Millions Of Ill People May Face ‘Extremely High Premiums’ Under House Bill, CBO Says

June 1, 2017 by · Leave a Comment 

The Republican overhaul of the federal health law passed by the House this month would result in slightly lower premiums and slightly fewer uninsured Americans than an earlier proposal.

But it would leave as many as one-sixth of Americans living in states where older and sicker people might have to pay much more for their health care or be unable to purchase insurance at all, the Congressional Budget Office said Wednesday.

In some states, said the report, “less healthy people would face extremely high premiums, despite the additional funding that would be available” in the bill to help offset those increases.

The report incorporates the changes to the bill made just before it narrowly passed the House on May 4. Those changes included an amendment offered by Rep. Tom MacArthur (R-N.J.) that would let states waive some key provisions of the health law, including requirements to cover “essential health benefits” and to offer insurance to people with preexisting conditions at no extra cost.

CBO said the current version would result in savings of $119 billion over 10 years and 23 million more uninsured people than would be expected under the current law.

According to the estimate, premiums would be slightly lower than under the Affordable Care Act, but mostly because “the insurance, on average, would pay for a smaller proportion of health care costs.”

Prior to the changes, the CBO estimated that the bill would result in savings of $150 billion over the next decade and grow the number of uninsured Americans by 24 million. That dollar figure was a considerable change from the original version of the bill that CBO said would have saved $337 billion, but lawmakers decided to spend back some of those savings on help for those likely to be cut off from insurance.

The two earliest versions of the bill could not muster enough support for the House leadership to bring them to a vote on the floor. Later, MacArthur and leaders of the conservative Freedom Caucus negotiated changes that they said should help bring down premium costs for consumers. That is the bill approved and now evaluated by CBO.

The CBO also estimated that in states deciding to take the option to waive requirements related to charging sicker people more, “the nongroup market would start to become unstable.” In particular, said the report, “people who are less healthy (including those with preexisting or newly acquired medical conditions) would ultimately be unable to purchase comprehensive nongroup health insurance at premiums comparable to those under current law, if they could purchase it at all.”

And in states that chose to waive the requirements for essential benefits, even people with insurance “would experience substantial increases in what they would spend on health care,” because their policies might no longer cover expensive treatments like those for maternity care or mental health and substance abuse.

Despite repeated claims from President Donald Trump and congressional Republicans that the Affordable Care Act is collapsing, the CBO specifically said that the market would continue “to be stable in most areas” under current law. It predicted the same for the original version of the House bill.

In fact, the only place the CBO specifically said the individual insurance market might become unstable is in states that decide to waive the ACA’s coverage requirements. It did not guess which states might do that, but the report says that one-sixth of the population could be subject to that instability.

“What is clear is that these waivers make life much, much worse for people with preexisting conditions, for older people, for sicker people,” said Aviva Aron-Dine, a senior fellow at the Center on Budget and Policy Priorities and former Obama administration health staffer.

The savings in the bill are mostly the result of capping federal funding to states for the Medicaid program for those with low incomes and scaling back the tax credits that help some people with low and modest incomes pay for private insurance. An estimated 14 million of the 23 million people who would no longer have insurance would otherwise have obtained it through Medicaid.

The bill would also repeal nearly all the taxes imposed in the ACA to pay for the new benefits, including taxes on wealthy individuals and much of the health industry.

Reaction to the new estimate fell mostly along predictable party lines.

“CBO continues to find that through our patient-focused bill, premiums will go down and that our reforms will help stabilize the market,” said a statement from House Energy and Commerce Committee Chairman Greg Walden (R-Ore.) and its health subcommittee chairman, Michael Burgess (R-Texas).

By contrast, Rep. Steny Hoyer (D-Md.) said the new estimate shows “TrumpCare will kick millions of Americans off their insurance coverage and force consumers to pay more for less.”

But the reaction was not completely partisan. Sen. Bill Cassidy (R-La.), a key swing vote in the Senate, said that “Congress’s focus must be to lower premiums with coverage which passes the Jimmy Kimmel test,” referring to the late-night host’s tearful monologue about the health problems of his newborn son. The House-passed bill, he said, “does not. I am working with Senate colleagues to do so.”

