she missed dozens of appointments because drivers just didn’t show up, she said. She was getting threatening letters from doctors’ offices over the noshows.

Once she had to hitchhike more than 30 miles home from a counseling appointment.

On other occasions, Lammers said, she did not receive the reimbursement she was owed for arranging her own rides.

“I just don’t go to the doctor anymore,” Lammers said. “If I go to the doctor, my boyfriend has to take the day off work, and if he takes the day off work, we have no money.”

During the last three months of 2022, Lammers canceled five appointments she had scheduled for the diagnostic abdominal procedures because her boyfriend had to work each time and couldn’t take her. She finally stopped rescheduling.

California Health & Wellness contracts with Modivcare, a Denver-based medical transportation company that is no stranger to patient complaints and lawsuits.

Before she gave up on the ride service, Lammers said, she would call California Health & Wellness to try to resolve the issue, only to be told that Modivcare was a separate company. “I’m like, ‘If you guys hired them and put them in charge of transportation, who oversees their screw-ups?’”

Courtney Schwyzer, a member of a legal aid team representing Lammers on various Medi-Cal matters, said the failure of medical ride services is a systemic problem.

In late February, Schwyzer and her fellow attorneys filed a petition in court that she hopes will force the state Department of Health Care Services to address the problem.

California Health & Wellness spokesperson Darrel Ng said the company monitors the quality of its contractors, but a shortage of transportation providers in rural areas “has created unique challenges.”

Modivcare provides more than 4 million rides for MediCal recipients annually, and more than 99% are without complaint, said Melody Lai, a company spokesperson.

Lammers, who is unemployed and trying to start a custom craft business called Stuff by Steph, said doctors have warned her that if she doesn’t reduce her stress level, it could shorten her life. But arranging medical care is the most stressful thing in her life right now, so she doesn’t try anymore.

“In order to keep from dying, I have to not go to the doctor,” she said.

‘It’s a Blessing’ Medi-Cal helped save the life of Carolina Morga Tapia, a 30-year-old, full-time mother of five who lives with her family amid almond groves in an agricultural enclave of Fresno.

Nine years ago, a bacterial infection triggered premature labor during the 25th week of her second pregnancy, and Morga

Tapia almost died. She spiked a fever, bled profusely, and needed immediate transfusions and emergency surgery. After several days in critical care, she fully recovered.

But the doctors could not stop the premature birth, and her baby came out weighing just 1 pound. She and her husband, David Nuñez, named her Milagros Guadalupe, and she died four days later, on Sept. 13, 2013 — a Friday.

In each of her subsequent pregnancies, Medi-Cal paid for Morga Tapia to get shots of synthetic progesterone, intended to prevent another preterm birth. Those shots — one a week for about 20 weeks — can cost an average of more than $10,000 per pregnancy.

Morga Tapia and Nuñez, a construction worker, signed up for Medi-Cal when she was pregnant with her first child more than a decade ago. They’ve been on the same Anthem Blue Cross Medi-Cal plan ever since.

The plan paid for prenatal care through all six of Morga Tapia’s pregnancies, and it has provided all the medical and dental care the family needs, she said.

“Without Medi-Cal, we would have to be paying for all of our children,” said Morga Tapia. “It saves a lot of money, and it’s a blessing to have that extra help.”

Her children, four girls and a boy, range in age from 1 to 10. They all go to the same children’s clinic and see the same pediatrician.

The kids, all in good health, get routine checkups, vaccinations, and other preventive care, Morga Tapia said. She gets appointment reminders via text and cards in the mail notifying her when it’s time for the kids’ vaccinations and wellness checks, as well as her Pap smears, she said.

Her family’s experience contrasts sharply with the state’s assessment of their health plan, according to a report on quality of care in Medi-Cal issued late last year. The report, which evaluated Medi-Cal health plans on pediatric care, women’s health, and chronic disease management, put Anthem Blue Cross in the lowest tier, and below par on multiple measures in numerous counties, including Fresno.

Another state report, released in late January, detailed how quickly insurers provide appointments for their patients, and put Anthem Blue Cross’ Medi-Cal plan near the bottom of the heap.

Anthem Blue Cross spokesperson Michael Bowman said in a statement that the period covered in the reports coincided with the covid-19 pandemic, “when our safety net providers dealt with significant challenges with workforce and appointment availability.”

Morga Tapia doesn’t give the insurer low marks. “It’s different for everybody. I have a good healthy family, and what MediCal covers is really fortunate for us,” she said.

‘I Don’t Want to Die Yet’

In late 2021, doctors gave Lucas Moreno Ramirez a few months to live.

Struggling with diabetes and late-stage lung cancer, Moreno Ramirez suffered debilitating pain as he hacked and labored for breath. His doctors recommended that he stop treatment and start hospice care. He felt as if they were giving up on him.

“They said they’re going to give me opioids for my pain and help me have a comfortable death,” said Moreno Ramirez, 68, who lives in Norwalk, in Los Angeles County. “I told them I don’t believe in that. I don’t want to die yet.”

A former landscaper and factory worker, Moreno Ramirez learned he had to be his own advocate, fighting for the care he believed he deserved from Medi-Cal.

He said his Christian faith gave him strength, and over the next few months, Moreno Ramirez pushed the program and his doctors to keep battling his cancer, using a different treatment with fewer side effects than chemotherapy.

“I believe in prayer,” he said.

