From Health and Fitness

Patients Turn To GoFundMe When Money And Hope Run Out

Tammy Fox wanted to help after a friend took ill with a rare and difficult-to-diagnose autoimmune disorder that required many trips to the Mayo Clinic.

Although Fox couldn’t do anything medically, she knew there was a way to ease some of the burden of medical bills and costs associated with doctor visits. She turned to the website GoFundMe and set up a site for her friend.

“You’ve got meals; you’ve got hotel stays,” she said. “And gas. So that all needed to be covered.”

Contributions came in from strangers, noted Fox, who lives in suburban Minneapolis. “It’s crazy cool how awesome people are and what they’re willing to give. People, when they come together, can just move mountains — and I think that’s awesome to see.”

GoFundMe, the largest online, crowdsourced fundraising platform, says contributors have raised more than $5 billion, all told, from 50 million donations in the eight years it has been in business.

Setting up a GoFundMe page has also become a go-to way for people in need of help to pay their doctors and other health providers. Medical fundraisers now account for 1 in 3 of the website’s campaigns, and they bring in more money than any other GoFundMe category, said GoFundMe CEO Rob Solomon.

“In the old paradigm you would give $20 to somebody who needed help,” Solomon said. “In the new paradigm, you’ll give $20, you’ll share that and that could turn into 10, 20, 50 or 100 people doing that. So, the $20 could turn into hundreds, if not thousands, of dollars.”

Stories of tragic illness and financial hardship — all of them with pictures of those suffering — are easy to find in GoFundMe’s medical section.

One such case is musician Carolyn Deal, from Marshall, N.C., who lost nearly all her hearing after a traumatic brain injury. Deal has raised nearly $25,000 for alternative treatments and procedures she would like to try that her health insurance won’t cover.

Americans’ confidence that they can afford health care is slipping, said Sara Collins, an economist at the Commonwealth Fund who studies American health care concerns. Even for conventional treatments covered under most health plans, the copays and high deductibles have left many people with health insurance they can’t afford to use.

Her organization recently surveyed working-age Americans, asking whether they felt they had the ability to pay an unexpected medical bill of $1,000 in 30 days. Nearly half said no.

“We find that underinsured people are nearly as likely to report problems paying their medical bills as people who don’t have any insurance,” she said. “And they also report not getting needed health care at rates that are nearly as high as those who are uninsured.”

So it shouldn’t be surprising that people are raising funds through crowdsourcing, Collins said. “But it really should be a deep concern for policymakers and providers.”

Solomon acknowledges that the challenges in understanding how health insurance works and the wide-ranging coverage landscape are driving interest in the site.

“There’s just a lot of cost associated with the medical space, and it has become a very important category on GoFundMe,” he said.

Until about a year ago, GoFundMe kept 5 percent of fundraising proceeds in addition to collecting a nearly 3 percent credit card processing fee. It still charges the credit card fee but no longer collects the 5 percent surcharge.

This story is part of a partnership that includes Minnesota Public Radio, NPR and Kaiser Health News.

GoFundMe CEO: ‘Gigantic Gaps’ In Health System Showing Up In Crowdfunding

Scrolling through the GoFundMe website reveals seemingly an endless number of people who need help or community support. A common theme: the cost of health care.

It didn’t start out this way. Back in 2010, when the crowdfunding website began, it suggested fundraisers for “ideas and dreams,” “wedding donations and honeymoon registry” or “special occasions.” A spokeswoman said the bulk of collection efforts from the first year were “related to charities and foundations.” A category for medical needs existed, but it was farther down the list.

In the nine years since, campaigns to pay for health care have reaped the most cash. Of the $5 billion the company says it has raised, about a third has been for medical expenses from more than 250,000 medical campaigns conducted annually.

