The Impact of Health Care Reform on Asian American and Pacific Islander Communities Access to Health Care for Immigrants under Health Care Reform

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1 The Impact of Health Care Reform on Asian American and Pacific Islander Communities Access to Health Care for Immigrants under Health Care Reform Jenny Rejeske Health Policy Analyst, National Immigration Law Center APIAHF VOICES 2011 Conference, Washington DC May 16, 2011

2 What s Good About the 2010 Health Care Reform Law? 1 st large scale attempt at fixing health care system in decades Allows more lawfully present immigrants access to affordable health insurance Increased focus on wellness and prevention More investment in community health centers More investment in workforce diversity in health care industry More federal money for states Increased focus on language access and cultural competency 2

3 What s Bad About the 2010 Health Care Reform Law? Excludes undocumented immigrants Requires everyone to verify citizenship/immigration status to buy health insurance in the exchange (even if not applying for tax credits) Continues discriminatory barriers on legal immigrants and residents of Compact Free Association states in federal Medicaid Not all workers are guaranteed employer based health insurance Unclear if everyone will be able to truly afford health insurance Reduces federal funding to safety-net hospitals and clinics over time Every state will have its own rules and process for the new exchanges 3

4 Naturalized Citizens Eligible for all health care reform provisions on the same basis as U.S. born citizens Verification of citizenship status in the insurance exchange: Can first be verified via Social Security Administration (SSA) records Higher error rates for naturalized citizens If unable to verify via SSA, will go to Department of Homeland Security s records to verify citizenship Will have opportunity to provide other proof or correct records if unable to be verified electronically Must buy health insurance under the individual mandate (unless unaffordable or exempt) and subject to tax penalty if no insurance No change under employer based health insurance 4

5 Legal Immigrants Immigrants who are lawfully present in the U.S. can: Buy health insurance in the state exchanges Apply for tax credits for premiums and co-payments Eligible for states high-risk insurance pools Only certain categories of low-income, legal immigrants ( qualified immigrants) eligible for federal Medicaid and adults still subject to five year waiting period and other barriers BUT states can still choose to cover a broader group of legal immigrants in their state-funded health programs Must buy health insurance under the individual mandate (unless unaffordable or exempt) and subject to tax penalty if no insurance No change under employer based health insurance 5

6 Undocumented Immigrants Not able to buy health insurance in the individual market of the state insurance exchange(s) (even if paying full cost of insurance). Not able to apply for tax credits for premiums or co-payments Exception: Eligible family members of undocumented family can apply for tax credits through their own application Not eligible for federal Medicaid, CHIP, or Medicare Exception 1: Eligible for Emergency Medicaid Exception 2: Eligible family members of undocumented family can apply for these federal health programs BUT states can still choose to cover a broader group of immigrants in their state-funded health programs Not subject to individual mandate or tax penalties 6

7 Undocumented Immigrants (cont d) Remain eligible for health programs that are available regardless of immigration status (e.g., public health) Hospitals must still provide emergency care regardless of insurance or immigration status Community health centers and other safety net providers can continue to provide non-emergency health care regardless of immigration status Eligible to be covered in group health insurance as dependent Insurance companies may offer insurance outside the state exchange(s) that are available to undocumented, but unclear how affordable or comprehensive those plans will be 7

8 Undocumented Children Not eligible for Medicaid, CHIP or to buy health insurance in insurance exchange(s) Eligible for Emergency Medicaid Remain eligible for health and other programs that are available regardless of immigration status Public health services (immunizations, WIC, etc.) Eligible to be covered by parent s group health insurance as dependent Eligible to seek health care services at community health centers and other safety net providers Not subject to individual mandate or tax penalties 8

9 Children of Undocumented Immigrants U.S. citizen or legal immigrant children of undocumented parents should have the same access to health insurance and health services as other children. Eligible for Medicaid or CHIP Eligible for tax credits to make health insurance affordable via their own application Eligible to buy health insurance in the exchange via their own application Eligible to be covered in group health insurance as dependent Will be subject to individual mandate (unless exempt for other reasons) Can seek health care services anywhere, including community health centers or school based clinics 9

10 Language Access Provisions Extends the application of Title VI of the US Civil Rights Act prohibiting discrimination on the basis of race, color or national origin The following programs or services must be culturally and linguistically appropriate: HIE Health plans notice of appeals processes & summary of benefits and coverage Consumer assistance programs and navigators Community Health Workers (ACA provides new grants) Health care workforce development initiatives to improve cultural competency (e.g. training, loan repayment) Development of model cultural competency curriculum 10

11 Language Access Issues to Look Out for: Work with your state to ensure competent interpretation and translation services at all levels of your state s health insurance exchange, including ensuring that: Limited-English proficient, immigrant and communities of color are represented in the exchange s governing and advisory bodies All consumer access points, from telephone to website to in-person assistance, provide language assistance services Consistent methods are created for collecting and reporting health data by race, ethnicity, and primary language from health insurers and the Exchange to identify disparities, monitor efforts to reduce disparities and ensure compliance with non-discrimination provisions Grant applications submitted by your state to HHS include requests for funding to improve services to limited-english proficient residents Require health plans to reimburse medical providers for language assistance services provided 11

12 Issues to Look Out for: Ensure your state includes all lawfully residing immigrants in any Medicaid expansions Ask your state to elect the new option in the 2009 CHIPRA bill to cover (with additional federal funding) lawfully residing immigrant children and pregnant women in Medicaid and CHIP Ensure your state s Emergency Medicaid becomes available to all low-income immigrant adults, as it will be in regular Medicaid (including childless adults) Oppose attempts to reduce or restrict access to health care services at safety-net hospitals or clinics 12

13 Issues to Look Out for: Encourage small business employers to provide health coverage to low and moderate income workers and apply for small business/nonprofit tax credit Work with your state to ensure application, enrollment and verification of immigration status in the new insurance exchange does not create new barriers for immigrant families Work with allies in labor and business to ensure employers do not require additional immigration verification for the employee or their family members in order to enroll in the company s group health insurance Seek out federal or state funding for community based groups to help with outreach and enrollment of special populations, such as low-income immigrant families 13

14 Health Care and Immigration Reform Federal immigration reform and DREAM Act: Increased employer verification and enforcement likely Pathway to legalization Fines, fees likely Uncertain how inclusive it will be Immigration reform unlikely to remove existing barriers for immigrants in health care Attempts to further restrict access to health care for newly legalized immigrants likely Newly legalized may have better access to employer based coverage, worker protections, and increased wages 14

15 Resource List National Immigration Law Center ( Asian & Pacific Islander American Health Forum ( Kaiser Family Foundation ( Kaiser State Health Facts ( National Health Law Program ( Families USA ( 15

16 Jenny Rejeske Health Policy Analyst National Immigration Law Center Washington, DC (202) x207