This story was produced by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.

The Health Challenge In Mixed-Status Homes

June 9, 2016 by · Leave a Comment 

Huntington Park resident Stephanie Martinez was just five years old when her parents brought her illegally to live in the United States. Now 23, she’s one of an estimated 853,000 people in the country who have temporary, quasi-legal status through President Obama’s Deferred Action for Childhood Arrivals (DACA) program enacted in 2012.

Today she has health insurance, but like so many in her situation the road to coverage was filled with obstacles, complicated by her family’s mixed-immigration status and a combined household income slightly too high to qualify for health subsidies but too low to pay for private insurance.

Under DACA, young people between the ages of 16 and 31 who were brought to the country illegally as children can temporarily avoid deportation and work legally in the U.S., provided they meet certain eligibility requirements, such as attending or completing high school and passing a criminal background check.

Lea este artículo en Español: Soñadores en Busca de Cuidado Asequible

For many who have qualified there’s a sense of normalcy, of no longer living in society’s shadow, that is unless like Stephanie you live in a “mixed-status” home, where some members of your family are citizens, legal residents, or DACA recipients, but others are undocumented.

When enacted in 2014, the Affordable Care Act (ACA)—also known as Obamacare—explicitly excluded DACA recipients – often referred to as “dreamers” – and undocumented immigrants from buying health insurance from state or federally sponsored health insurance marketplaces and the premium tax credits, subsidies and other savings on marketplace plans.

“It’s political,” Gabrielle Lessard, a health policy attorney with the National Immigration Law Center told EGP, explaining that the Obama Administration knew it would face a backlash if the undocumented and DACA recipients were allowed to take part in the program, even though they pay into the tax pool that subsides the coverage.

In her early twenties, Stephanie wasn’t worried about not having health insurance; after all, she’s young and healthy. The same couldn’t be said for her father Alvaro Martinez who suffers from diabetes and needs ongoing medical attention, but struggles to get care because he is undocumented.

So last year, when Stephanie’s father asked her to apply for health coverage for the family through the state’s health exchange, Covered California, she gladly filled out the application at a local health fair sponsored by AltaMed.

Marketing Coordinator Laura Ochoa works on AltaMed’s “Dreamers and Medi-Cal” program, which screens DACA recipients for eligibility for the state’s Medi-Cal program for low-income families. DACA recipients can qualify for coverage under the state’s recognition of the Permanently Residing in the United States Under Color of Law (PRUCOL), a public benefits eligibility category created by the courts.

According to US immigration officials, “an individual may be eligible for Medicaid (Medi-Cal), if the individual is an alien residing in the United States with the knowledge and permission of the Immigration and Naturalization Services (INS) and the INS does not contemplate enforcing the alien’s departure,” as in the case of DACA recipients.

California and New York see DACA recipients as having met the PRUCOL standard, Lessard said.

Stephanie Martinez reviews the Medi-Cal documents she received by mail. (EGP photo by Jacqueline Garcia)

Stephanie Martinez reviews the Medi-Cal documents she received by mail. (EGP photo by Jacqueline Garcia)

Requirements to qualify for California Medi-Cal for DACA recipients include having a valid work permit, a social security number, identification and proof they are low-income, Ochoa told EGP.

But Stephanie’s case was more complicated. Her family’s combined household income of $46,000 exceeded the maximum Federal Poverty Level (FPL) of 138%, or $33,534 a year for a family of four to qualify for Medi-Cal. Their mixed-immigration status, her parents are still undocumented, also made group coverage through the health exchange unlikely. Private insurance is too expensive, Stephanie said.

A study by the UCLA Labor Center’s Dream Resource Center found that one in seventeen children in the U.S. live in mixed-immigration status homes.

“Mixed-status families are a growing demographic in the United States” and their health outcome provides insight into the health of the future of the U.S. population, according to “Undocumented and Uninsured; A five part Report on Immigrant Youth and the Struggle to Access Health Care in California.”

Stephanie attends Santa Monica College and works part-time. She says she’s still dependent on her family for necessities like food and the roof over her head.

