tag:newamericamedia.org,2009-04-06://19 2013-05-17T16:29:39Z New America Media is a nationwide association of over 3000 ethnic media organizations representing the development of a more inclusive journalism. Founded in 1996 by Pacific News Service, New America Media promotes ethnic media by strengthening the editorial and economic viability of this increasingly influential segment of America's communications industry. tag:newamericamedia.org,2013://19.11413 2013-05-13T08:00:00Z 2013-05-17T16:29:39Z

Anthony Advincula ]]> http://publisher.namx.org/mt-cp.cgi?__mode=view&blog_id=19&id=103 When three of Khorshadul Kabil’s children came home from school with high fevers, dread set in for the 42-year-old immigrant from Bangladesh and his wife.  Three of their four kids have severe asthma. In a few hours, the children— ages 3 to 14— were heavily wheezing and coughing. Their father rushed them to a nearby hospital.

Kabil knows all too well that those symptoms can quickly escalate to a dire situation. The couple’s 14-year-old daughter has had convulsions. The 3- and 7-year-old boys have shortness of breath and chest pains at least twice a month.

“Our situation [is] not good,” said Kabil, who lives in Florida. “My job [doesn’t pay enough for me to buy] health insurance,” he said in broken English.

He works part-time at a small grocery store a few blocks from their rented house in Fort Lauderdale, Fla. His wife is a stay-at-home mom. There are times, he said, when they can’t afford to pay for their kids’ medicines.

The state has a nearly free, low-income health insurance program for children called KidCare, but the Kabils don’t qualify to take advantage of it. That’s because that program, like Medicaid, has a five-year residency requirement. The family emigrated from Bangladesh to the area just two years ago.

Kabil and his wife could enroll their children in KidCare, but they would have to pay much higher fees for each child -- almost $200 per child as compared to $20 per month for all his children.

Five-year ban slapped on new immigrants

When the Welfare Reform Act  passed in 1996,  the five-year ban was slapped on immigrants.  

But in 2009, when Congress passed the Children’s Health Insurance Program Reauthorization Act (CHIPRA), states were given the option of extending eligibility  to even newly minted immigrant children. CHIPRA even offered to pick up 70 percent of the costs if Florida did away with the waiting period.

Momentum had been building in the state to do away with the five-year ban. Two state bills, introduced last year and sponsored by Republican Sen. Rene Garcia (SB 704) and Republican Rep. Jose Felix Diaz (HR 4023), would have eliminated the five-year waiting period for lawfully residing children.

Both bills failed to pass last week. Given the fact that Florida is in the midst of preparing for the onset of health care reform, including Medicaid expansion for low-income people, "there was only so much energy and time, and the Medicaid expansion -- rightfully so -- took a lot of that energy," lamented Linda Merrell, the convener for Florida Child Healthcare Coalition. The Medicaid expansion program became a higher priority for lawmakers, she said.

The five-year waiting period impacts somewhere between 20,000 and 40,000 immigrant children across the state, according to a Florida Center for Fiscal and Economic Policy (FCFEC) report. According to Merrell, Florida has the second highest number of uninsured children in the nation.

Karen Woodall, executive director of FCFEP, said that unless the bill is reintroduced and is passed next year, these children would remain uninsured.

“The Affordable Care Act…does not remove the five-year wait,” she said. “These kids will continue to use a more expensive emergency-room treatment, and the government will pay more for these services.”

Misinformation

There was also misinformation and confusion about the costs of eliminating the five-year waiting period and expanding Medicaid to include those children.

A fiscal analysis by Florida Agency for Health Care Administration (AHCA) reported that expanding healthcare to lawfully residing immigrant children would dramatically increase the healthcare costs for the state. Even though AHCA  retracted its analysis later on, advocates said, the damage twas done.

The Florida Center for Fiscal and Economic Policy contends that the maximum cost to the state to extend coverage to these children would be $17.6 million per year, an amount that could already be covered by unspent state funds already earmarked for children’s health coverage as well as funds freed up as a result of increased federal-match rates.

Florida currently receives about $39 million from the federal government, but that amount would increase to slightly more than $63 million if the state eliminated the five-year waiting period for legal immigrant children.

A strong anti-immigrant sentiment in the state also played a role in defeating the measures, advocates say.

“There’s still a very strong anti-immigrant sentiment among legislators,” Woodall explained. “It does not matter whether these children are lawful-residing immigrants.”

Sponsors of SB 704/HB 4023 pledge to reintroduce the bills again at the first state legislative session in 2014 or even earlier at a special session.

Life-changing Accident

Palm trees and white beaches were part of the American Dream for Kabil and his family when they first came to Fort Lauderdale.

“We love it here. The weather [is] like Bangladesh; it’s comfortable,” he said.

But, just a year after they arrived, things took a bad turn. Kabil had a hit-and-run accident that left him nearly crippled. The driver has not been found.

“I was walking to my work and the car came [from behind me]. I did not see it,” he recounted. “I was on the ground, but the driver did not stop.”

Although he can still walk, the accident has affected his mobility. He gets tired easily, he says, particularly if he works for a long time in a day.

“I need a doctor. My kids need a doctor,” Kabil said. “Every day we have health problems, but we have no access to health care.”


]]> tag:newamericamedia.org,2013://19.11409 2013-05-11T08:00:00Z 2013-05-11T06:03:55Z

Alejandra Alarcon ]]> http://publisher.namx.org/mt-cp.cgi?__mode=view&blog_id=19&id=103 Photo: The author, Alejandra Alarcon, as a baby with her older sister Gabriela (Gaby) and brother Robert (Rocky), in the family van. Their mother usually made the van comfortable for the long trips to Mexicali.

Editor's Note: The author of this commentary, Alejandra Alarcon, 18, writes for Coachella Unincorporated, a youth and community media organization founded by NAM to serve residents of the rural Eastern Coachella Valley in Riverside County, California.

COACHELLA -- Like a lot of other families living in the Eastern Coachella Valley, when one of our family members fell sick, it meant driving about a hundred miles across the border into Mexico, to the City of Mexicali, to get taken care of by a doctor. The only other option, it seemed, was not being taken care of at all.

Now, because of healthcare reform efforts in the United States, young people growing up today in the Eastern Coachella Valley – the unincorporated rural communities of southern Riverside County -- don’t need to go without health insurance the way I did. The scenario is finally beginning to change. At least, it can change – if people here are made aware of the health services now available to them through federal health care reform, right in their own community.

“We owe it to our country to inform the citizens to take advantage of all these resources that are available,” said Ronnie Cho, associate director of public engagement for the White House, during a speech about health care reform that I attended in Washington D.C. as a reporter last April.

Cho is right. For the Affordable Care Act (ACA) to make a difference, people need to first be aware that health care is an option for them. People need to know that they can afford to visit a doctor, without having to stray more than a few miles away from their home.

When my family would go to visit relatives across the border in Mexicali, we always took advantage of the opportunity to stop by the Mexican pharmacy to buy medicine for ourselves, as well as for our friends and neighbors who always requested some.

As a child, I thought those trips to Mexicali to visit the doctor were the only way – it was just what people did -- until later on in my youth, when my father got a job with a new trucking business that gave him medical benefits that included family coverage. Because my dad worked for a lot of different trucking companies during the years, and because there were lengths of time when he was unemployed, our health care situation was never stable. But at least for those few years, my family and I received the best health care we’d ever had.

“Young people are relatively healthy, so they think, ‘I don’t need health care,’ until something happens and they actually need it,” said Cho.

Again, Cho got it right. I can remember my worried mother, back in 2008, telling my little sister and me that we once again did not have health insurance and would have to resume our trips to Mexicali. In retrospect, I never minded the long trips to the doctor or dentist’s office. In fact, I never worried about my health. My parents always had medicine from Mexicali available in our cabinets for emergencies. For my siblings and me, it was not something that got in the way; it was something that we believed had to be done because there was no cheaper option.

The irony is that even though being uninsured felt normal to me and my siblings growing up, it is families like ours that need that insurance the most. Families like mine that live in the unincorporated communities of the Eastern Coachella Valley – most of us are Latino, many (like my parents) are immigrants, and many make a living as farmworkers or do some other type of physical labor – are especially in need of the protections provided by health insurance, because of occupational hazards and other health risks associated with living in an area where people lack money and resources.

Today, the Affordable Care Act, which will be fully implemented on January 1, 2014, is helping families like mine take control of our medical insurance, by providing options and a sense of security. It’s an idea – health care security -- that at one time, at least for my family and I, seemed impossible to imagine. The health insurance that for so long seemed like such a special privilege will now become available to more people than ever before.

