Health
Study: Fewer Struggle with Medical Costs as Coverage Grows

This Nov. 12, 2014 file photo shows the HealthCare.gov website, where people can buy health insurance, on a laptop screen, shown in Portland, Ore. (AP Photo/Don Ryan, File)
RICARDO ALONSO-ZALDIVAR, Associated Press
WASHINGTON (AP) — Not only do more Americans have health insurance, but the number struggling with medical costs has dropped since President Barack Obama’s health care law expanded coverage, according to a study released Thursday.
The Commonwealth Fund’s biennial health insurance survey found that the share of U.S. adults who did not get needed care because of cost dropped from 43 percent in 2012 to 36 percent last year, as the health care law’s main coverage expansion went into full swing.
The proportion of people who got treatment but had problems paying their bills also dropped, from 41 percent in 2012 to 35 percent last year.
It was the first time that either measure of financial distress declined since the survey began asking the questions, in 2003 and 2005, respectively.
“Expanded insurance coverage is helping people get the care they need by reducing financial barriers to care,” the study said.
The health care law offers subsidized private insurance to people who don’t have coverage on the job, combined with expanded Medicaid in states that agree to broaden eligibility for that safety-net program.
Soon after the coverage expansion launched last year, a large ongoing survey by Gallup started documenting a sustained drop in the number of uninsured people. The Commonwealth Fund survey fills out that picture by adding details about the affordability of care.
The New York-based Commonwealth Fund is a private foundation dedicated to expanding coverage and improving the quality and cost-effectiveness of the health care system. While those goals generally align with Obama’s health care law, the group is nonpartisan.
The findings come at a crucial juncture for Obama’s law, as the Supreme Court prepares to hear another challenge from opponents committed to rolling it back. Republicans newly in charge of Congress are also planning more repeal votes.
Plaintiffs in the court case argue that the law as written only allows the federal government to subsidize coverage in states that have set up their own insurance markets. Supporters of the law say that while its wording may be confusing, Congress intended for subsidies to be available across the country, regardless of state actions.
Since Washington is currently running the insurance markets in 37 states, a ruling favoring of the plaintiffs would unravel coverage gains in many states.
Among the survey’s other highlights:
—The improvements in affordability are tempered. Many insured people still have problems paying medical bills, partly due to skimpy coverage that shifts costs to patients. That puts even many low-income workers with health insurance in a predicament. Thirty-three percent of insured adults with incomes under 200 percent of the federal poverty level ($47,100 for a family of four) said they did not get needed care in the past year because of costs.
—While nationally the share of Americans without health insurance declined from 20 percent in 2010 to 16 percent by the second half of 2014, a divide has opened between states that agreed to expand Medicaid and states choosing not to. Thirty-five percent of adults below the poverty line remained uninsured in states that did not expand eligibility, compared with 19 percent in states that did.
—Hispanics continued to lag other ethnic groups in coverage, despite the health care law. In 2014, 34 percent of Latinos were still uninsured, compared to 18 percent of African Americans and 10 percent of whites.
The Commonwealth Fund survey was conducted by Princeton Survey Research Associates International from July 22 to Dec. 14, 2014. The report’s analysis was based on interviews with 4,251 adults age 19-64. It has a margin of sampling error of plus or minus 2 percentage points.
Copyright 2015 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.
Advice
Support Your Child’s Mental Health: Medi-Cal Covers Therapy, Medication, and More
Advertorial
When children struggle emotionally, it can affect every part of their lives — at home, in school, with friends, and even their physical health. In many Black families, we’re taught to be strong and push through. But our kids don’t have to struggle alone. Medi-Cal provides mental health care for children and youth, with no referral or diagnosis required.
Through California Advancing and Innovating Medi-Cal (CalAIM), the state is transforming how care is delivered. Services are now easier to access and better connected across mental health, physical health, and family support systems. CalAIM brings care into schools, homes, and communities, removing barriers and helping children get support early, before challenges escalate.