“But I believe in science and medication, too.”

Moreno Ramirez is one of the roughly 1.6 million Californians enrolled in both Medicare, which covers people who are 65 and older or have disabilities, and MediCal, which kicks in to cover the costs and benefits that Medicare doesn’t.

He also relies on his MediCal insurer to help him navigate the byzantine system. L.A. Care, the largest Medi-Cal plan with nearly 2.6 million members, connected him with a care manager who worked with him to identify a different treatment called Tagrisso and advocated for him to get it.

Even with the new medication, Moreno Ramirez’s coughing fits returned last year, and his symptoms grew so painful he suspected the cancer was growing. He asked to see his pulmonologist but was told the first appointment would be in June 2023. So he switched doctors and scored an appointment nearly six months sooner.

“My old doctor didn’t help me. I didn’t trust him,” Moreno Ramirez said. “He was always too busy for me. I told my doctors, ‘Give me a chance.’” Having taken his care into his own hands, he says he’s not in pain, his cough has subsided, and he feels hopeful for the future. “Now I feel good,” he said. He has also sought more attention for his diabetes and received a continuous glucose monitor to measure his blood sugar. It’s better controlled now than it has been in decades, he said.

“You have to stand up for yourself and advocate,” said Joann Pacelo, the care manager who helped Moreno Ramirez change doctors, get quicker referrals to specialists, and get approved for in-home nursing visits.

“A lot of times it’s difficult with Medi-Cal because the doctors are busy and the reimbursements are so low, but no one should be denied the care they deserve.”

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

Fire prevention

AT the end of February, the Bureau of Fire Protection held a parade featuring some of its trucks and equipment as well as new regular personnel: women firefighters.

The parade kicked off events to mark Fire Prevention Month, while at the same time saluting Women’s Month. March, usually the warmest, driest month of the year, has been picked to raise public awareness of fire safety measures. Coincidentally, the deadliest fire in the country, which claimed 162 lives, occurred on March 16, 1996, with most of the fatalities students celebrating their graduation at the Ozone Disco in Quezon City.

The BSP wants the public to be mindful in particular of electrical wiring at home and in offices. Records show that faulty electrical wiring has been the most common cause of fires nationwide. At around 2 a.m. on Dec. 4, 1998, degraded electrical wiring in a decades-old building housing the Bahay Kalinga orphanage in Paco, Manila set off a fire that razed the structure, killing 28 people, mostly children and infants.

On Dec. 23, 2017, an electrical short-circuit on the third floor of the New City Commercial Center mall in Davao City set off a fire that burned for 32 hours. Thirty-eight people, most of them working in a call center on the fourth floor, were trapped and perished in the fire. Probers said the mall

ON Feb. 14, Juan Ponce Enrile celebrated his 99th birthday with a grand celebration, attended by political heavyweights, including President Marcos Jr. and his fellow nonagenarian Imelda Marcos, reminding people of a trope that’s been running for a decade now: Enrile as the avatar of biological and political longevity.

The memes and tweets, of course, can be quite funny: Enrile having a dinosaur as his first pet, Enrile in the Garden of Eden, Enrile surviving countless plagues and pandemics, Enrile being older than many things— from the discovery of penicillin to the inauguration of the Third Reich. At one point, I joined the fun by tweeting about “nine lives of Juan Ponce Enrile,” from Marcos’ Minister of Defense and EDSA leader to Senate president and plunder suspect.

I would be proven wrong, of course, in implying that his final act is that of infamy—and today, the indefatigable Enrile is chief presidential legal counsel:

A NEWS report on Thursday, March 2 in Business Mirror that headlined “Senate grills defense brass on plans for EDCA expansion, sites” raised much curiosity for its sheer lack of detailed information. I found this unusual for a reportage by veteran newsman Butch Fernandez, whom I have known for decades.

Defense Secretary Carlito Galvez Jr. led a team that updated senators on the 2014 Enhanced Defense Cooperation Agreement (EDCA), the report began, but was confronted with questions from the chair of the foreign relations committee about the selection of new EDCA sites.

The report said Galvez briefed the senators on the following: “The status/completion rate of the five EDCA sites; purpose of each site (both old and new); benefits and risks of the sites and other matters related to EDCA.” But it did not provide a single data or detail on any of these important points of the briefing.

Had the Senate committee, or Galvez’s team, requested the reporters covering the hearing lacked a working sprinkler system.

Faulty electrical wiring was also seen as the cause of the predawn fire that struck the Manor Hotel in Quezon City on Aug. 18, 2001. Probers said the six-story building lacked fire escapes, fire alarms, water sprinklers and emergency lighting. Seventy-five people died, many of them participants in a Christian crusade organized by a Texas-based ministry.

Chemical fires can be particularly difficult to put out, so factories and other industrial installations are encouraged to be fully compliant with fire safety standards. On May 13, 2015, a fire ignited by welding sparks at the entrance to the Kentex rubber slipper factory in Valenzuela City trapped the employees as the rear gate could not be opened and there were no fire exits. It took five hours to put out the fire. By that time, over 70 people were dead including some of the owners.

Local government units should also be mindful of their responsibilities in ensuring compliance with building and fire safety codes. LGU officials in charge of inspecting buildings for compliance with the safety standards and issuing business permits have been convicted of graft and negligence in carrying out their duties in connection with deadly fires.

Last year, over 13,000 fires were reported