According to Ochoa, Stephanie’s best option is to apply as an individual. She said students who earn about $10,000 could qualify for Medi-Cal even if their parents claim them as deductions.

“If they are part-time students and part-time workers, most likely they are eligible,” she added.

Earlier this year, Stephanie applied as an individual and was approved for Medi-Cal coverage effective June 1 through the L.A. Care Health Plan.

While exploring her family’s options, Stephanie also discovered that Mr. Martinez qualifies for coverage under Los Angeles County’s Ability to Pay (ATP) program, which offers affordable health services to L.A. county residents who do not qualify for Medi-Cal, Medicare or Covered California plans, regardless of their immigration status.

The program is free to “individuals with incomes at or below $1,367 per month” and has a “low-cost [option] for individuals with incomes above $1,367 per month,” which works for Mr. Martinez.

ATP applicants only pay for the month they visit the hospital or its partner clinics. Services include doctor and ER visits, hospital care, tests and medicines, explains the Health Services of L.A. County website.

The “Undocumented and Uninsured” study states that the health of undocumented Californians is crucial to the wellbeing of the state.

They recommend expanding ACA to all Californians regardless of their immigration status or income level.

“There’s no such thing as individual health; all health is public and communal,” states the study.

A bill by state Sen. Ricardo Lara, SB 10, the Health For All Waiver, recently approved by state lawmakers, could allow undocumented immigrants to buy health coverage through the Covered California online marketplace, but would first require federal approval.

Martinez told EGP she is happy she now has health insurance, but still worries about her father’s ongoing health issues. “He has more need than me,” she said.

Immigrants with one of the following statuses qualify to use the Marketplace:
•Lawful Permanent Resident (LPR/Green Card holder)

•Asylee •Refugee •Battered Spouse, Child and Parent

•Victim of Trafficking and his/her Spouse, Child, Sibling or Parent

•Individual with Non-immigrant Status, includes worker visas and student visas

•Deffered Action Status (Exeption: Deferred Action For Childhood Arrivals -DACA)

[For a full list of eligible statuses visit https://www.healthcare.gov/immigrants/immigration-status/]

 

The three-part series was produced as a project for the California Health Journalism Fellowship, a program of the Center for Health Journalism at the USC Annenberg School for Communication and Journalism.

 

To read Part 1: DACA and Obamacare: Who Qualifies?

To read Part 3: SB10 is it worth it? What is an exemption?

—-

Twitter @jackiereporter

jgarcia@egpnews.com

Dreamers In Search of Affordable Health Care

June 2, 2016 by · Leave a Comment 

June 15, 2012 was a historic day for thousands of young immigrants who under President Obama’s executive action became eligible for temporary relief from deportation.

“These are young people who study in our schools … they pledge allegiance to our flag. They are Americans in their heart, in their minds, in every single way but one: on paper,” said Obama when he introduced Deferred Action for Childhood Arrivals (DACA), a program making nearly 1.5 million youth brought to the country illegally as children eligible for a reprieve from deportation and a work permit, both renewable every two years.

Lea este artículo en Español: Soñadores en Busca de Cuidado de Salud Asequible

Over 853,000 immigrants between the ages of 16 and 31, often referred to as “dreamers,” have applied for DACA status since the president’s announcement. For many, with the ability to work legally came the hope of higher wages and perhaps benefits.

Getting health insurance, however, has not been easy for some. For others, it’s not a priority.

The Affordable Care Act (ACA) enacted in 2014—commonly known as Obamacare— excluded DACA recipients from coverage because they are not permanent legal U.S. residents or citizens.

In this three-part series, EGP looks at some of the challenges this group of dreamers face in their search for affordable health care and the options they have to access services.

 

DACA and Obamacare: Who Qualifies?
Los Angeles resident Nidia Torres was brought illegally to the U.S. when she was six years old. She lived in the shadows for over two decades, hoping not to be discovered or deported back to Mexico, a country she does not call home.

In 2013, everything changed. Torres was granted DACA status and excitedly started planning for the future. The opportunities a work permit, driver’s license and social security number would bring to her life were endless, including providing a better future for her U.S. born daughter, Torres told EGP.

“No more shame for being undocumented,” she recalls thinking when her work permit arrived in the mail.