The ACA was put into place in part to make sure insurance companies cannot end your coverage plan when you need it the most, cannot bill you into debt, cannot discriminate due to pre-existing medical conditions.

Among other provisions, the ACA will secure medical insurance for American citizens after getting laid off or changing jobs. It will require insurance companies to cover the cost of mammograms and cancer screenings. And for the first time, young adults will remain eligible to be covered under their parent's or guardian’s health insurance plan through the age of 26, even if they are married.

As a result, 3.1 million young adults are now covered along with their families, and over 107,000 Americans with pre-existing conditions who didn’t previously have insurance, are now receiving health coverage, according to federal data.

If you know where to look, it is free and simple to apply for affordable or no cost medical insurance programs such as Medicaid and the Childrens’ Health Insurance Program (CHIP), which cover medical services that include doctor check-ups, emergency care, hospital care, vaccinations, prescription drugs, vision, hearing, and dental. 

There was a time, for a lot of us living here in the Eastern Coachella Valley, when driving across the border seemed like the easiest and most affordable way to access health care. Fortunately, for many of us, that no longer needs to be the case. Our communities can have the security of health insurance that for so long seemed just beyond our reach, if we just know where to find it.

To see if you qualify for Medicaid or CHIP, or to apply online, visit: http://insurekidsnow.gov

To find out what is your best insurance option for your specific demographics and needs go to: http://finder.healthcare.gov


]]> tag:newamericamedia.org,2013://19.11382 2013-05-07T08:25:00Z 2013-05-06T23:37:37Z

Last week, 400,000 poor and underserved Louisianans, many them people of color, were shut out of potentially life-saving health insurance under the Affordable Care Act (ACA).
A Louisiana House health committee voted down a measure that would have forced Governor Bobby...

Marc Morial ]]> http://publisher.namx.org/mt-cp.cgi?__mode=view&blog_id=19&id=103 Last week, 400,000 poor and underserved Louisianans, many them people of color, were shut out of potentially life-saving health insurance under the Affordable Care Act (ACA).


A Louisiana House health committee voted down a measure that would have forced Governor Bobby Jindal to opt into the Medicaid expansion provision of ACA that is being subsidized by the federal government to cover vulnerable communities.

Even more discouraging was the unfortunate reality that the vote was right along party lines. Is it too much to ask to keep partisanship out of our health care? I certainly hope not.
Gov. Bobby Jindal made it perfectly clear that he won’t accept federal funding to expand Medicaid.

As he appears to be more focused on positioning for his own political future, this is coming at a huge cost to Louisianans. 
Louisiana has the second-highest rate of uninsured adults in the country. Many people — especially women and African Americans — in the state lack access to basic health care.

In fact, the American Congress of Obstetricians and Gynecologists estimates that of Louisiana’s 64 parishes, 33 do not have a single OB/GYN. Accepting federal dollars would mean that an estimated 398,000 more hardworking Louisianans would get basic health care when they need it, without facing devastating medical bills.

Medicaid expansion would also have the most positive impact on African Americans in the state; nearly half of those in our community who don’t have health insurance would likely gain coverage. Across the board, the percentage of uninsured in the state could actually drop by as much as 60 percent. 
It would also be a huge benefit to the state’s economy.

If the state doesn’t accept federal funding, it could actually cost Louisiana’s economy $15.7 billion over the next decade – money that could go to job creation and supporting small businesses, the backbone of our nation’s economy. 
There is no doubt that this would be life-changing for many Louisianans. More people would be able to afford preventive health care. They would be able to avoid chronic health problems, costly long-term medical care, and personal bankruptcy -- especially among African Americans, who often shoulder the increased cost of health care.


Of course, Louisiana is just one example. 
Some politicians in other parts of the country continue to put their own self-interests before the hardworking families in their state. In Texas, for example, Governor Rick Perry has vowed to block Medicaid expansion. That’s especially disturbing as Texas is the only state in the country that ranks higher than Louisiana in terms of uninsured people.

I write this as someone who understands via experience – not just hypotheses and projections – the fiscal burden many local governments are facing. As the former mayor of New Orleans, a former Louisiana State Senator and current head of the National Urban League, I’ve seen how basic health care can help empower people in underserved communities.


State lawmakers have a unique opportunity to care for more people than ever before, to make their states healthier than ever before and, in the process, save their states millions of dollars. It’s a pity that Louisiana lawmakers seem determined to reject what could be a boon for the state and for its residents who have suffered enough in recent years.


Folks like Bobby Jindal and Rick Perry must act on behalf of the millions of hardworking families across the country that will benefit from this funding, rather than play politics with their health and well-being.
It’s up to lawmakers to lead on these issues, to accept federal aid to expand Medicaid and provide basic health care to millions of women and families.

By doing so, they have the potential to transform their states, improve – and save – lives, and reduce taxpayer costs.

Marc Morial is President and CEO of the National Urban League

]]> tag:newamericamedia.org,2013://19.11375 2013-05-06T16:15:00Z 2013-05-10T00:05:25Z

中文翻譯한국어 번역 NEW YORK -- October 1 is D-day for New Yorkers to start shopping for affordable health care coverage on the New York Health Benefits Exchange. Some 2.9 million residents are uninsured (out of a population of 19.2 million),...

Text: Khalil Abdullah / Video: Josue Rojas ]]> http://publisher.namx.org/mt-cp.cgi?__mode=view&blog_id=19&id=103 中文翻譯
한국어 번역

NEW YORK -- October 1 is D-day for New Yorkers to start shopping for affordable health care coverage on the New York Health Benefits Exchange. Some 2.9 million residents are uninsured (out of a population of 19.2 million), and experts and advocates are ramping up to make New York the benchmark state for maximizing health care access for the uninsured, the underinsured, children and even undocumented immigrants.

"We are doing something that very few other states are doing," Elisabeth Benjamin, vice president of health initiatives at the Community Service Society of New York, told a group of reporters--most from ethnic news organizations--at a roundtable briefing convened by New America Media. "Our exchange truly will be one-stop shopping allowing apples-to-apples comparisons of the variety of health insurance plans available."

Unlike other states whose exchanges may refer certain applicants to other agencies, New York's exchange will offer consumers the full menu of available options, from qualified commercial health plans to public assistance programs like CHP (Child Health Plus) and Medicaid. "You go into the New York Exchange and it's extraordinary," Benjamim added. "You will come out with coverage, maybe even emergency Medicaid if you're undocumented."

New York is one of 19 states that opted to build and design its own exchange instead of relying on the federal government to do so. Because the ACA requires everyone to purchase health insurance, states that are more effective in bringing larger numbers of its residents into coverage will presumably be able to drive down insurance premium costs.

In New York, one study estimates the premium costs for an individual and families could be reduced by as much 66 percent per month. That’s a significant decrease in state where individuals and families pay $1,200 and $3,400 a month respectively, (the latter for a family of four). Individuals and families who do not qualify for Medicaid because their incomes are too high may still be eligible for subsidies to assist them in purchasing health care insurance.

Although enrollment through the exchange does not begin until October 1, the ACA has already yielded tangible benefits. It has allowed some 160,000 young adults, for example, to stay on their parents’ health insurance plans until age 26 -- and New York has extended that age to 29. This is helping to reverse a decade long national trend for the 19 to 25 age group, according to data compiled by the Commonwealth Fund: the percentage of young adults who were uninsured fell from 48 percent to 41 percent between 2010 and 2012.

New York is also ahead of the curve in committing funds -- some $27 million annually -- for ACA's Navigator program which provides one-on-one counseling and referrals to consumers. By contrast, Ohio, with a much smaller population but a high rate of uninsured, is committing only $2.3 million on a one-time basis.

Sarah Rothstein, assistant director of policy and planning for the New York State Health Benefit Exchange, described how the Navigator program will bridge the state's language access issues through a multi-layered approach. People who don't want to enroll over the phone or through the website will be able to get in-person assistance from community based organizations that have been certified as navigators. Though the website for the exchange currently carries instructions in English and Spanish, other languages will be added. Call centers will also commence in October with staff versed in multiple languages including Arabic, Russian, Cantonese, Mandarin, Creole, French, Hindi, Korean, Polish, Punjabi, Urdu and Bengali.

Lorraine Gonzalez-Camastra, director of health policy for the Children's Defense Fund in New York, emphasized the state's goal of providing universal coverage for children -- "regardless of income or immigration status." Some 283,746 children in New York are uninsured, of whom 51 percent are minorities, including many noncitizens of immigrant families.