Take, for instance, the 25-year-old California woman who had a stroke and “needs financial support for rehabilitation, home nursing, medical equipment and uncovered medical expenses.” Or the Tennessee couple who want to get pregnant, but whose insurance doesn’t cover the $20,000 worth of “medications, surgeries, scans, lab monitoring, and appointments [that] will need to be paid for upfront and out-of-pocket” for in vitro fertilization.

The prominence of the medical category is the symptom of a broken system, according to CEO Rob Solomon, 51, who has a long tech résumé as an executive at places like Groupon and Yahoo. He said he never realized how hard it was for some people to pay their bills: “I needed to understand the gigantic gaps in the system.”

This year, Time Magazine named Solomon one of the 50 most influential people in health care.

“We didn’t build the platform to focus on medical expenses,” Solomon said. But it turned out, he said, to be one of those “categories of need” with which many people struggle.

Solomon talked to Kaiser Health News’ Rachel Bluth about his company’s role in financing health care and what it says about the system when so many people rely on the kindness of strangers to get treatment. The conversation has been edited for length and clarity.

Q: KHN and other news outlets have reported that hospitals often advise patients to crowdfund their transplants. It’s become almost institutionalized to use GoFundMe. How do you feel about that?

It saddens me that this is a reality. Every single day on GoFundMe we see the huge challenges people face. Their stories are heartbreaking.

Some progress has been made here and there with the Affordable Care Act, and it’s under fire, but there’s ever-widening gaps in coverage for treatment, for prescriptions, for everything related to health care costs. Even patients who have insurance and supposedly decent insurance [come up short]. We’ve become an indispensable institution, indispensable technology and indispensable platform for anyone who finds themselves needing help because there just isn’t adequate coverage or assistance.

I would love nothing more than for “medical” to not be a category on GoFundMe. The reality is, though, that access to health care is connected to the ability to pay for it. If you can’t do that, people die. People suffer. We feel good that our platform is there when people need it.

Q: Did anyone expect medical funding would become such a big part of GoFundMe?

I don’t think anyone anticipated it. What we realized early on is that medical need is a gigantic category.

A lot of insurance doesn’t cover clinical trials and research and things like that, where people need access to leading-edge potential treatments. We strive to fill these gaps until the institutions that are supposed to handle this handle it properly. There has to be a renaissance, a dramatic change in public policy, in how the government focuses on this and how the health care companies solve this.

This is very interesting. In the places like the United Kingdom, Canada and other European countries that have some form of universal or government-sponsored health coverage, medical [costs] are still the largest category. So it’s not just medical bills for treatment. There’s travel and accommodations for families who have to support people when they fall ill.

Q: What have you learned that you didn’t know before?

I guess what I realized [when I came] to this job is that I had no notion of how severe the problem is. You read about the debate about single-payer health care and all the issues, the partisan politics. What I really learned is the health care system in the United States is really broken. Way too many people fall through the cracks.

The government is supposed to be there and sometimes they are. The health care companies are supposed to be there and sometimes they are. But for literally millions of people they’re not. The only thing you can really do is rely on the kindness of friends and family and community. That’s where GoFundMe comes in.

I was not ready for that at all when I started at the company. When you live and breathe it every day and you see the need that exists, when you realize there are many people with rare diseases but they aren’t diseases a drug company can make money from, they’re just left with nothing.

Q: But what does this say about the system?

The system is terrible. It needs to be rethought and retooled. Politicians are failing us. Health care companies are failing us. Those are realities. I don’t want to mince words here. We are facing a huge potential tragedy. We provide relief for a lot of people. But there are people who are not getting relief from us or from the institutions that are supposed to be there. We shouldn’t be the solution to a complex set of systemic problems. They should be solved by the government working properly, and by health care companies working with their constituents. We firmly believe that access to comprehensive health care is a right and things have to be fixed at the local, state and federal levels of government to make this a reality.

Q: Do you ever worry that medical fundraising on your site is taking away from other causes or other things that need to be funded?

We have billions being raised on our platform on an annual basis. Everything from medical, memorial and emergency, to people funding Little League teams and community projects.

