Health Care Access for Latino Patients: Health Coverage

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Health Care Access for Latino PatientsHealth
Coverage

• Olveen Carrasquillo, MD, MPH
• Associate Professor of Medicine, Health Policy
  Community Partnerships
• Director, Columbia Center for the Health of Urban
  Minorities (CHUM)

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Do not take notes-Email me!!!!

• oc6_at_columbia.edu

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Shah Carrasquillo Health Affairs Nov 06
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Change in Uninsured (1,000)
Source AJPH 19998936-41 Harvard J Hisp
Policy 20001233-46. JAMA 2003 28991167 Health
Affairs Nov 06 analysis of CPS 07 data
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NHWs No longer a majority of the
uninsuredTrends in composition of uninsured
population

• 1987
• NHWS 58
• Blacks 19
• Hispanics 19
• Asians 3

• 2006
• NHWS 45
• Blacks 16
• Hispanics 32
• Asians 5

Source Current Population Surveys
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LATINO UNINSURED
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Racial/ethnic disparities in insurance coverage
by citizenship status
Analysis CPS 06 data, Carrasquillo
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Insurance coverage among Hispanic sub-groups by
citizenship status
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NYS Insurance coverage by Hisp. Sub-group
N 925,000 650,000
300,000 800,000
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Health Coverage in NYC of Uninsured Adults
Source LANYC Immigrant Survey/ Urban Inst.
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The Latino UninsuredFailure of the Private
Sector
Source Analysis of March 2002CPS Data
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McCain A Call to Action
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A Call to Action

• Health care should be available to all and not
  limited by where you work or how much you make.
• Families should be in charge of their health care
  dollars and have more control over care.

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A Call To Action

• A direct refundable tax credit - effectively cash
  - of 2,500 for individuals and 5,000 for
  families to offset the cost of insurance
• Can keep employer coverage but no longer tax
  exempt
• Coverage that is about 12-15K would need to pay
  taxes
• -Guaranteed Access Plan or GAP
• ensure these patients have access to health
  coverage
• nonprofit corporation that would contract with
  insurers to cover patients who have been denied
  insurance join with other state plans to enlarge
  pools and lower overhead costs
• reasonable limits on premiums, and assistance
  would be available for Americans below a certain
  income level
• Yes funded by government / taxes

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A Call to Action

• Drug re-importation
• More research
• IT
• Stop Smoking
• Tort Reform

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Clinton American Health Choices Plan
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American Health Choices Plan

• Keep the insurance you have
• Even if you leave your job
• Help you buy health Insurance
• Tax credits to help you buy insurance
• Tax credits to help small business buy insurance
• Employer mandates for large businesses
• Community rating and no denials for pre-existing
• Premiums capped at ? proportion of income
• Reinsurance for catastrophic expenses
• Can buy FEHBP or Medicare like product

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American Health Choices Plan

• Promote Individual Responsibility
• Individuals To get and keep insurance in a
  system where insurance is affordable
• Large Employers required to provide health
  insurance or contribute to the cost of the system
• Small businesses offer tax incentives to
  continue or begin to offer coverage

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American Health Choices Plan

• Prioritize Prevention
• Chronic care management programs
• Effectiveness Research
• Drugs fair prices and accurate information
• IT / modernize/ promote best practices
• Stop Medicare HMO overpayments
• Reduce uncompensated care payments

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BARACK OBAMAS PLAN FOR A HEALTHY AMERICA
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Plan for a Healthy America

• A New National Health Public Plan Benefit
  package similar to Federal Employees Health
  Benefits Program (FEHBP)
• fair premiums and minimal co-pays / deductibles
  for preventive services.
• Private Insurance
• Insurance connector as watchdog
• Guaranteed Issue
• Stable premiums
• Income-related federal subsidies
• Mandatory Coverage of Children

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Plan for a Healthy America

• Health IT investment
• Improving prevention
• Management of chronic conditions
• Providing reinsurance for catastrophic coverage
• Reduce spending on uncompensated care

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Who is Left out

• McCain Who is left in?
• Clinton
• ? Everyone covered
• Mass already 20 of uninsured excluded from
  coverage
• Obama
• Only children are mandated
• How about the 8 million Latinos your plan
  excludes?