Latinos make up 23 percent -- the largest cohort -- of the state's uninsured population overall, noted Becca Telzak, Health Policy Supervisor for Make the Road New York, a grassroots organization. "Imagine not being able to speak the language of the person who's talking to you," she said. "It makes it a thousand times harder" to negotiate some of the complexities of selecting the appropriate insurance plan.

Meanwhile Asian Americans are growing rapidly in the state, especially in counties that have otherwise seen declines in the white population. The influx reflects both growing numbers of refugees from Bhutan and Myanmar, and rising birth rates among more established Asian American groups, noted Noilyn Abesamis-Mendoza,  health policy director for the Coalition for Asian American Children and Families.

Government agencies and advocacy organizations expect to bring one million New Yorkers under the healthcare insurance umbrella. The open enrollment period begins October 1 and will extend through March 31, 2014 for the first year of implementation. Medicaid eligible persons will be able to enroll at any time throughout the year, as will those with children who qualify for New York’s CHP program. Forty-six percent of those who get public coverage will be non-Hispanic whites, while 28 percent will be Hispanic; 13 percent will be black; and 13 percent will be Asian Americans and others.

The New York Health Benefit Exchange will also run the Small Business Health Options Program (SHOP) which is expected to attract many from immigrant communities who own their own business. SHOP will enable employers to compare the qualified health plans on the exchange and even leverage their purchasing power by partnering with other businesses.

SHOP will be made available to businesses that have 50 employees or less during the first two years of enrollment, 2014 and 2015. Businesses with 100 employees or less will be able to use SHOP in 2016.

From its website to in-person counseling, CDF’s Gonzalez-Camastra said the state has taken great care to ensure that “there is no wrong door” for New Yorkers to obtain accurate guidance.


This story was written as part of a series of press briefings on healthcare reform with ethnic media organized by New America Media and funded by the Atlantic Philanthropies.


]]> 65184821 tag:newamericamedia.org,2013://19.11371 2013-05-04T15:27:10Z 2013-05-04T15:39:31Z

Renato Ciria-Cruz ]]> http://publisher.namx.org/mt-cp.cgi?__mode=view&blog_id=19&id=103 SAN FRANCISCO -- Supporters of health care reform once again sounded the alarm that California has only four to six weeks left to resolve budget issues that are hampering the timely rollout of Medi-Cal expansion, a key part of Obamacare’s implementation in the state.

Alameda County Supervisor Wilma Chan noted “the federal government will [fully] cover the first three years of Medi-Cal expansion to cover the uninsured.” She warned “the state could lose a lot of that funding if the expansion is not started on time, by January 1, 2014.”

“The Feds will start funding Medi-Cal [California’s Medicaid program] expansion on that day, but if we’re not ready at that time, every day that the expansion isn’t ready, is another day of funding gone. It will be a waste,” warned Anthony Wright, executive director of Health Access, a statewide health policy advocacy group.

Wright and Chan, as well as Mike Odeh of Children Now, were panelists at a Friday media briefing at the offices of New America Media on how a delay in expanding Medi-Cal could impact communities of color.

The Medi-Cal expansion would enroll an estimated 1.4 million uninsured Californians into the Affordable Care Act (ACA) coverage. But setting up the infrastructure for this is being hampered by disagreements between Governor Jerry Brown and state legislators.

For example, Brown rejects the use of self-enrollment electronic stations, which advocates argue would simplify and quicken the enrollment of hundreds of thousands. He also wants to be able to turn off Medi-Cal expansion coverage should there be reductions in federal funding.

Under ACA, the federal government has promised to cover 100 percent of expansion costs in the first three years, and at least 90 percent thereafter.

The governor also wants counties to operate the expansion program, a suggestion that is unpopular with county officials, who believe that it should continue to be a state-operated program.

Mike Odeh of the non-profit, Children Now, said up to 700,000 children need to be enrolled in expanded Medi-Cal but could be jeopardized if “enrollment categories are not simplified.”

The biggest budget debate, according to Wright, Chan, and Odeh, is that the Brown administration wants counties to turn over monies that now fund counties’ Low-Income Health Programs (LIHPs), which serve as a safety net for the uninsured, once expanded Medi-Cal begins functioning.

Advocates want those funds retained at the county level to cover the remaining uninsured—undocumented immigrants, legal immigrants who have been here for fewer than five years and can’t afford to buy insurance from the exchange, and people “who fall through the cracks”—not only to make sure that health care safety nets remain, but also to prevent the uninsured from resorting to costly emergency care.

“Open enrollment for Medi-Cal starts in October,” said Chan, “but these unresolved issues are delaying the preparations needed to inform, educate and enroll hundreds of thousands before the program kicks in by January 1.”

]]> tag:newamericamedia.org,2013://19.11364 2013-05-03T08:00:00Z 2013-05-03T20:29:38Z

Viji Sundaram ]]> http://publisher.namx.org/mt-cp.cgi?__mode=view&blog_id=19&id=103 SAN FRANCISCO – To buy or pay the penalty?

That is the question that will confront many U.S. residents in the coming months, when open enrollment season begins for health insurance coverage, under the terms of the Affordable Care Act (ACA), also known as Obamacare.

ACA will be fully implemented on January 1, 2014, when most legal U.S. residents will be required to have “minimum essential health coverage” or make a “shared responsibility payment,” as the Congressional Budget Office puts it in regulations it rolled out last fall. That’s code for penalty.

The penalty “is enforced through a (Internal Revenue Service) tax code,” noted Karen Pollitz, a senior fellow at the Kaiser Family Foundation in Washington, D.C.

So when you file your 2014 tax returns, you will have to let Uncle Sam know what kind of health insurance coverage you have and what, if any, tax credit you are eligible for, unless you can claim you are exempt from buying health insurance.

Non-financial exclusions include:

• You are between jobs and without insurance for up to three months.
• It contradicts your religious beliefs.
• You are an undocumented immigrant.
• You are a member of an Indian tribe.
• You are in jail.

The financial exclusions for not having health insurance include having a family income so low that you don’t have to file an income-tax return, Pollitz said. Or your minimum essential coverage exceeds a certain percentage of your household income for the most recent taxable year. In 2014, that is 8 percent.

Coverage could take many forms. It could be a government-sponsored plan like Medicaid or Medicare, an employer-sponsored plan or a plan purchased on the individual market.

Applicable penalty

The individual one-time penalty under ACA in 2014 will be $95 per adult, or one percent of your income, whichever is greater. So say your annual income is $50,000, you’d pay $500. For every uninsured child, the penalty is $47.50. The family maximum is $285.

“Coverage is assessed on a monthly basis,” said Pollitz. “So if you were uninsured for six months, you’d owe half the otherwise applicable penalty.”

She said that the government has given a wide window – from Oct. 1, 2013 to March 31, 2014 – for enrollment this time, but from next year on there will only be a three-month window to sign up.

Will people take the gamble and skip coverage, hoping that their youth or good health will protect them?

If the state of Massachusetts, which passed a landmark health care law in 2006, which became the blueprint for the 2010 ACA, is any indication the number of people who will refuse to get some form of coverage will be low, Pollitz surmised.

In Massachusetts, she observed, “there’s a culture of coverage. Most people want to comply with the law.”

Indeed, within a year and a half after the law passed there, the majority of people signed up for coverage.

But when it comes to the ACA, an estimated 6 million people, who cannot claim legitimate exclusions, will likely take the gamble and remain uninsured in 2016, the government predicts.

Pollitz said there are no criminal penalties to those who violate the law, just a civil one. That could mean seizing your refund.



]]> tag:newamericamedia.org,2013://19.11356 2013-05-02T09:10:00Z 2013-05-03T17:02:28Z

Anna Challet ]]> http://publisher.namx.org/mt-cp.cgi?__mode=view&blog_id=19&id=103  
The Affordable Care Act will make pediatric dental care more accessible than ever before, but many children’s advocates are concerned about the affordability of coverage and the availability of providers. NAM spoke with Joe Touschner, a Senior Health Policy Analyst at the Center for Children and Families of the Georgetown University Health Policy Institute, about what changes families can expect.

Generally speaking, how will the Affordable Care Act change families’ access to dental coverage for their children?

For a lot of families, the ACA won’t change their coverage directly. If a family gets its dental coverage through a large employer, that will continue, or if the child is covered by a public program like Medicaid, that will remain similar. Where the ACA will improve coverage, though, is in places where it was previously harder to obtain children’s dental care, such as in the individual market and in small group insurance. The ACA guarantees that there will be dental coverage available for purchase, either together with other benefits or through stand-alone plans. It has made children’s dental coverage part of what are called “Essential Health Benefits,” which are categories that have to be covered by individual and small group plans. Pediatric dental care has to be included as part of that coverage.