Help is Available, and it’s Covered
Under Medi-Cal, every child and teen under age 19 has the right to mental health care. This includes screenings, therapy, medication support, crisis stabilization, and help coordinating services. Parents, caregivers, and children age 12 or older can request a screening at any time, with no diagnosis or referral required.
Medi-Cal’s Mental Health and Substance Use Disorder Program
For children and youth with more serious mental health needs, including those in foster care or involved in the justice system, Medi-Cal offers expanded support, including:
- Family-centered and community-based therapy to address trauma, behavior challenges, or system involvement.
- Wraparound care teams that help keep children safely at home or with relatives.
- Activity funds that support healing through sports, art, music, and therapeutic camps.
- Initial joint behavioral health visits, where a mental health provider and child welfare worker meet with the family early in a case.
- Child welfare liaisons in Medi-Cal health plans who help caregivers and social workers get services for children faster
Keeping Kids Safe from Opioids and Harmful Drugs
DHCS is also working to keep young people safe as California faces rising risks from opioids and counterfeit pills. Programs like Elevate Youth California and Friday Night Live give teens mentorship, leadership opportunities, and positive outlets that strengthen mental well-being.
Through the California Youth Opioid Response, families can learn how to avoid dangerous substances and get treatment when needed. Song for Charlie provides parents and teens with facts and tools to talk honestly about mental health and counterfeit pills.
DHCS also supports groups like Young People in Recovery, which helps youth build skills for long-term healing, and the Youth Peer Mentor Program, which trains teens with lived experience to support others. These efforts are part of California’s strategy to protect young people, prevent overdoses, and help them make healthier choices.
Support for Parents and Caregivers
Children thrive when their caregivers are supported. Through CalAIM’s vision of whole-person care, Medi-Cal now covers dyadic services, visits where a child and caregiver meet together with a provider to strengthen bonding, manage stress, and address behavior challenges.
These visits may include screening the caregiver for depression or anxiety and connecting them to food, housing, or other health-related social needs, aligning with CalAIM’s Community Supports framework. Notably, only the child must be enrolled in Medi-Cal to receive dyadic care.
Family therapy is also covered and can take place in clinics, schools, homes, or via telehealth, reflecting CalAIM’s commitment to flexible, community-based care delivery.
Additionally, BrightLife Kids offers free tools, resources, and virtual coaching for caregivers and children ages 0–12. Families can sign up online or through the BrightLife Kids app. No insurance, diagnosis, or referral is required.
For teens and young adults ages 13–25, California offers Soluna, a free mental health app where young people can chat with coaches, learn coping skills, journal, or join supportive community circles. Soluna is free, confidential, available in app stores, and does not require insurance.
CalHOPE also provides free emotional support to all Californians through a 24/7 support line at (833) 317-HOPE (4673), online chat, and culturally responsive resources.
Support at School — Where Kids Already Are
Schools are often the first place where emotional stress is noticed. Through the Children and Youth Behavioral Health Initiative (CYBHI), public schools, community colleges, and universities can offer therapy, counseling, crisis support, and referrals at no cost to families.
Services are available during school breaks and delivered on campus, by phone or video, or at community sites. There are no copayments, deductibles, or bills.
Medi-Cal Still Covers Everyday Care
Medi-Cal continues to cover everyday mental health care, including therapy for stress, anxiety, depression, or trauma; medication support; crisis stabilization; hospital care when needed; and referrals to community programs through county mental health plans and Medi-Cal health plans.
How to Get Help
- Talk to your child’s teacher, school counselor, or doctor.
- In Alameda County call 510-272-3663 or the toll-free number 1-800-698-1118 and in San Francisco call 855-355-5757 to contact your county mental health plan to request an assessment or services.
- If your child is not enrolled in Medi-Cal, you can apply at com or my.medi-cal.ca.gov.
- In a mental health emergency, call or text 988, the Suicide and Crisis Lifeline.
Every child deserves to grow up healthy and supported. Medi-Cal is working to transform care so it’s accessible, equitable, and responsive to the needs of every family.
