It may have taken a pandemic, but now thousands of low-income Mission and Bayview residents, who previously had no access to health insurance or a primary care doctor, now have both.
This happened over the last year as clinic-run Covid-19 testing and vaccination sites heightened residents’ awareness of the city’s public health services, and as residents who lost both jobs and employer-provided insurance sought alternative options.
In the past year, some 9,100 new patients have enrolled with the San Francisco Health Network, which includes 14 adult primary care clinics, Zuckerberg San Francisco General Hospital and some specialist medical services. The network attends to some of the city’s lowest-earning residents, including uninsured and undocumented people, and accepts affordable coverage like Medi-Cal and Healthy San Francisco.
Between November, 2019, and April, 2021, the neighborhoods reporting the most new recruits come from the Mission, with 1,184 new patients, and Bayview Hunters Point with 1,114. However, those figures might be affected by the health network’s emergency decision to keep patients who might ordinarily be disenrolled, and both neighborhoods also topped the health network’s enrollment in 2019. Nevertheless, the data suggests needs are being met; the Mission and Bayview are two historically underserved areas that have also been San Francisco hotspots for the coronavirus — and have reported the most deaths.
And, while U.S. Census data shows that only about 33,000 San Franciscans, or 4 percent of the population, were uninsured in 2019, connecting residents to healthcare for the first time amid a deadly pandemic remains a source of pride for the Department of Public Health.
The spike came in part because the need for a public Covid-19 response forced clinics to reach out in novel ways, like setting up a testing site on the sidewalk, said Anna Robert, the deputy director of primary care for the SF Health Network, nurse, and a leader in the Southeast Health Center Clinic in the Bayview.
When hard-to-reach populations like undocumented immigrants flocked to clinics or General Hospital for a nose swab, medics advised them that these institutions provided other economical medical services.
“Though our doors have always been open, we’ve got to open our doors to the community in a way that we haven’t before,” Robert said. “Throughout this pandemic, the health network has really been a source of very-low-barrier testing and low-barrier vaccines.”
Both brought in residents who had previously been unconnected with a clinic or a primary physician.
Community advocates, doctors and the Health Department added walk-up vaccination and testing sites in the Mission and Bayview to address the disproportionate impact of Covid-19.
Meanwhile General Hospital has opened up walk-up vaccine appointments to scores of residents in underserved zip codes and advertised them widely on social media. The hospital even doled out doses to San Franciscans who had private healthcare but couldn’t land a vaccine appointment early on.
Southeast Health Center in the Bayview has done this for months, too. UCSF and the Latino Task Force’s efforts in the last year have also connected residents to health care and sent residents to the San Francisco General Hospital for vaccinations. “At some point, they were sending us between two and three hundred patients a day to San Francisco General Hospital for vaccines,” Robert said.
But the new batch of enrollees also encompassed those whom the pandemic hit hard. Ricardo Duarte, the nurse manager at the Castro-Mission Health Center, said that most of the Castro-Mission’s new patients — he estimates about half of whom are Latinx — had lost their jobs and health coverage, causing them to scramble for other health plans.
Most of the new patients are “younger [than usual], working class,” Duarte remarked. “They had insurance and all of a sudden they lost a job or had to find different work.”
Duarte recalled one Latino man in his thirties who became unemployed and lost access to his Kaiser Permanente insurance, a situation he wanted rectified quickly. The young man had asthma, and worried about refilling his inhaler prescription and contracting the virus, which can be exacerbated by respiratory conditions. But once he reached Castro-Mission, he happily learned that he’d not only be able to swiftly attain a new doctor, but that he qualified for a same-day covid shot.
The city’s health-coverage program Healthy San Francisco also saw growth. The program only serves residents with a family income at or below 500 percent of the federal poverty level — about $11,042 for a family of four — and who had no insurance for at least three months or lost it from unemployment.
In 2021, Healthy SF reported 2,266 more patients than in 2020, and has also chosen not to disenroll members. The lion’s share are also working-age and Latinx — 79 percent of current Healthy SF clients are between 29 and 57, and 71 percent identify as Latinx.
In turn, some institutions that accept Healthy SF also had enrollment jump, even if they weren’t one of the 14 clinics within the SF Health Network. Brenda Storey, who runs the health network affiliated Mission Neighborhood Health Center on Shotwell, said in late 2020 that the clinic gained about 1,000 patients. The MNHC did respond for updated comment by press time.
Despite the encouraging numbers, Castro-Mission’s nurse manager, Duarte, knows there’s work left to be done for those still without coverage. And that could happen. Duarte said the SF Health Network’s pandemic-improved image also played a part in roping in new clients; sometimes he volunteers at General Hospital’s vaccination site, and he’s noticed that people are “pleasantly surprised” to find that the network provides quality care.
Long term, Duarte hopes to enroll more residents by taking pages out of the pandemic playbook, such as embracing more front-facing public relations. At present, the clinic is averaging between 80 to 100 new patients per month.
“We had a lot of positive impact on people. People think having ‘safety net healthcare’ is bad, but maybe it’s not as bad as you thought,” Duarte said. “It might even be better than some other places.”