Will families who have insurance that does not cover pediatric dental care be required to purchase dental coverage for their children?

At the federal level there is no requirement in the exchange, but some people are concerned about this being established as a state requirement, and there are states that are considering it, including California. It would be up to the state to require families to purchase a stand-alone plan if their current insurance doesn’t offer it.

Are there concerns about stand-alone plans being affordable?

There are some concerns, but first I would say that if a family does not have pediatric dental care as part of its existing plan, the fact that there are stand-alone plans offered through the state exchanges will be helpful … There are many plans right now that have a very low limit for what they’ll cover, but because pediatric dental care is now a part of the Essential Health Benefits, that coverage has to be more comprehensive, and the ACA is eliminating those annual and lifetime limits. As a result, though, the monthly premium may end up being higher for some families. Affordability will be a challenge – it’s going to be important for the state exchanges to keep affordability in mind.

Could you briefly explain health insurance exchanges?

Every state will have an exchange … It’s basically a set of rules aimed at improving competition among health plans, to get them to compete to offer quality coverage for a low cost. Not all plans will be able to sell on the exchange; plans will have to compete to get there, and will have to offer lower costs while still providing for the Essential Health Benefits. The exchanges are also going to be the place where people can get federal subsidies; the ACA will pay part of your premium for you on the exchange if your income is at or below 400 percent of the poverty level, and you don’t have access to insurance through your job. The tax credits will help people afford the coverage, and this ensures that there’s business for the health plans to compete for.

In California, families whose pediatric dental care was covered under the Healthy Families Program are being transitioned into Medi-Cal this year; there’s a concern that relatively few dentists accept Medi-Cal because of low reimbursement rates. What kinds of changes need to be made in California to ensure that low-income families have real access to dental care?

The [reimbursement] rates are pretty low in California, and other states struggle with this too. The states need to work to make it easy for providers and beneficiaries to enroll in public programs. They can also increase the use of technology to help dentists see more kids, such as with teledentistry. And states like California can consider raising the Medicaid reimbursement rates. Certainly California has some budget challenges right now, but it’s something that could be looked at in the future.


One of the recommendations that’s been made by advocacy organizations with regard to serving rural and low-income communities is to increase the number of dental health professionals by training professionals who work under the supervision of dentists, comparable to nurse practitioners. But the American Dental Association sued a group in Alaska (the Alaska Native Tribal Health Consortium) that provided for the training of dental therapists who would work in rural communities and tried to block them from practicing. Is there a concern about the ADA pushing back if steps like this are taken to increase the availability of care?

The idea of dental practitioners is something that several states have been interested in – Minnesota in addition to Alaska. There is certainly opposition, but we need to focus on the needs of kids. If we’re seeing that kids have low access to dental services, having new kinds of providers is something that we need to look at. We need to look at the services that need to be provided and the providers that are available. If the services are not available, finding providers who can perform services at a lower cost may be the way we have to go.

What do you see for the future of dental care for kids?

I think that the ACA has taken a great step forward in making pediatric dental care part of the Essential Health Benefits. We’re getting to a place where dental care is seen as integral to every kid’s health … Having access to dental care is now being seen as just as important as having access to a doctor, and just as necessary – which is a good thing. It’s going to take changes to current dental practices – for example, the training of other kinds of practitioners – to create more access.

Is there any hope for this kind of access being extended to adults?

For adults, the future is a little more uncertain. When Congress passed the ACA, it made a choice to include dental care for kids and not for adults. We may have a ways to go as far as seeing dental care as an integral part of medical care for everyone. Maybe down the line we could think about adding care for adults, but it’s hard to see that happening anytime soon.
]]> tag:newamericamedia.org,2013://19.11295 2013-04-19T18:00:00Z 2013-04-24T18:58:44Z

Viji Sundaram ]]> http://publisher.namx.org/mt-cp.cgi?__mode=view&blog_id=19&id=68
中文翻譯

Español

SACRAMENTO – Health care advocates warn that time is running out on drawing down federal dollars to expand Medi-Cal, a move that would prevent nearly 1.4 million low-income Californians from remaining uninsured when health care reform is fully implemented Jan. 1, 2014.

“California must take aggressive action now to implement the Medi-Cal expansion program fully and urgently for our health system and our economy,” asserted Anthony Wright, executive director of Health Access California, the statewide health care consumer advocacy coalition, while speaking at a press conference organized by the coalition here at the State Capitol on Thursday.

“If we don’t put together an infrastructure, we will be leaving behind federal dollars in D.C., instead of bringing them into our economy,” he added.

Health care advocates and lawmakers noted that up until now, California has been at the forefront of implementing a number of provisions of the Affordable Care Act, also known as Obamacare. It was the first state, for example, to pass legislation to set up the online exchange where people can purchase affordable and federally subsidized health insurance coverage, starting in January.

But recent disagreements between Gov. Jerry Brown’s administration and Democratic lawmakers over the Medi-Cal expansion program have left California trailing behind other states in ACA implementation.

Last month, Democratic Senate Health Committee chair Dr. Ed Hernandez introduced a bill (SBX1-1) that would expand Medi-Cal -- the state’s name for the low-income health insurance program known as Medicaid in the rest of the nation -- eligibility to more than one million Californians and simplify the enrollment process.

A companion bill (ABX1-1) was introduced in the Assembly by Speaker John A. Perez.

Together, the bills would expand Medi-Cal coverage to include even childless adults, who under existing Medi-Cal rules are not eligible for enrollment. They would also remove the asset test for eligibility – under current rules, individuals with cash and savings above $2,000 ($3,000 for a couple) don’t qualify.

Both bills have sailed through their respective chambers, but have stalled because Gov. Brown and lawmakers are at odds over some of the benefits that should be included in the expansion.

For instance, Brown’s plan for the expansion would move certain groups now covered by Medi-Cal, including recent documented immigrants, to the health insurance exchange. Democrats want the groups to remain eligible for Medi-Cal coverage.

Brown has proposed funding the Medi-Cal expansion by reducing the roughly $2 billion that the state annually provides counties, to pay for treatment of uninsured individuals. Democrats point out that taking money away from counties is unnecessary since the federal government will fund the expansion for the first three years.

“The federal government will fully fund Medi-Cal coverage for newly eligible Californians for the first three years, and not below 90 percent into the future,” noted Hernandez at the press conference.

The Brown administration and lawmakers have also locked horns over which entity will administer Medi-Cal expansion. Brown wants it to be administered by the counties, but health care advocates say that dividing the federal dollars among 58 counties will not be easy, given how much they vary in size and wealth.

“After the first three years, the counties will have to pick up some of the costs and not every county will be able to afford it,” asserted Alameda County Supervisor Wilma Chan. She said that in her county, there are an estimated 200,000 uninsured, of which 42,000 will be eligible for Medi-Cal when it expands.

Wright pointed out that it has taken three years to get California counties to launch the Low-Income Health Program (LIHP), a “bridge” program run by counties and funded by the federal government that allows people to have some form of health coverage until Jan. 1, 2014. And even now, he said, five of the 58 counties have still not come on board.

How, he asked, could counties be expected to meet all their federal requirements for Medi-Cal expansion, in the next six months?

“Federal reimbursements for Medi-Cal expansion begins on January 1, 2014,” Assembly Health Committee Chair Dr. Richard Pan pointed out, adding: “There are a whole chain of events that have to happen by a certain date (before that). Every month that goes by, there are people who are going to be on the uninsured list.”

“As a physician caring for Medi-Cal and uninsured patients,” he went on, “I understand the difference Medi-Cal coverage makes (in) people’s health.”

]]> tag:newamericamedia.org,2013://19.11249 2013-04-11T21:22:55Z 2013-04-11T23:00:01Z

Eva Dominguez ]]> http://publisher.namx.org/mt-cp.cgi?__mode=view&blog_id=19&id=103 Photo: Courtesy USC Roybal Institute on Aging

Traducción al español

WASHINGTON, D.C.--The Social Security and Medicare cuts President Obama included in his proposed budget would disproportionately harm Latino Americans and are deeply unpopular in our community.

Rather than being part of a “Grand Bargain” offered to Republicans in exchange for possible tax increases, these cuts are a great betrayal of a group that proved essential to the president’s victory in the 2012 election.

President Obama won an unprecedented 71 percent of the Latino vote nationwide, allowing him to edge out Mitt Romney in the key swing states of Colorado, Florida, Nevada and New Mexico.

What many may not know is that like most Obama supporters, Latinos voted for the president in no small part, because they believed they could rely on him to protect Social Security, Medicare and Medicaid.