Another thing that’s happened in the last few years is we’ve really become the “take action button.” Whenever there’s a news cycle on something where people want to help, they create GoFundMe campaigns. This government shutdown, for example: We have over a thousand campaigns right now for people who have been affected by it — they’re raising money for people to pay rent, mortgages, car payments while the government isn’t.

Americans Are Now More Likely To Die In An Accidental Opioid Overdose Than A Car Crash

But most Americans are still most likely to die of natural causes such as heart disease or cancer. In other news on the opioid crisis: a mass drug overdose in California leaves at least one dead and more than a dozen in care; Purdue asks the court to review a decision about unsealing the company’s secret records; can medical marijuana help in the fight against the epidemic; and more.

Scientists Take Issue With Anti-Abortion Movement’s ‘Pro Life Is Pro Science’ Slogan

The “pro-science” emphasis is a somewhat new one for the anti-abortion advocates, who are gearing up for the March for Life on Friday, but March leaders say now is the perfect time to embrace the slogan. Scientists in the field, however, say the movement’s vocal opposition to fetal tissue research is at fundamental odds with the “pro-science” branding.

How Reselling Unused Test Strips For Blood Glucose Is Driving An Unusual Trade Online And On The Streets

Often the sellers of the strips are insured and paid little out of pocket for them, while the buyers may be underinsured or uninsured, and unable to pay retail prices, which can run well over $100 for a box of 100 strips. Unlike the resale of prescription drugs, which is prohibited by law, it is generally legal to resell unused test strips.

House Dems Open Investigation Into Pharma’s Drug Pricing Strategies, Calling The Probe One Of The Broadest In Decades

House Oversight and Reform Committee Chairman Elijah Cummings sent letters to drugmakers requesting detailed information about their pricing practices, focusing on drugs that are the costliest to Medicare Part D as well as drugs that have had the largest increases over a five-year period. The move is just the latest in a flurry of legislation and congressional action taken on the topic of high drug prices this year.

California’s Top Lawyer Cements His Role As Health Care Defender-In-Chief

SACRAMENTO, Calif. — Xavier Becerra, the political savvy Democratic attorney general of California, has sued the Trump administration 45 times in the past two years, often with much fanfare.

In winning a legal challenge Sunday against new government rules limiting birth control, he once against cemented himself as a national figure leading a fight against the administration across a range of issues — especially health care.

The 12 other states and the District of Columbia that had joined Becerra’s lawsuit also gained a last-minute reprieve from the federal regulations that would have taken effect Monday. They would have allowed most employers to refuse to provide insurance coverage for workers’ birth control by raising a religious or moral objection.

Those rules were also halted for the rest of the country on Monday when a Pennsylvania judge granted a nationwide injunction in a similar lawsuit.

The contraception case is one of several fronts where Becerra has led state coalitions to defend the Affordable Care Act in lawsuits in Texas, California and Washington, D.C.

“The Trump administration is trying to chip away at those protections,” said Andrew Kelly, an assistant professor at the Department of Health Sciences at California State University-East Bay. “It’s left to states like California and Attorney General Becerra in taking a lead in confronting these efforts.”

Becerra is perhaps best known for leading the opposition to the Texas v. U.S. lawsuit. In that suit, the Texas attorney general argued that the Affordable Care Act should be rendered unconstitutional because Congress eliminated the tax penalty on the uninsured. A federal judge last month sided with Texas, ruling that the federal health care law is unconstitutional.

Becerra, who said he helped write the health care law, said he felt compelled to step in when the Trump administration decided not to defend the law. Sixteen states and the District of Columbia joined that lawsuit, which is now on appeal.

The multistate strategy is one that attorneys general have used often in the past few decades when they don’t agree with policies coming out of Washington, legal and political experts say. And it’s not unique to one political party.

Republican attorneys general, for example, sued the Obama administration to block the expansion of Medicaid in their states. When George W. Bush was president, the state of Massachusetts led Democratic states in an effort to force the Environmental Protection Agency to regulate greenhouse gas emissions from cars.

