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Los Angeles reporter talks about how she covers the ‘megaclinic’ phenomenon Date: 10/30/15

Susan Abram

By Mary Otto

In a recent story for the Los Angeles Daily News, reporter Susan Abram informed readers that once again, a city sports arena was being transformed into a massive health clinic, and once again, hundreds of dentists, optometrists, nurses and other volunteers were preparing to offer free care to people in need.

This was not the first time Abram had covered a Los Angeles "megaclinic." But she managed to skillfully couple her reporting on past events with insights into the nation’s evolving health care system to bring a new angle to this year's story:

“…the services offered will be different compared to six years ago, when a similar event was first held at the Los Angeles Forum,” Abram wrote. “Back then, images of these megaclinics held nationwide and primarily in rural settings became symbolic of the fractured health care system before reform and the lengths many Americans would go for much needed medical and dental care. … Now, as the provisions under the Affordable Care Act take hold and more people are insured for primary care, some services at the upcoming large-scale clinic have changed while others have been expanded.”

In this Q & A, Abram reflects on the things she has learned covering urban "megaclinics" over the years. And she shares some wisdom with fellow reporters on returning to an old story with new eyes.

Q: Many of the stories about free clinics over recent years have featured events held in rural areas, but the clinics you have written about are taking place right in Los Angeles. You have described huge events, held in big city sports venues, that draw hundreds of volunteer providers and thousands of patients. Many of the patients who turn to the rural clinics for care have spoken about transportation barriers and the shortage of providers in their isolated communities, but maybe it is different in Los Angeles. What are the main challenges described by the patients you have met?

A: Most patients I've met who attend the clinics are in need of dental care. In the early days, people drove for miles to get a cavities filled, new crowns, or root canals done because those services are so expensive for many without some coverage from employers. At the first event I covered in 2009, the first man to receive free care had stayed in his car for three days in the parking lot of the Forum so he could have two root canals done. Dental care was the top need, because the state had made cuts to the Denti-Cal program, which had worked through Medi-Cal, California's version of Medicaid. A little bit of the funding has returned but not that much, which is why people still turn to the megaclinic for dental care.

Q: You are always mindful of placing these events in a larger context. You mentioned your coverage of the clinic back in 2009, organized by the nonprofit Remote Area Medical (RAM). "At a time when health care reform stumbles and staggers on Capitol Hill and incites rage at town hall meetings, RAM quietly manages to garner volunteers and in-kind cash to support the clinics," you wrote. Did the debate over the Affordable Care Act (ACA) lend a heightened sense of urgency to those efforts – and your coverage – back then?

A: I wish I knew for sure if these stories had an impact on the need for health care reform. I believe what really illustrated the urgency more than my coverage was a segment on “60 Minutes” that showed how far families who lived in rural areas would drive for free medical, dental and vision care. It was heartbreaking and difficult to believe that this was happening in the United States. I know many of us often associate the lack of basic health needs with images of families in other countries who walk miles to be seen in makeshift clinics.

Q: You made a point in your latest story of saying that needs have changed since the passage of the ACA. "The services will be different than six years ago," you wrote. While basic primary care is more available, dental and vision and mental health care are still needed. Were there enough of those services to go around this year?

A: Each year I ask that question of the organizers and they tell me there are never enough volunteers to help the nearly 4,000 people who come to the free clinic. Don Manelli, the organizer, said each year he hopes to give out less wrist bands to enter the event than the year before. That would mean that people's needs are being met, he told me.

Q: Have you gotten a sense from the organizers that the overall goals and approaches of these clinics are changing with the times?

A: Absolutely. In the beginning, they were offering primary care services that included treating people who suffered from complications relating to diabetes, for example. As time has gone on and the provisions under the Affordable Care Act take hold, more people are being cared for at community clinics. These megaclinics are now trying to offer specialized care that community clinics are struggling to offer for various reasons, including long wait lists. Also, more community clinics are offering basic dental cleanings, but dentures are still pretty costly. This year, the megaclinic was able to expand that service.

Q: You recently wrote about the dedication of a new $5 million adult wellness center in San Fernando. "The Affordable Care Act built this building," one official told you. The project included a pediatric dental suite. Are you planning more stories about how the ACA is changing the landscape for poor and undeserved people in Los Angeles?

A: Yes. With funding through the ACA, more community clinics operators are updating and re-inventing their services and their approach to attract patients of all economic backgrounds. I'm interested in this evolution, from a "doc in a box" type place to a full-service health center. Also, California is ahead in many ways, because under Covered California and the expansion of Medicare, more than 11 million people who were uninsured now have some kind of coverage, mostly Medi-Cal. In addition, Gov. Jerry Brown signed a bill that extends Med-Cal to low income, undocumented children. In Los Angeles County, a program called My Health L.A. is a county funded program that covers undocumented adults. Several California counties have similar programs, with the goal of keeping wait times and costs down at emergency departments. I hope to look into the results of those goals at some point.

Q: Finally, how do you gear up for an event that you have covered before – maybe even more than once? Covering events year after year is one of the great unsung challenges many reporters face. Please share a little wisdom on how you keep finding something new and important to say.

A: That's a great question. I began covering health before the ACA was signed, so I think that gives me some context and makes me want to know what's changed since those days when people were denied health coverage because of pre-existing conditions. I've visited the megaclinic in Los Angeles three times since that first one was organized in 2009 and each year, I want to know what's different than the year before and if it will continue as we get deeper into a different health care landscape.