Latinos Depend More on Social Security

Latino voters believed President Obama in his 2011 State of the Union speech when he said we must “strengthen Social Security . . . without putting at risk current retirees, the most vulnerable or people with disabilities; without slashing benefits for future generations; and without subjecting Americans’ guaranteed retirement income to the whims of the stock market.”

Social Security matters to Latinos, because we depend on it more than any other group. Three in four (77 percent) Latino households ages 65 or older rely on Social Security for a majority of their income, and over half (55 percent) rely on it for 90 percent of their income.

That means Latino seniors are 18 percent more likely than the overall U.S. population to rely on Social Security for a majority of their income and 52 percent more likely to rely on it for 90 percent of their income.

A major benefit cut in the president’s proposal would be to switch the formula for calculating annual cost-of-living adjustment (COLA) in Social Security and other programs. This so-called chained-Consumer Price Index (chained-CPI), would allow inflation to erode program benefits over time—and would hit Latinos especially hard.

Because we are more likely to have lower career earnings, our Social Security benefits tend to be more modest to begin with—$12,491 each year for the average Latino senior and only and $10,438 per year for the average Latina senior.

After 20 years receiving benefits under the chained-CPI—when they would be in their 80s--the average older Latino would lose an accumulated $7,774 in benefits, and the average Latina elder would lose $6,307. After 30 years, the cuts would grow, resulting in total benefit cuts of $17,049 for average Latino seniors and $13,832 for average Latina seniors.

Change Would Increase Poverty

Worse still, the chained-CPI punishes Latinos for being blessed with higher-than-average life expectancy, often combined with greater levels of chronic illness. Because the chained-CPI cuts benefits more as beneficiaries age, it would hit long-living Latinos harder than most.

It’s no coincidence then that some experts fear that the chained-CPI will increase poverty among Latino seniors. More than one in four Latino seniors already lives in poverty—nearly twice the rate among white seniors.

The White House claims it will protect “the most vulnerable” chained-CPI, with a special “birthday bump” increase for those seniors at age 76. But in the past, such carve-outs have proven inadequate.

An analysis by Social Security Works showed that protecting all vulnerable groups from the chained-CPI would erase half of the budget savings from the measure.

Even if significant numbers of Latinos were shielded from the chained-CPI due to their lower incomes, this birthday bump might have unintended consequences. Carve-outs—special treatment--of any kind are likely to be misconstrued as handouts for ethnic groups. We already have to deal with enough nasty stereotypes portraying us as recipients of “welfare” or “government handouts.”

Proposed Medicare ‘Pain’

The Medicare benefit cuts President Obama proposes are also a step in the wrong direction that would cause Latino seniors real pain.

Rather than dealing with the high costs of health care, the budget shifts health costs to beneficiaries by increasing deductibles, premiums and co-payments. The president’s plan would also create a new surcharge.

The White House claims these cuts will make Medicare beneficiaries better health care consumers, but this is a flawed argument. Doctors--not beneficiaries—make medical decisions, so the idea that seniors can shop around for health care is ludicrous. As a result, Latino seniors who cannot afford the higher out-of-pocket costs are liable to forego needed care—until their conditions become more acute and costly to treat.

So-called means testing of Medicare will not only affect the rich—over time, it would increase premiums for Latino seniors making up to $47,000 a year.

Seniors already spend three times more of their incomes on their direct health care costs as the rest of the population. Under the president’s budget, the reduction in Latino seniors’ income would be two-fold: They would be hit by the chained-CPI, and their out-of-pocket health care costs would increase on top of that.

In addition, the president’s budget provision requiring a $100 co-payment per episode for home health care services could severely impact those who depend on home health aides to treat their diabetes and other chronic diseases. This would disproportionately affect Latino seniors who have higher rates of diabetes than the overall population.

For example, in Chicago, where diabetes is the most prevalent in the country, 25.8 percent of Latinos over 65 suffered from diabetes compared with 15 percent of non-Hispanic whites.

The White House has defended the proposed Social Security and Medicare reductions as “not ideal” measures needed to achieve a compromise with Republicans in Congress.

Not the Problem—But a Solution

There is no question that the president faces difficult choices as he navigates unprecedented Republican obstruction. But at times, President Obama appears to have adopted the Republican framing as well: That our budget problems are due to over-generous Social Security and Medicare benefits.

In fact, Social Security does not and legally cannot contribute one penny to the annual deficit and cumulative national debt. Medicare’s rising costs are due to skyrocketing private health care costs. In fact, Medicare has proven far more effective at controlling medical inflation than its counterparts in the private insurance market.

Latinos voted for a president bold enough to start a new conversation about the challenges of aging, health care and economic security, not someone beholden to the same old Republican talking points.

A real “adult” conversation on our aging boomer population would begin by acknowledging that America has a retirement security and health care crisis. Social Security and Medicare are the solutions to those crises, not the problem.

The Latino community appreciates President Obama’s leadership on immigration rights and health care reform. Now it is time for him to honor his promise to Latinos and other vulnerable elders to protect and strengthen Social Security and Medicare.

Eva Dominguez is the executive director of Latinos for a Secure Retirement, an advocacy group in Washington, D.C.



]]> tag:newamericamedia.org,2013://19.11241 2013-04-10T08:00:00Z 2013-04-11T15:06:14Z

Anthony Advincula ]]> http://publisher.namx.org/mt-cp.cgi?__mode=view&blog_id=19&id=63 Image: Florida resident Irina Flores-Montalban is on a five-year waitlist to receive subsidized medical care for her ailing son. 

MIAMI — About seven months after they moved to Florida, Irina Flores-Montalban found out that her 11-year-old son, Jose, had a blood clot in his heart and needed an operation. Without health insurance, she was advised to enroll him in the state’s Medicaid program in order to get immediate treatment.

But her situation became more dire when the 38-year-old Sarasota mother was told that Jose — as well as his two siblings — was not qualified. Although they have a green card, the family did not meet the state’s five-year residency requirement.

“I didn’t know that every state is different,” Montalban, an Ecuadorian immigrant, said in Spanish. “In New York, where we used to live, they just asked me to fill out the form and soon I got the medical cards in the mail.”

Desperate, she asked one of her children to go online and look for a cardiologist. At the time, Jose had already been experiencing frequent nosebleeds. “I was getting frustrated but [I was] determined to get my son treated. I was willing to pay the consultation fees,” Montalban said.

When they arrived at the doctor’s office, the doctor informed her that Jose had a congenital heart condition and was like “a ticking time bomb.” Because he needed to have an operation right away, the doctor’s aide helped put Jose in an emergency care program, but the post-operation medical bills were not covered.

In Florida, lawful immigrants are eligible for public benefits such as Medicaid and the State Children’s Health Insurance Program (SCHIP) only if they have been residing in the United States for five years. Under the 1998 welfare reform law -- which introduced restrictions for federal income-based benefits related to immigration status and length of U.S. residency -- 22 other states, including Washington, D.C. enforce the same eligibility requirement.

Confusion among immigrants limited in their English ability and unfamiliar with the nation’s health care system is common.

“It’s just not right,” said Diana Ragbeer, director of public policy and communications at the Children’s Trust of Miami-Dade County. “We’re not even talking here about undocumented adults; we’re talking about lawful children.”

Filling the Coverage Gap

In Florida, the law impacts somewhere between 20,000 and 40,000 immigrant children across the state, according to a Florida Center for Fiscal and Economic Policy (FCFEC) report. Health care advocates there say getting rid of the five-year waiting period would go a long way toward closing that gap.

“The only way to [cover these children] is for the state to lift the five-year ban,” said Nicholas Duran, health care coordinator for the non-partisan Children’s Movement of Florida, which works to expand coverage for children in the state. “Even Obama’s Affordable Care Act won’t change or impact the ban.”

Since 2009, with passage of the Children’s Health Insurance Program Reauthorization Act (CHIPRA), states have had the option of extending eligibility for Medicaid and CHIP to all lawful immigrant children residing in the United States, with no waiting period.

Florida, however, has yet to change any provisions in its law.

Legislation to lift the ban was introduced last year. The bill, known as the Flordia Kidcare Program (SB 704), is currently being considered by the state legislature. Opponents of the bill say it will lead to increased state spending and that it aims to include undocumented immigrant children, charges that supporters roundly dismiss.

“It is important to note that SB 704 does not seek to open up eligibility for undocumented immigrant children or those who are temporarily residing in the country,” Duran said. “And it [SB 704] also took into account the enhanced federal matching dollars” that would come from CHIPRA if the state does away with the waiting period.

The maximum cost to the state of extending coverage to all legal immigrant children, the FCFEC findings also showed, would be $17.6 million. Most of this budget is already available, supporters of SB 704 contend, as it would use unspent state funds already earmarked for children’s coverage.