Nidia Torres, 34 with her four-year old daughter said DACA has provided her great opportunities, in this country, which she consider home. She just needs to find an option for medical insurance. (Courtesy of Nidia Torres)

Nidia Torres, 34 with her four-year old daughter said DACA has provided her great opportunities, in this country, which she considers home. She just needs to find an option for medical insurance. (Courtesy of Nidia Torres)

Torres soon landed a job waitressing at a national restaurant chain where she was paid minimum wage plus tips, but did not offer health insurance.

“I can work legally, my daughter has Medi-Cal, so I think I’m OK,” she told EGP, explaining that after years of low-paying jobs and long hours that left her little time for her daughter, the new job was a big step forward.

“I just wanted a job,” she told EGP. “Plus I don’t really get sick,” so health insurance was not a big deal, she said, adding she had no idea where to get coverage on her own.

Torres, who speaks both English and Spanish and has some college education has since been promoted to manager and is earning more money, but still has no health benefits.

The goal of the Affordable Care Act was to increase “the quality, availability, and affordability” of private and public health insurance to the then over 44 million uninsured Americans, providing they are legal permanent residents or U.S. citizens. To keep costs down, large numbers of young, healthy individuals — the same group targeted by DACA — would have to be enrolled, yet undocumented immigrants and DACA recipients are ineligible to buy health coverage through government sponsored health exchanges or receive premium tax credits or other savings on marketplace plans, even though they pay into the tax system.

Gabrielle Lessard, a health policy attorney with the National Immigration Law Center, calls the policy unjust. DACA recipients are working and paying taxes for a service that they can’t apply for, she told EGP.

“The exclusion of DACA recipients probably increases the price of insurance for all other people,” Lessard said.

In California, however, some low-income undocumented immigrants and DACA recipients may qualify for Medi-Cal, a state funded health insurance program for low-income families, people with disabilities, pregnant women, children in foster care and low-income adults who meet certain requirements.

(DHHS)

(CDHCS)

Torres is not one of them. According to the California Department of Health Care Services and federal eligibility requirements, Torres’ $23,000 a year income puts her just slightly above the $22,108 maximum Federal Poverty Level (FLP) for a family of two, making her ineligible for Medi-Cal.

Like many other DACA recipients with incomes “too high” for health insurance subsidies, Torres’ options for health coverage are limited, and the process for finding affordable coverage can be complex, according to the UC Berkley study, “Realizing the Dream for Californians Eligible for Deferred Action for Childhood Arrivals: Health Needs and Access to Health Care.”

Many DACA recipients don’t even know they have options, the study found. The lack of information reflects “the complexity” of the network of programs available and the process to access them, researchers stated.

Getting health care doesn’t have to be a problem, says Irene Holguin, director of community relations with Arroyo Vista Family Center, a network of five clinics serving the east and northeast side of Los Angeles.

During a free family health fair Friday at Arroyo Vista’s clinic in Lincoln Heights, Holguin told EGP there are options for everyone, regardless of immigration status or income.

When people arrive at one of our clinics for the first time they undergo a financial screening to determine what types of programs they are eligible for, she said. “We don’t turn anyone away,” she added. She explained that the clinic offers discount programs and fees to those who not qualify for state or federal funded program.

For example, if a patient can only pay $10, Arroyo Vista will help them set up an affordable payment plan for the balance, Holguin said.
The Arroyo Vista clinics provide primary health care in communities where approximately 98% of families are Latino and many of them low-income, explained Holguin.

“There’s a lot [more] that needs to be done in regard to informing the community and encouraging people to be proactive and seek preventive health services,” she said, “because a lot of people have illnesses that they don’t even know they have.”

As for Torres, she told EGP she would be open to going to a clinic like Arroyo Vista to look into her what her options are. “Better safe than sorry,” she said.

 

The three-part series was produced as a project for the California Health Journalism Fellowship, a program of the Center for Health Journalism at the USC Annenberg School for Communication and Journalism.

 

To read Part 2: The Health Challenge In Mixed-Status Homes

To read Part 3: SB10 is it worth it? What is an exemption?