The legal tit for tat is what Nicholas Bagley, a professor at the University of Michigan Law School, described as a disconcerting “militarization” of the state attorneys general offices to press an agenda in the courts.

“At a time of polarized politics, there’s every incentive to pull whatever levers are available to you to try to advance your goals,” Bagley said. “Over time, the state attorneys general have come to the view that the courts are an important forum to have these fights over important questions.”

The behavior of the attorneys general also comes in response to an administration that is using its executive authority to push initiatives that it can’t get Congress to approve.

President Donald Trump is left “to try to use either the regulatory process or executive order to accomplish his goals,” said Gerald Kominski, a professor of health policy at UCLA. “Anyone who opposes those goals has to proceed through the legal process to challenge them.”

Becerra, the first Latino to serve as California attorney general, has sued the Trump administration on a wide range of issues: health care, immigration, the Muslim travel ban, citizenship questions on the census, the border wall, climate change and clean-water rules.

When the former congressman was sworn in to his second term last week, he declared that he had “been a little busy keeping the dysfunction and insanity in Washington, D.C., from affecting California,” and defending the state from the “overreach of the federal government.” And he doesn’t have any plans to let up.

“Whether it’s the criminals on our streets or the con man in the boardrooms or the highest office of the land,” Becerra said, “we’ve got your back.”

But Becerra’s record has been mixed.

The victory in court Sunday was limited. Oakland-based U.S. District Judge Haywood Gilliam Jr. blocked the rules from taking effect in the District of Columbia and the 13 states that challenged them, but he refused to stop them from taking effect in the rest of the country. That national reprieve came a day later in a Pennsylvania court, with U.S. District Judge Wendy Beetlestone describing the harm to women as “actual and imminent.”

If the administration appeals, as expected, Pennsylvania, along with California and its legal coalition would move ahead with their cases to permanently throw out the rules, arguing that the Affordable Care Act guaranteed women no-cost contraception as part of their preventive health care, a provision that they say has benefited more than 62 million women since 2012, when the regulations went into effect.

The Trump rules, California argued in legal filings, would “transform contraceptive coverage from a legal entitlement to an essentially gratuitous benefit wholly subject to an employer’s discretion.” In its proposed regulations, the U.S. Department of Health and Human Services described the exemption as narrow and one that would affect a fraction of women — no more than 127,000.

That’s a number Becerra disputes.

In claiming victory on the birth control lawsuit, Becerra said Sunday that his coalition will continue to advocate for women’s access to reproductive health care.

How much more will Becerra fight during the next four years? Addressing the crowd who gathered this month to see him sworn in to a second term, he conveyed a simple response:

“The sky is the limit.”


This story was produced by Kaiser Health News, which publishes California Healthline, a service of the California Health Care Foundation.

California’s Top Lawyer Cements His Role As Health Care Defender-In-Chief

SACRAMENTO, Calif. — Xavier Becerra, the political savvy Democratic attorney general of California, has sued the Trump administration 45 times in the past two years, often with much fanfare.

In winning a legal challenge Sunday against new government rules limiting birth control, he once against cemented himself as a national figure leading a fight against the administration across a range of issues — especially health care.

The 12 other states and the District of Columbia that had joined Becerra’s lawsuit also gained a last-minute reprieve from the federal regulations that would have taken effect Monday. They would have allowed most employers to refuse to provide insurance coverage for workers’ birth control by raising a religious or moral objection.

Those rules were also halted for the rest of the country on Monday when a Pennsylvania judge granted a nationwide injunction in a similar lawsuit.

The contraception case is one of several fronts where Becerra has led state coalitions to defend the Affordable Care Act in lawsuits in Texas, California and Washington, D.C.

“The Trump administration is trying to chip away at those protections,” said Andrew Kelly, an assistant professor at the Department of Health Sciences at California State University-East Bay. “It’s left to states like California and Attorney General Becerra in taking a lead in confronting these efforts.”