They add that with the federal government’s 71 percent funding increase for Florida’s CHIP program, an additional $3.8 million will flow into the state.

Choosing One Among Her Children

After separating from her husband, Montalban and her three young children – Margarita (17), Emilio (9) and Jose – moved from New York to Florida to start a new life. Her brother bought a house in Sarasota, and asked her to take care of the house and have their mother live with them.

It was an opportunity for her to save rent and, at the same time, her kids would be closer to their grandmother, she said.

Montalban works part-time at the clothing retailer Forever 21 and earns about $600 a month, enough to cover food costs and other basic needs. Several days a week she attends an ESL class at a local community center.

But that routine was upended the day she registered Jose for school. When he took the required physical exam, nurses discovered that his blood pressure was well above normal. They later learned of clots in his aorta. His condition is congenital, Montalban said, meaning he may need a cardiologist for the rest of his life.

Aware that her kids were ineligible for Medicare, she found herself facing a painful dilemma: choosing which of them to insure.

In retrospect, the choice was clear.

“I had no choice but to get health insurance only for Jose. I pay $141 a month for his insurance. I would not be able to afford insuring my other children, so I pray that they won’t have the same health problems.”

Montalban then added that passage of SB 704 would be “more than a blessing” for her and her children. “If they qualify for Kidcare, I’ll only be paying $20 a month to cover their health insurance,” she said. “I know that there are a lot of people who are in my situation.”

Liz Gonzalez of New America Media in San Francisco, CA and Ryan Morris of Florida CHAIN in Tampa, FL contributed to this report. This story was written as part of a series on healthcare reform funded by the Atlantic Philanthropies.
]]> tag:newamericamedia.org,2013://19.11240 2013-04-10T07:50:00Z 2013-04-10T21:24:32Z

Valeria Fernández ]]> http://publisher.namx.org/mt-cp.cgi?__mode=view&blog_id=19&id=103 PHOENIX, Ariz.--Teresa Ramirez learned to live with the pain of ovarian cysts after she was diagnosed a year ago. As an undocumented immigrant, she doesn’t qualify for Medicaid, which would cover an operation, and she can’t afford private insurance.

“I’m waiting for immigration reform so I can go to Mexico to have an operation,” said
Ramirez, who is 45.

Undocumented immigrants like Ramirez make up one in seven medically uninsured people in the United States. And they are excluded from the Affordable Care Act (ACA) that will take effect in 2014, expanding Medicaid and offering tax credits to help people buy insurance.

Although comprehensive immigration reform could create a path to citizenship for 11 million undocumented immigrants, the current framework would keep Ramirez from ACA for 10 to 15 years, until she becomes a legal permanent resident. They would form a new category of residents--authorized to be in the U.S., but denied treatment coverage unless they could pay out of pocket.

Denying Care Could Be Costlier

The political argument to exclude this new category of aspiring citizens from ACA is framed in economic terms, but health care advocates argue that the long-term impact of leaving a segment of the population in health care limbo would be costlier.

A recent report from the Migration Policy Institute (MPI) says that by keeping this new category of immigrants –in many instances low-income- from accessing affordable healthcare, would shift the costs of their care to localities and states.

States with the largest unauthorized population will face the bigger challenges, once these immigrants gain legal status but are excluded from ACA. MPI’s report, just published in the prestigious journal, Health Affairs, identifies California, Texas, Florida, Arizona and Georgia.

“The states and localities will continue to pay a high share of the uninsured cost,” said Randy Capps, senior policy analyst at MPI and one of the authors of the study.

He explained that in this case, a new group of U.S.-approved immigrants would join the ranks of the uninsured in states that already have mandates to provide services to authorized immigrants.

“It will be particularly harder for those states, which in the past have been extending health benefits to immigrants, to look the other way,” Capps said.

Another challenge for localities, Capps said, would be that federal reimbursement for hospitals caring for the uninsured is expected to decrease after ACA is implemented, although health care reforms will increase funds for community health centers and clinics that provide primary health care.

Those changes would not answer the needs of Ramirez and her mixed-status family.
Her husband, for example, has checkups for his diabetes at a local charity clinic that provides free services. But he recently had to be hospitalized for two days, and the family is struggling to pay over $5,000 in bills.

The challenges Ramirez and her family face are no different than what uninsured, low-income U.S. citizens experience, but they are compounded by fear of seeking help.

The state provides Medicaid coverage to two of Ramirez’s grandchildren because they were born in the U.S., but Arizona won’t cover the other children because their father, an undocumented immigrant, makes slightly more than the earnings limit to qualify.

“He makes $40 more than you’re supposed to,” said Leticia Ramirez, whose husband brings home $500 a week. The threshold for a family that size is $1,963. (Amounts differ by state.)

National Advocates for Health Access

“The largest question is why are we keeping people from participating in a system that is fundamental to the American infrastructure in which we ultimately want them to be participating,” said Jen Ng’andu, director of health and civil rights policy for the National Council of La Raza (NCLR).

NCLR and other groups are pushing for any immigration reform package to include a way for the aspiring citizens to obtain affordable insurance by at least being able to receive tax credits for purchasing it in the market place, such as the subsidy under ACA.

Currently, not all immigrants-- even permanent legal residents -- have immediate access to all the components of ACA. Green card holders or legal permanent residents get some benefits but have to wait five years to participate of Medicaid.

Creating roadblocks to health care for a segment of the population has an overall impact on everyone’s access, said Sonal Ambegaokar, a health policy attorney at the National Immigration Law Center (NILC).

“If you don’t give them any options for affordable insurance then they have to wait until they get very sick. We’re not saving any money by excluding them now,” Ambegaokar said. “The question is what is the most efficient way to make sure people don’t get sick and we don’t pay unnecessary expenses.”

Whether the status quo changes or not, some local groups in Arizona are preparing to ramp up their primary health care services to fill the current void for undocumented immigrants, who are often fearful about seek affordable treatment.

Phoenix Allies for Community Health (PACH) has been functioning for two years as a mobile service with volunteer doctors and nurses taking house calls for undocumented families and organizing health fairs.

The group’s vice president, Jason Odhner, who is cofounding a health clinic in the heart of an immigrant neighborhood in Phoenix, has seen the value of offering people preventive care. He has also seen the worse case scenario.

Odhner remembered an undocumented man who couldn’t afford the care for his diabetes and eventually had a leg amputated.

“Regardless of what happens with immigration reform, we need to provide basic care,” said Odhner, who is also a registered nurse.

An advantage to having more immigrants become authorized U.S. residents is that more would be considered for jobs offering health insurance or enabling them to afford coverage. “If we had a better-paying job, you’ll pay for your own insurance,” said Ramirez.

On the other hand, undocumented immigrants who now have insurance may loose it, said Capps. That is because under ACA small employers won’t be mandated to provide health insurance so they might decide to drop it or give people a stipend to help them buy it privately.

Politics vs. Public Opinion

The frameworks of both President Obama’s and Congress’ so-called Gang of Eight (the bipartisan group negotiating a reform plan) exclude this new category of immigrants from ACA. That is consistent with the administration’s directive to exclude deferred action recipients from it as well, although if reform passes this group of young people may get on a fast track towards citizenship.

Although debate in Washington is apt to be contentious in the coming months, the issue might not be as polarized among the public. Opinion polls have shown support from Americans towards including a new category of provisional immigrants into ACA.

In a poll released this February by the Kaiser Family Foundation, 63 percent of respondents said they would support ACA coverage for provisional immigrants whose income is low enough to qualify for Medicaid.

If things don’t change, for immigrants like Ramirez, the choice maybe to continue to rely on the safety net of free clinics, emergency rooms and charities in Arizona, with the advantage of accessing less expensive care on the other side of the border.

“I think that if they’re going to do a legalization they should legalize healthcare too,” Ramirez said.




]]> tag:newamericamedia.org,2013://19.11207 2013-04-04T08:00:00Z 2013-04-14T21:45:15Z

SAN FRANCISCO -- After undergoing emergency brain surgery in November 2010 to drain fluid that doctors believed was being caused by a tumor, Erica Chain cut short her stay in Asia where she had been doing volunteer work and...

Viji Sundaram // Video: Josué Rojas & Edith Romo ]]> http://publisher.namx.org/mt-cp.cgi?__mode=view&blog_id=19&id=103 SAN FRANCISCO -- After undergoing emergency brain surgery in November 2010 to drain fluid that doctors believed was being caused by a tumor, Erica Chain cut short her stay in Asia where she had been doing volunteer work and returned to California where she hoped to continue her medical care.