Activism
Essay: Intentional Self Care and Community Connections Can Improve Our Wellbeing
At the deepest and also most expansive level of reality, we are all part of the same being, our bodies made from the minerals of the earth, our spirits infused by the spiritual breath that animates the universe. Willingness to move more deeply into fear and pain is the first step toward moving into a larger consciousness. Willingness to move beyond the delusion of our separateness can show us new ways of working and living together.
By Dr. Lorraine Bonner, Special to California Black Media Partners
I went to a medical school that was steeped in the principles of classical Western medicine. However, I also learned mindfulness meditation during that time, which opened me to the multifaceted relationship between illnesses and the interconnecting environmental, mental and emotional realities that can impact an individual’s health.
Therefore, when I began to practice medicine, I also pursued training in hypnosis, relaxation techniques, meditation, and guided imagery, to bring a mind-body focus to my work in medical care and prevention.
The people I saw in my practice had a mix of problems, including high blood pressure, diabetes, and a variety of pain issues. I taught almost everyone relaxation breathing and made some general relaxation tapes. To anyone willing, I offered guided imagery.
“My work embraced an approach to wellness I call “Liberatory Health” — one that not only addresses the treatment and management of disease symptoms but also seeks to dismantle the conditions that make people sick in the first place.”
From my perspective, illness is only the outermost manifestation of our efforts to cope, often fueled by addictions such as sugar, tobacco, or alcohol, shackled by an individualistic cult belief that we have only ourselves to blame for our suffering.
At the deepest and also most expansive level of reality, we are all part of the same being, our bodies made from the minerals of the earth, our spirits infused by the spiritual breath that animates the universe. Willingness to move more deeply into fear and pain is the first step toward moving into a larger consciousness. Willingness to move beyond the delusion of our separateness can show us new ways of working and living together.
To put these ideas into practical form, I would quote the immortal Mr. Rogers: “Find the helpers.” There are already people in every community working for liberation. Some of them are running for office, others are giving food to those who need it. Some are volunteering in schools, libraries or hospitals. Some are studying liberation movements, or are working in urban or community gardens, or learning to practice restorative and transformative justice, or creating liberation art, music, dance, theater or writing. Some are mentoring high schoolers or apprenticing young people in a trade. There are many places where compassionate humans are finding other humans and working together for a better world.
A more compassionate world is possible, one in which we will all enjoy better health. Creating it will make us healthier, too.
In community, we are strong. Recognizing denial and overcoming the fragmenting effects of spiritual disorder offer us a path to liberation and true health.
Good health and well-being are the collective rights of all people!
About the Author
Dr. Lorraine Bonner is a retired physician. She is also a sculptor who works in clay, exploring issues of trust, trustworthiness and exploitation, as well as visions of a better world.
Activism
Prescribing Prevention: Doctors Turn to Lifestyle, Herbs and Veggies to Protect Against Chronic Illness in Black Californians
By Charlene Muhammad, California Black Media
Leibo Glover received his diabetes diagnosis at the same time he found out he needed a below-the-knee amputation.
“Minor,” thought the 63-year-old.
Glover had been self-medicating a toe injury before seeing the doctor.
But while driving from South Los Angeles to Miami on a family trip, an infection set in.
“I had it but didn’t know,” said Glover. “I was just going to come back to California, but they told me if I had left, I would have come home as a corpse,” Glover told California Black Media (CBM).
A majority of the nearly 3.5 million Californians diagnosed with diabetes have preventable Type 2 diabetes, according to researchers at the UCLA Center for Health Policy Research.
In 2023, diabetes was diagnosed in 1 in 6 adults with the lowest incomes (16.7% at 0–99% of the federal poverty line), compared to 1 in 11 adults with the highest incomes (8.9% at 300% or more of the federal poverty line). Age is a factor, too: more than 1 in 5 older adults age 65 and over (22.3%) had diabetes, about twice the rate of adults age 18–64 (8.6%).
Another study by Health Economics and Evaluation Research (HEER) mapped patients with diabetes in California who had amputations. Researchers found that patients living in low-income ZIP codes were far more likely to have had lower-limb amputations than those in higher-income ZIP codes, essentially identifying amputation “hot spots.”