—-

Twitter @jackiereporter

jgarcia@egpnews.com

CA Sen. Lara Urges Undocumented Parents to Sign Kids Up For Health Care

May 19, 2016 by · Leave a Comment 

New America Media – Kicking off his statewide tour to promote California’s Health for All Kids program, the new law’s author, State Sen. Ricardo Lara, D-Bell Gardens, said undocumented parents should set their fears aside and enroll their children in the program. The legislation would expand the state’s health insurance program for low-income people.

“There’s a misconception among immigrants,” Lara said, that asking for government help could land them in trouble. He made this observation during a May 12 media presentation at San Francisco’s Mission Neighborhood Health Center.

Mindful of this, the Health for All Kids program – which launched on Tuesday — was designed so children who currently have limited access to health care through the Emergency Medi-Cal, Healthy San Francisco or Healthy Kids programs would “seamlessly transition” into full-scope Medi-Cal (California’s version of Medicaid), said Lara. He was flanked on the podium by State Sen. Mark Leno, D-San Francisco, and Democrat Assemblymembers Phil Tang and David Chiu.

Representatives of such health advocacy groups as Children Now, Health Access, California Pan-Ethnic Health Network, Asians Advancing Justice and California Immigrant Policy Center also spoke at the media briefing.

 California State Sen. Lara at a press conference promoting the California Health for All Kids program. Photo courtesy Jesse Melgar)

California State Sen. Lara at a press conference promoting the California Health for All Kids program. Photo courtesy Jesse Melgar)

170,000 California Children Eligible
An estimated 170,000 undocumented children are eligible to enroll in the state-funded program, expected to cost $40 million in the first year of its operation, and $137 million annually “in perpetuity,” Lara said.

Lara drew on his experience growing up in the United States as the child of poor undocumented immigrants from Mexico to emphasize why it’s important to have children enrolled in health insurance.

“Children shouldn’t have to worry about how their parents are going to pay for a broken arm or for a dentist,” the lawmaker said.
Leno, who chairs the Senate Budget Committee, said the importance of the Health For All Kids program can not be overemphasized because illnesses make no distinction between documented and undocumented people.

“Our bodies, viruses, bacteria don’t know what our immigration status is,” Leno said. He noted that dental problems alone results in around 500,000 children in California missing school each year.

He also observed, “Without a high school diploma, a child is more likely to find his way into the criminal justice system.”

‘Get a Clue, Donald Trump’
Leno’s elicited laughter when he quipped, “Get a clue, Donald Trump.” He was referring to the Republican presidential presumptive GOP nominee’s vow to upend the Affordable Care Act (ACA) should he become president.

Undocumented Bay Area resident Teresa Lopez, a mother of four children, said she would be relieved to see her Mexico-born daughter, Litzy, age 15, enroll in the full-scope Medi-Cal program and enjoy accessing health care the way her two U.S.-born children currently do.
“Having to make copayments for every visit, and for medications is taking a toll on my family,” said Lopez, speaking in Spanish, through an interpreter. “It will be nice when all my children have the same kind of health care benefits.”

Lara noted earlier this week that the California Department of Health Care Services, which operates Medi-Cal, has said it is ready for the influx of thousands of children when the Health For All Kids program begins next week.

Lara is hopeful that Gov. Jerry Brown will sign his second bill, SB 10, which is currently making its way through the Legislature. It would allow the state’s undocumented adults to buy unsubsidized health insurance on Covered California, the online marketplace set up under ACA, with their own money. More than 2 million people currently have no access to health care, Lara said.

California has sought a federal waiver to allow its undocumented population to purchase health insurance on the marketplace.

“We hope we get the waiver before the administration in Washington changes,” Lara said, suggesting that the next U.S. president might either dismantle ACA or make drastic changes to it.

Teresa Lopez with her U.S.-born child, said she hopes to enroll her Mexico-born daughter, age 15, into the new Health For All Kids Program.  (Photo courtesy Jesse Melgar)

Teresa Lopez with her U.S.-born child, said she hopes to enroll her Mexico-born daughter, age 15, into the new Health For All Kids Program. (Photo courtesy Jesse Melgar)

Medi-Cal Provider Shortage
In the wake of the new Health For All Kids program, Lara was asked how the state could cope with the large influx of new Medi-Cal enrollees when there is already a shortage of doctors and dentists in the Medi-Cal network.