Sorry, she was told by every health insurance company she contacted, you are “medically uninsurable” because of your pre-existing condition.

“Being 27, diagnosed with a life-threatening brain tumor and denied coverage was the lowest I ever felt,” Chain, now 29, recalled.  

But before long, Chain found out through a friend about a federally funded program administered by California, which grew out of the 2010 Affordable Care Act (ACA). The program allows people like her with pre-existing health conditions to secure affordable health coverage in the insurance market place.

Called the Pre-Existing Condition Insurance Plan (PCIP), it guarantees access to insurance for United States citizens who have a pre-existing health condition and have been uninsured for at least six months. To prevent people with private health insurance from switching to the less costly PCIP, the health reform law put in the six-month requirement provision. Applicants need only show a letter from a doctor stating they have had a medical condition in the past year.

For Chain, enrolling in PCIP couldn’t have come sooner. Within days after she did, she fell into a coma and was admitted to neuro-ICU at UCSF. There, doctors performed brain surgery to remove a rare aneurysm that had burst in her midbrain, which was previously thought to be an in-active and inoperable tumor.

The young woman remained in what doctors called a “living coma” for the next two months. She was awake, but wasn’t aware of anything going on.

“I thought I was living a bad dream,” she said.

PCIP in California

Meant to be nothing more than a “bridge” program, PCIP will fold into the ACA when the federal healthcare reform  is fully implemented Jan. 1, 2014, when insurers will no longer be able to deny individuals with pre-existing conditions coverage, or charge them higher rates because of those conditions.

Since the PCIP program began in September 2010, California has consistently led the nation in the number of enrollees. As of Dec. 31, 2012, the state had an estimated 15,100 people, with Los Angeles County boasting the highest enrollment.

At 56.9 percent, white enrollees far outnumber other ethnic groups, with Asian and Pacific Islanders (API) coming in a distant second. Chain, who is of Chinese descent, is among the 9.3 percent of API enrollees.

Health care advocates have lauded the PCIP program for providing access to health care to thousands at an affordable cost. Chain said her monthly payments are about $200.

PCIP suspended

Health care advocates worry about the recent federal directive from the Centers for Medicare and Medicaid Services (CMS), that California, as well as all other states nationwide, suspend new enrollment in its PCIP program, beginning March 2. CMS, which funds PCIP, defends the move as necessary in order to ensure that there are sufficient funds available for the rest of the year to cover those already enrolled.

The Managed Risk Medical Insurance Board (MRMIB), an arm of the state’s Health and Human Services Agency, which operates California’s PCIP program, said that while it would comply with the directive, it will still enroll anyone who is enrolled in another state but moves to California.

And it will continue to screen applications submitted after March 2 to see if the individual qualifies for the state’s own high-risk pool -- the Major Risk Medical Insurance Program (MRMIP), which health advocates say is not as attractive as PCIP.

“(MRMIP’s monthly premiums) are a lot more expensive and it offers less benefits than PCIP,” pointed out Anthony Wright, executive director of Health Access, a statewide consumer health advocacy group.

“What is more egregious is that it has a $75,000 annual cap on coverage,” he added. PCIP had none.
Wright observed that if “we had a different Congress,” one more supportive of the ACA, California and other states could have asked for more money to continue enrollment in PCIP.

Chain estimates that her medical bills would have set her and her family back by about $1.3 million, forcing them into bankruptcy. That amount includes her long rehab, where she had to relearn how to walk, talk and eat on her own.

“I came out of the coma with no short-term memory and double vision,” she said.

Thanks to PCIP, she said, she has made a hundred percent recovery, which she calls nothing short of a “miracle.”

She lamented that some people who learned of her enrollment in the program from her blogs think she got a “free ride” at the taxpayers’ cost. That, she asserted, is a misconception.

“It’s just like paying for any other normal health insurance,” she said, adding: “Without it, my case would have fallen into a county hospital or charity care,” and that would have cost the taxpayers a lot of money.

Chain’s work in health care snagged her an invitation to the White House during Obama’s second inaugural. Seven other U.S. citizens who had contributed to education, energy and other areas on the President’s agenda got to meet him in the Oval Office.

As Chain received a presidential hug, she thanked Obama for saving her life.
]]> 63288396 tag:newamericamedia.org,2013://19.11199 2013-03-31T10:00:00Z 2013-04-01T07:19:37Z

Thirty-two-year-old Arijit Guha, a Ph.D. student at Arizona State University and founder of the popular Poop Strong campaign, died March 22, after battling stage four colon cancer for the past two years. The Indian American graduate student spoke to India-West...

Monica Luhar ]]> http://publisher.namx.org/mt-cp.cgi?__mode=view&blog_id=19&id=103 The Indian American graduate student spoke to India-West in an earlier interview last year (I-W, Nov. 18) about his frustration with a “broken healthcare” system and his struggle to pay the rest of his cancer bills after maxing out on a $300,000 lifetime cap placed by an Aetna student health insurance plan at ASU.

In 2011, Guha was diagnosed with stage four colon cancer after returning from a trip to India with his wife. Soon after, he began to experience gastrointestinal problems and vomited frequently. After consultations with doctors, he learned that he had a large tumor – nearly six centimeters wide — in his colon. Despite undergoing a colonoscopy, the cancer later spread to Guha’s abdominal cavity.

During the months following chemotherapy treatments, Guha used social media to initiate a discourse about the healthcare system, not expecting the CEO of Aetna, Mark Bertolini, to respond. Much to his surprise, Bertolini tweeted Guha and asked Aetna to pay the remainder of Guha’s cancer bills – an additional $118,000 that Guha had accumulated while he was uninsured after maxing out on the student health plan.

“If [someone] has some sort of dire, catastrophic health event, the insurance can’t kick them off because they are too expensive – and that’s exactly why we need insurance more than any other time,” Guha had told India-West in the earlier interview.

Guha was hesitant to credit social media for playing a role in helping pay off the rest of his cancer bills. In that interview, he explained that social media was not the solution to problems that many individuals, both uninsured and insured, face.

“There’s hundreds and hundreds of thousands of people in very similar situations to mine, where they’ve had inadequate insurance or were underinsured. It’s not as if you can expect each person to tweet at the CEO of their insurance company and have their bills magically paid out,” Guha had pointed out to India-West.

In February of 2012, Guha, characterized as a “rabble rouser, do-gooder, mustache enthusiast,” launched his campaign, PoopStrong.org, as a way to pay the rest of his cancer bills by selling t-shirts, bracelets, and other merchandise. But he didn’t just stop there.

Guha told India-West that since Aetna agreed to pay off his remaining cancer bills, he would make sure that the rest of the $130,000 that he had raised through his campaign would go directly to three main cancer organizations: the University of Arizona Cancer Center’s Patient Assistance Fund, The Wellness Community-Arizona, and the Colon Cancer Alliance.

Guha had taken a break from chemotherapy last summer and used the time to travel with his wife and enjoy life. But shortly after, Guha began experiencing abdominal pain and ended up in the hospital again.

“We learned that the tumors had returned and were putting pressure on his bowels, creating blockages and essentially shutting down his GI tract,” a post from his blog titled “Stage IV Hope” noted.

In December of 2012, Guha had a gastrostomy tube placed in his stomach to prevent him from experiencing nausea and vomiting. His vomiting ceased for some time, but other problems surfaced.

Guha ended up undergoing another round of chemotherapy, to regulate his digestive system. But this time, the chemotherapy failed to work after surgeons realized that the tumors had reentered his abdominal cavity. Instead of going through additional rounds of treatments, Guha made the decision to end treatment and focus on hospice care. He died in his home, surrounded by family and friends in Arizona.
]]> tag:newamericamedia.org,2013://19.11206 2013-03-30T08:20:00Z 2013-03-30T01:03:53Z

Viji Sundaram and Paul Kleyman ]]> http://publisher.namx.org/mt-cp.cgi?__mode=view&blog_id=19&id=103 Photo: Arsenio I. Jimenez, MD, examines patient at Sacramento’s Molina Medical Clinic. (Courtesy of Molina Healthcare)

SACRAMENTO – California became the fifth and largest state this week to win federal approval for a new plan aimed at improving care for almost a half-million of the state’s most vulnerable patients.

Called Cal MediConnect, the new three-year demonstration program initially will enable the eight counties to pool funding and resources for so-called “dual-eligibles,” lower-income people who qualify both for federal Medicare and the federal-state Medi-Cal program for the poor (California’s name for Medicaid).

In announcing the program Wednesday in a teleconference from Sacramento, California Health and Human Services Secretary Diana Dooley, said the triple aim of Cal MediConnect is to provide enrollees with “better care, better health and at lower cost.”