At the time of Glover’s 2018 diagnosis, he was experiencing housing instability and going through financial hardships. Now, he has more stable housing and he has improved his health through lifestyle changes like eating healthier and getting more sleep.
“If the equipment is right, I can stand on my leg for hours. I can actually run, jump, dance and all of that,” said Glover, who got his diabetes under control, in part, by avoiding carbohydrates and sugars.
As chronic illnesses continue to disproportionately impact Black Californians — often leading to preventable amputations and premature deaths — a growing number of doctors and advocates are expanding their care from just treatment to including prevention. From promoting diet and lifestyle changes to cultivating community farms focused on prevention and wellness like Dr. Bill Releford’s Bloom Ranch in Acton.
Releford, a podiatrist based in Los Angeles started the 250-acre Bloom Ranch in 2023 as part of his strategy for preventive care.
“This is my assignment,” said Releford.
“Bloom Ranch has been a perfect backdrop for me to be creative and to find avant-garde ways to make fresh fruits and vegetables more accessible to food deserts in Los Angeles County,” he stated.
California produces nearly half of the nation’s fruits and vegetables, yet more than 1 in 5 Californians — about 8.8 million people — currently struggle with food insecurity, according to the California Association of Food Banks.
“Studies have shown that 75% of amputations are preventable. And African Americans have the highest amputation rate in the nation,” Releford said.
As such, Releford continued, the mortality rate associated with high-level amputation is 50%, which means “if we had 10 people that all had high level amputations, five of those would be deceased in three years.”

Monday, June 28, 2025. Leibo Glover at his home in Los Angeles, California. The security professional’s leg was amputated below the knee.
Releford’s ranch is the largest Black-owned farm in L.A. County. He plans to partner with UCLA and the Charles R. Drew University of Medicine and Science to develop prescriptive vegetable boxes.
“Certain vegetables and herbs can lower blood pressure naturally, like beets, turnips, dill, basil, garlic and others,” said Releford.
“Hopefully, this will inspire other farmers to take this model and replicate it across other urban areas,” Releford added.
“A lot of studies have shown that gardening has so many health benefits – being in the sun, Vitamin D,” said Releford. “The dirt has a lot of microbes that are good for your immune system. Studies have shown that people who work in the dirt have strong immune systems.”
Gardening can potentially decrease the risk of dementia, enhance cognition, reduce stress, and boost immunity, indicates research by Genoa Barrow of the University of Southern California Center for Health Journalism as part of the 2024 Ethnic Media Collaborative, Healing California.
During a recent picturesque day at Bloom Ranch, families, school children, farmers and members of The Ultimate Book Club 1998, founded by Alina Anderson, sampled and purchased fresh produce while taking photographs.
“This is huge. “All of us have families that could use this information,” said Anderson.
Doctors like Releford, who are committed to tackling the most chronic diseases impacting all their patients utilize peer-to-peer support programs with self-management training led by individuals living with chronic conditions to provide role models and support for patients, according to a recent study by the California Health Care Foundation.
“The unifying feature of these programs is that they seek to build on the strengths, knowledge, and experience that peers can offer,” the report states.
Liz Helms, CEO of the California Chronic Care Coalition, addressed state-backed prevention policy and initiatives.
“It’s in horrible shape. It needs to get so much better, especially in underserved areas, where the Black population has a whole set of different needs,” she said.
Helms, who started advocacy after being denied access to care in the early 1990s, applauded new developments in telehealth. The opportunity to choose between visiting a doctor’s office or placing a phone call makes a difference, especially if there are transportation or distance issues, or if one is too sick, she said.
Fear is one thing people, especially in the Black community, must overcome, emphasized Helms.
“I had to get over my fear of going to the doctor, of not speaking up,” continued Helms, urging patients to “understand the baseline” of their health.
“Don’t let anyone stigmatize you or tell you that you’re not good enough to get care or look down on you. Everyone has a right to good, quality, affordable, timely health care,” said Helms.
To engage Bloom Ranch for preventive care focused on wellbeing and healthy living, call (323) 388-4828 or sign up at Bloomranchofacton.com
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