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Do undocumented pay taxes?

• About half of undocumeted work using fradualent
  SS and thus pay federal, social security,
  Medicare, and state taxes
• Social Security Administration has estimated that
  three quarters of undocumented immigrants pay
  payroll taxes, and that they contribute 6-7
  billion in Social Security funds that they will
  be unable to claim (Porter 2005).
• Any extension of legal work authorizationwhether
  temporary or permanent would give a substantial
  boost in tax revenue

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Do undocumented pay taxes?

• Undocumented immigrants pay the same real estate
  taxeswhether they own homes or taxes are passed
  through to rentsand the same sales and other
  consumption taxes as everyone else.
• The majority of state and local costs of
  schooling and other services are funded by these
  taxes.

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• Contrary to the public's perception, when all
  levels of government are considered together,
  immigrants generate significantly more in taxes
  paid than they cost in services received.
• This surplus is unevenly distributed among
  different levels of government, however, with
  immigrants (and natives) generating a net surplus
  to the federal government, but a net cost to some
  states and most localities.
• Feds will not pay Medicare or SS costs
• States and localities absorb most health care
  costs and education
• This disparity has intensified over the past
  decade, as federal support for the few federal
  programs targeted to immigrants and to the
  communities in which they settle has declined
  sharply.

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• When these trends are viewed in the light of the
  growing concentration of the immigrant population
  in six states and in the nation's already
  stressed urban areas, they raise serious
  questions about institutional capacity, fiscal
  fairness, and the direction of immigration
  policy.
• All of these concerns suggest that questions of
  intergovernmental fiscal equityan important
  aspect of immigrant policyrequire attention

http//www.urban.org/publications/305184.html
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Who else gets short end of stick The Poor

• A Call to Action Medicare and Medicaid
• Coordinated care
• Not pay for Medical errors
• American Health Choices Plan
• Strengthen Medicaid / SCHIP
• Fix holes in current system
• Plan for a Healthy America
• expand eligibility Medicaid and SCHIP programs
• ensure that these programs continue to serve
  their critical safety net function.

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So if you are poor

• Place poor into separate and unequal systems of
  care
• Segregation in health care is OK and will be
  further institutionalized
• Poor do not deserve same level of coverage as
  members of Congress

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Medical Apartheid
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Source Separate and Unequal Medical Apartheid
in New York City 2005 Bronx Health REACH, The
Institute for Urban Family Health
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Separate and Unequal
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Medical Apartheid in the US.
Carrasquillo Torres, In press
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Racial/ Ethnic Disparities in Care at NY
Presbyterian Hospital

• No health insurance call 1-800- Harlem Hosp
• Medicaid- go to clinic, long waits, see
  physicians in training, you want to see a
  sub-specialist- Good luck!!!
• No Hablas Ingles- Tienes pain en tu chesto???
• Neccesitas psychiatrist- HA!!!!

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Amazing Things are Happening Here

• ER- several hours wait, no beds
• 8 month wait for screening colonoscopy
• At New York Heart Institute the Cardiology clinic
  wait is 4 months

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Case Report 1

• JS, 55 yr H F on routine mammo had suspicion for
  malignancy, pt called back had biopsy cancer,
  PMD notified
• Breast clinic meets once per week, totally booked
  next week then holiday then totally booked can
  see her in one month one month wont really make
  a difference
• Private breast surgeon secretaries sorry do not
  take Medicaid, no way will they see her must go
  to clinic
• Befriend one Spanish secretary, beg, beg, allows
  me speak to surgeon agrees see her but must
  follow up in clinic
• Pt in OR 2 days later

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Politically Vulnerable

• Programs specifically created to serve the poor
  and dis-enfranchised will always be vulnerable
• Programs that serve all are harder to cut
• Medicare gets 500 billion infusion
• Medicaid gets cut by 10 billion

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Harlem Health Care Rally in support of HR 676
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