Becerra is perhaps best known for leading the opposition to the Texas v. U.S. lawsuit. In that suit, the Texas attorney general argued that the Affordable Care Act should be rendered unconstitutional because Congress eliminated the tax penalty on the uninsured. A federal judge last month sided with Texas, ruling that the federal health care law is unconstitutional.

Becerra, who said he helped write the health care law, said he felt compelled to step in when the Trump administration decided not to defend the law. Sixteen states and the District of Columbia joined that lawsuit, which is now on appeal.

The multistate strategy is one that attorneys general have used often in the past few decades when they don’t agree with policies coming out of Washington, legal and political experts say. And it’s not unique to one political party.

Republican attorneys general, for example, sued the Obama administration to block the expansion of Medicaid in their states. When George W. Bush was president, the state of Massachusetts led Democratic states in an effort to force the Environmental Protection Agency to regulate greenhouse gas emissions from cars.

The legal tit for tat is what Nicholas Bagley, a professor at the University of Michigan Law School, described as a disconcerting “militarization” of the state attorneys general offices to press an agenda in the courts.

“At a time of polarized politics, there’s every incentive to pull whatever levers are available to you to try to advance your goals,” Bagley said. “Over time, the state attorneys general have come to the view that the courts are an important forum to have these fights over important questions.”

The behavior of the attorneys general also comes in response to an administration that is using its executive authority to push initiatives that it can’t get Congress to approve.

President Donald Trump is left “to try to use either the regulatory process or executive order to accomplish his goals,” said Gerald Kominski, a professor of health policy at UCLA. “Anyone who opposes those goals has to proceed through the legal process to challenge them.”

Becerra, the first Latino to serve as California attorney general, has sued the Trump administration on a wide range of issues: health care, immigration, the Muslim travel ban, citizenship questions on the census, the border wall, climate change and clean-water rules.

When the former congressman was sworn in to his second term last week, he declared that he had “been a little busy keeping the dysfunction and insanity in Washington, D.C., from affecting California,” and defending the state from the “overreach of the federal government.” And he doesn’t have any plans to let up.

“Whether it’s the criminals on our streets or the con man in the boardrooms or the highest office of the land,” Becerra said, “we’ve got your back.”

But Becerra’s record has been mixed.

The victory in court Sunday was limited. Oakland-based U.S. District Judge Haywood Gilliam Jr. blocked the rules from taking effect in the District of Columbia and the 13 states that challenged them, but he refused to stop them from taking effect in the rest of the country. That national reprieve came a day later in a Pennsylvania court, with U.S. District Judge Wendy Beetlestone describing the harm to women as “actual and imminent.”

If the administration appeals, as expected, Pennsylvania, along with California and its legal coalition would move ahead with their cases to permanently throw out the rules, arguing that the Affordable Care Act guaranteed women no-cost contraception as part of their preventive health care, a provision that they say has benefited more than 62 million women since 2012, when the regulations went into effect.

The Trump rules, California argued in legal filings, would “transform contraceptive coverage from a legal entitlement to an essentially gratuitous benefit wholly subject to an employer’s discretion.” In its proposed regulations, the U.S. Department of Health and Human Services described the exemption as narrow and one that would affect a fraction of women — no more than 127,000.

That’s a number Becerra disputes.

In claiming victory on the birth control lawsuit, Becerra said Sunday that his coalition will continue to advocate for women’s access to reproductive health care.

How much more will Becerra fight during the next four years? Addressing the crowd who gathered this month to see him sworn in to a second term, he conveyed a simple response:

“The sky is the limit.”


This story was produced by Kaiser Health News, which publishes California Healthline, a service of the California Health Care Foundation.

Providers Walk ‘Fine Line’ Between Informing And Scaring Immigrant Patients

While the Trump administration decides whether to adopt a controversial policy that could jeopardize the legal status of immigrants who use public programs such as Medicaid, doctors and clinics are torn between informing patients about the potential risks and unnecessarily scaring them into dropping their coverage or avoiding care.