He said that said he hopes lawmakers would make the program more attractive to health care providers by increasing reimbursement rates, currently among the lowest in the nation.

“We are going to keep pushing for this,” Lara said.

Many Californians Say Health Insurance Cost Too High

April 7, 2016 by · Leave a Comment 

New America Media – Two-thirds of Californians who did not have health insurance in 2014 were actually eligible for coverage, but many did not enroll because of the high cost, according to a study released March 31 by the UC Berkeley Center for Labor Research and the UCLA Center for Health Policy Research.

“We’re a relatively high cost-of-living state,” said Miranda Dietz, a researcher at UC Berkeley and the study’s lead author, in a press release. “It’s no wonder some Californians, who may be unaware they qualify for health subsidies [on the marketplace exchange called Covered California] and other programs, still find the cost of health insurance out of reach.

“Few people who are already stretched paying their rent, filling the car to get to work and feeding the kids, figuring out how to come up with more money for health care on top of that is a lot to handle.”

The researchers based their findings on data from the California Health Interview Survey (CHIS) of 2014, the most recent CHIS data available.

While President Obama’s 2010 Affordable Care Act (ACA) allowed millions of Californians access to health care by allowing them to purchase insurance on the online marketplace exchange or by enrolling in Medicaid (Medi-Cal in California), the ACA was placed off limits to those who were not legal residents.

Nearly one-third of the almost 1 million Californians who do not qualify for health coverage under the ACA are predominantly low-income, Latino and have limited English proficiency, the study showed.

Nearly half of the state’s so-called “remaining uninsured” – about 2.2 million of them — said that cost was the main reason for not having health insurance.

UCLA researcher Nadereh Pourat, who co-authored the new study, said that many just don’t understand how to get health insurance.

“You almost need a degree to understand health insurance coverage,” she said.

Another finding that emerged from the study was that young males were more likely to be uninsured and that could be because they were in low-paying jobs or haven’t been on the workforce for very long, Pourat said. They were more likely to think of themselves as “young invincibles” than their female counterparts.

Pourat said California should take steps, which includes doing more outreach, to ensure that all of its residents have health insurance. The new study should give policy makers a “good baseline to start from.”

The “hundreds of thousands of men, women and children who power California’s economy” face potential financial ruin because they do not have health insurance, she said.

“From an economic perspective,” she said, “it’s bad business to rely on workers and then not to offer them equal health protection. And from a humanitarian perspective, it’s just wrong.”

Lara’s ‘Health Care for All’ Bill Is a Sensible Undertaking

January 8, 2015 by · 1 Comment 

It may surprise many that not all undocumented immigrants need Medi-Cal to cover their medical expenses, as one might think from the ongoing discussions on how to make sure all Californians have affordable medical insurance.

It’s true, many of California’s residents are in the country without authorization, and they have contributed to the overcrowding of emergency medical care delivery systems such as hospital emergency rooms because they have no other option to receive the medical care for which they cannot afford to pay.

While undocumented immigrants can purchase private insurance, the options available to them are often very limited and cost prohibitive, as it is for millions of legal residents.

The new DAPA – expanded DACA – rules allowing some undocumented immigrants to live and work in the U.S. temporarily without fear of deportation, could also open the door for many of them to receive subsidized medical insurance, either through their employer or government programs such as state funded Medi-Cal.

While that’s an important step forward, more than one million Californians will still be left without medical insurance due to federal regulations that do not allow them to participate in the benefits of the Affordable Care Act, such as insurance through Covered California.

State Sen. Ricardo Lara of Bell Gardens wants to fill that void and has introduced SB 4, “Health Care for All,” a measure that would expand health care access to all Californians regardless of their immigration status. Support for passage in the 2015 legislative session is growing.

We believe Lara’s bill is an important step in ensuring the health of all Californians and freeing up our overburdened emergency care system. We urge the State Legislature to pass and Gov. Brown to sign SB 4 into law.

Passage will put us on a path to a more enlightened, healthier future for all Californians.

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