Ends Checkerboard of Health Programs

With the approved federal-state agreement, eight California counties will test a new approach that supporters of low-income seniors and people with disabilities hope will better integrate and coordinate their care. The present system often makes many jump around a checkerboard of programs resulting in higher government cost, poor continuity of care and preventable health problems.

But consumer advocates, while generally hopeful that the new program will end that care fragmentation, are also raising concerns that program announced this week will not allow participating health plans and providers enough time to absorb so many additional patients by Oct. 1, when the program will start.

During Wednesday’s call and a follow-up teleconference on Thursday, Dooley and her staff outlined the benefits of the program to hundreds of “stakeholders,” such as health care plans, providers and consumer advocates.

Dooley explained that provisions of the 2010 Affordable Care Act (ACA) offer enhanced options to improve care for dual-eligibles. One is the patient-centered medical home that is designed to integrate care for various health needs.

Also, the pilot project grew out of Gov. Jerry Brown’s 2012 Coordinated Care Initiative to move low-income seniors and people with disabilities now aided by multiple state programs—adult day health care, case management and In-Home Supportive Services (IHSS)--into managed care plans.

The new eight-county pilot program will enable health care providers to go beyond coordinating those three long-term support and services programs for people with continuing care needs by also including Medicare’s coverage of hospitals, doctors and prescription drugs.

In outlining the Cal MediConnect program on Wednesday, Toby Douglas, director of the California Department of Health Care Services (CDHC), noted it was originally set to begin in March. But under the new agreement with the U.S. Centers for Medicare and Medicaid Services (CMS), the launch date was moved to October, to enable participating agencies “to talk to each other,” Douglass said, smoothing out the transition.

‘Live and Operational’ Oct. 1

Total enrollment will be capped at 456,000, Douglas said, a little less than half of California’s 1.1 million dual-eligibles. Seven in 10 are age 65 and older, and the majority are women, and about one-third are younger people with disabilities, according to the website, CalDuals.org [www.calduals.org/].

The eight demonstration-project counties are Alameda, Los Angeles, San Bernardino, San Diego, San Mateo, Santa Clara, Orange and Riverside.

During Thursday’s teleconference, CDHC Deputy Director Jane Ogle told the 600 stateholders on the line that in most of the counties the Cal MediConnect demonstration will begin enrolling dual-eligibles in August and the program. “The implementation date is Oct. 1,” she stated. Programs will have to “go live and be fully operational,” providing services on that date, she said.

A major change for dual-eligibles in California is that about 80 percent now receive care on a “fee-for-service” basis, with the fee paid by the state or federal government for each doctor, test or procedure. That makes it difficult for patients to navigate more than one system, sometimes exacerbating health conditions, according to the program’s website.

However, Ogle allayed previous widespread confusion about whether patients would be forced into health maintenance organizations (HMOs) for all of their care.

She assured stakeholders on Thursday’s teleconference that for the federal Medicare part of the Cal MediConnect program, patients can still retain their current doctor and coverage, even if it is in Medicare’s fee-for-service plan. They would not have to join a Medicare Advantage HMO.

However, those who also need the long-term services and supports under the state initiative will be shifted into managed care for those ongoing services.

The new demonstration program will enroll dual-eligibles on IHSS automatically in Cal MediConnect. However, individuals in the Community Based Adult Services program (for adults day health care), or the Multipurpose Senior Service Program (for case management) will still have to be qualified separately by the state to continue receiving those services within the pilot project.

Advocates’ Concerns

Although optimistic about the potential for Cal MediConnect to improve care, Kevin Prindiville, a staff attorney with the National Senior Citizens Law Center (NSCLC) office in Oakland, said, “There are still concern that the number of participants will be too large, and the timeline too fast.”

Prindiville served as a consumer representative on the state health department’s work group on consumer protection that helped develop the new programs. He said, “We will still push the Department of Health Services and CMS to reconsider.”

Patient advocates are worried, he explained, that Cal MediConnect is including too many beneficiaries at this point.

“We think the system should be set up with smaller groups to give the state, the plans and the providers a chance to adjust,” he said.

Even though the newly approved program cuts the original number for Los Angeles County in half—from 400,000 to 200,000 people—Prindiville said their cases will be handled by two private health plans with little experience managing their complications of long-term support and services.

He added, “We don't think any type of enrollment should begin any sooner than January 2014,” rather than this October. Moreover, he said, the state should move more slowly by starting all of the county programs with voluntary enrollments, as the other four federally approved states have done, signing up people who learn about it and are ready for the change.

But the Cal MediConnect, Prindiville said, there are different enrollment timeframes with only Los Angeles initially offering voluntary enrollment from October through the end of December. Starting in January, the state will automatically enroll others throughout 2014. The other counties must all start with automatic enrollments in October.

“Transitions can be tricky,” he emphasized. “For instance, people will want to change providers or prescription drug plans. Moving more slowly would give time for people and the system to adjust to their needs at a detailed level.”

Quality Care and Access

Prindiville said he was pleased to see that the state and CMS were receptive to requests by consumer advocates to include an ombudsman program in the final Cal MediConnect agreement. The ombudsman will investigate beneficiary complaints. State health officials and CMS are still working out the program’s details, according to CDHC’s Ogle.

Prindiville said he hopes ombudsmen will be available in each county for one-on-one help to file an appeal or complaint, such as if the quality of care is not up to a good standard.

“Assistance should be available in their county, not at an office in Sacramento,” he said. “Typical problems have been denial of services, problems finding a doctor in a plan’s network, or a person’s current provider not being on the plan.”

During Thursday’s tele-call, Ogle noted that the state’s materials would be translated into several languages listed in state law. But Prindiville, stressed, “The next step would be to ensure translation is done in the designated language by the health plans.”

“A big component of this demonstration program, Prindiville said, “is achieving state budget savings.” Health plans in Cal MediConnect will receive rate reductions from the 2013 level of 1 percent rate the first year, 2 percent the second year and 4 percent the third year.

“The major question is what kind of pressure will this put on plans? Will quality or access suffer?” he asked.

DHCS Director Douglas emphasized in a statement: “We are confident that the managed care plans we selected will make a positive impact on enrollees’ lives by coordinating care across the full continuum of services.” And he noted, “We have taken extensive measures to plan for and enforce strict quality and readiness standards.”


]]> tag:newamericamedia.org,2013://19.11196 2013-03-29T08:05:00Z 2013-03-29T15:46:28Z

Anna Challet / Video: Silicon Valley Debug ]]> http://publisher.namx.org/mt-cp.cgi?__mode=view&blog_id=19&id=103 SACRAMENTO -- Trina Meza lost her job almost a year ago, in April of last year. Her story is like that of so many others – along with her income, she abruptly lost her medical and dental coverage, as well as coverage for her son, Simon, who is 11.

Meza had applied for Medi-Cal for Simon, but the application status had been listed as “pending” for weeks, and when she called to ask about it, she couldn’t get any answers about the delay.

“I thought, ‘I need to talk to someone,’” she said.

Meza was one of thousands who lined up for the WeConnect Community Resource Fair and Highway to Health Festival at Hiram Johnson High School here on March 16. Sponsored by The California Endowment (TCE), a private health foundation that provides grants to community-based organizations in the state, the fair and others like it are meant to increase enrollment in health care programs under the Affordable Care Act.



At these events, uninsured Californians can be screened for eligibility for a variety of public health programs, and volunteers are available to help them enroll. The fairs also offer free tax preparation for lower-income individuals, as well as health and dental screenings with resources for finding low-cost providers. The day is punctuated with free entertainment, like a Zumba class and a performance by the Sacramento Kings Dancers.

Meza and her son live in Sacramento, and she learned about the event at the Teichert Branch of the Boys and Girls Club.

Meza, who formerly worked in records management, has been constantly applying for jobs since last April. With help from CalWORKs, California’s welfare-to-work program, she has been able to start going to school to become a pharmacy technician, but until Saturday her son still lacked medical coverage.

Volunteers at the fair screened her for eligibility and were ultimately able to enroll Simon in Medi-Cal.

“They filled out all the paperwork and got him signed up,” she said.

Thousands of low-income people filed through the high school gym throughout the day, demonstrating the widespread lack of medical coverage and the need for help finding the necessary information to access public health programs.

“People like me who used to be self-sustaining, it feels like we’re taking steps backward these days,” Meza says. “I’ve become very good at finding resources like this.”

TCE will be holding three more such events in the state over the next few months – in San Diego, Kern County and Oakland.


New America Media's ongoing coverage of the Affordable Care Act is supported by a grant from The California Endowment.]]>