“We are walking a fine line,” said Tara McCollum Plese, chief external affairs officer at the Arizona Alliance for Community Health Centers, which represents 176 clinics. “Until there is confirmation this indeed is going to be the policy, we don’t want to add to the angst and the concern.”

However, if immigrants do come to a clinic wondering whether using Medicaid can affect their legal status, trained staff members will answer their questions, she said.

Other providers prefer to prepare their patients proactively in case the proposal is adopted. At Asian Health Services, a clinic group that serves Alameda County, Calif., staff members pass out fact sheets about the proposed changes, provide updates via their patient newsletter and host workshops where patients can speak to legal experts in several Asian languages.

“We can’t just sit back and watch,” said CEO Sherry Hirota. “We allocate resources to this because that’s part of our job as a community health center — to be there not only when they’re covered, but to be there always,” even when that coverage is in jeopardy, she said.

The proposed “public charge” rule, which is awaiting final action by the U.S. Department of Homeland Security, would allow the federal government to consider immigrants’ use of an expanded list of public benefit programs including Medicaid, CalFresh and Section 8 housing as a reason to deny lawful permanent residency — also known as green card status. Medicaid is the state-federal health insurance program for low-income people.

Currently, people are considered public charges if they rely on cash assistance (Temporary Assistance for Needy Families or Supplemental Security Income) or need federal help paying for long-term care.

Should the rule go into effect, it could force patients to choose between health care and their chance at a green card, McCollum Plese said. “And most people will probably not take the services,” she said.

The rule would not be retroactive, meaning it wouldn’t take into account past use of public benefits like Medicaid, according to legal experts.

But health centers and medical providers know that if they tell patients about it now, they risk scaring some of them into premature decisions about their benefits, including dropping coverage.

Some immigrant patients already are skipping medical appointments out of fear stoked by the proposed rule, providers and advocates report.

“For now, our focus has been on correcting misinformation, not necessarily raising awareness among those who haven’t heard about the potential changes,” said Erin Pak, CEO of KHEIR Center, a clinic group with three locations in Los Angeles. “This is a proposal that thrives on fear and misunderstanding, so we wanted to be thoughtful about how and when to engage patients on the issue, given that nothing has passed into law.”

The Department of Homeland Security is reviewing more than 200,000 comments from the public before it issues a final rule. It’s possible the department won’t adopt the rule at all, legal experts say.

At KHEIR Center, the patient population is predominantly Korean immigrants, a group that is highly aware of the proposed public charge rule because of the coverage it has received in Korean-language media, according to Kirby Van Amburgh, the center’s director of external affairs.

Other groups served by the clinic, such as Latino and Bengali immigrants, have asked few questions, she said.

Trained staff address patients’ questions one-on-one, and hand out a fact sheet when needed.

Last month, L.A. Care health plan, which covers more than 2 million Medicaid enrollees in Los Angeles County, hosted a public charge webinar for about 180 providers. David Kane, an attorney at Neighborhood Legal Services of Los Angeles, led the webinar and urged doctors to tell concerned patients that nothing has changed yet, and that most immigrants would not be affected.

He also explained that if the federal government adopts the rule, it would not be effective immediately. There would most likely be a 60-day grace period before the changes take effect, Kane said. After that, implementation could be further delayed in court.

John Baackes, CEO of L.A. Care, who has been critical of the public charge proposal, said his organization offered the webinar because of the estimated 170,000 legal immigrants on his plan who could potentially be affected.

“I think we’ve got to let people know what could come, and try to give them more accurate information so that they don’t act imprudently,” he said. To do that, “we have to stay current.”


This story was produced by Kaiser Health News, which publishes California Healthline, a service of the California Health Care Foundation.

Providers Walk ‘Fine Line’ Between Informing And Scaring Immigrant Patients

While the Trump administration decides whether to adopt a controversial policy that could jeopardize the legal status of immigrants who use public programs such as Medicaid, doctors and clinics are torn between informing patients about the potential risks and unnecessarily scaring them into dropping their coverage or avoiding care.

“We are walking a fine line,” said Tara McCollum Plese, chief external affairs officer at the Arizona Alliance for Community Health Centers, which represents 176 clinics. “Until there is confirmation this indeed is going to be the policy, we don’t want to add to the angst and the concern.”

However, if immigrants do come to a clinic wondering whether using Medicaid can affect their legal status, trained staff members will answer their questions, she said.

Other providers prefer to prepare their patients proactively in case the proposal is adopted. At Asian Health Services, a clinic group that serves Alameda County, Calif., staff members pass out fact sheets about the proposed changes, provide updates via their patient newsletter and host workshops where patients can speak to legal experts in several Asian languages.

“We can’t just sit back and watch,” said CEO Sherry Hirota. “We allocate resources to this because that’s part of our job as a community health center — to be there not only when they’re covered, but to be there always,” even when that coverage is in jeopardy, she said.

The proposed “public charge” rule, which is awaiting final action by the U.S. Department of Homeland Security, would allow the federal government to consider immigrants’ use of an expanded list of public benefit programs including Medicaid, CalFresh and Section 8 housing as a reason to deny lawful permanent residency — also known as green card status. Medicaid is the state-federal health insurance program for low-income people.

Currently, people are considered public charges if they rely on cash assistance (Temporary Assistance for Needy Families or Supplemental Security Income) or need federal help paying for long-term care.

Should the rule go into effect, it could force patients to choose between health care and their chance at a green card, McCollum Plese said. “And most people will probably not take the services,” she said.

The rule would not be retroactive, meaning it wouldn’t take into account past use of public benefits like Medicaid, according to legal experts.

But health centers and medical providers know that if they tell patients about it now, they risk scaring some of them into premature decisions about their benefits, including dropping coverage.

Some immigrant patients already are skipping medical appointments out of fear stoked by the proposed rule, providers and advocates report.

“For now, our focus has been on correcting misinformation, not necessarily raising awareness among those who haven’t heard about the potential changes,” said Erin Pak, CEO of KHEIR Center, a clinic group with three locations in Los Angeles. “This is a proposal that thrives on fear and misunderstanding, so we wanted to be thoughtful about how and when to engage patients on the issue, given that nothing has passed into law.”

The Department of Homeland Security is reviewing more than 200,000 comments from the public before it issues a final rule. It’s possible the department won’t adopt the rule at all, legal experts say.

At KHEIR Center, the patient population is predominantly Korean immigrants, a group that is highly aware of the proposed public charge rule because of the coverage it has received in Korean-language media, according to Kirby Van Amburgh, the center’s director of external affairs.

Other groups served by the clinic, such as Latino and Bengali immigrants, have asked few questions, she said.

Trained staff address patients’ questions one-on-one, and hand out a fact sheet when needed.

Last month, L.A. Care health plan, which covers more than 2 million Medicaid enrollees in Los Angeles County, hosted a public charge webinar for about 180 providers. David Kane, an attorney at Neighborhood Legal Services of Los Angeles, led the webinar and urged doctors to tell concerned patients that nothing has changed yet, and that most immigrants would not be affected.

He also explained that if the federal government adopts the rule, it would not be effective immediately. There would most likely be a 60-day grace period before the changes take effect, Kane said. After that, implementation could be further delayed in court.

John Baackes, CEO of L.A. Care, who has been critical of the public charge proposal, said his organization offered the webinar because of the estimated 170,000 legal immigrants on his plan who could potentially be affected.

“I think we’ve got to let people know what could come, and try to give them more accurate information so that they don’t act imprudently,” he said. To do that, “we have to stay current.”


This story was produced by Kaiser Health News, which publishes California Healthline, a service of the California Health Care Foundation.