Health Care and Health Reform for Immigrants In Colorado

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Health Care and Health Reform for Immigrants In
Colorado

• Elisabeth Arenales, Esq.
• Colorado Center on Law and Policy
• 789 Sherman, Suite 300 Denver, CO 80203
• [phone] x 313
• earenales_at_cclponline.og
• www.cclponline.org
• December 2009

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Immigrant Statistics

• 31 million or 11 population US (2000)
• 14 US Workforce
• 20 low wage workers (200 FPL)
• 1998-2022 will contribute 500 billion to Social
  Security
• 83 are in working families
• Colorado population 443,000 9.8 (2005)
• Undocumented 225,000-275,000
• Source Pew Hispanic Center

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ImmigrantBarriers to Health Care

• Lack of access to public and private insurance
• Language and cultural barriers
• Fragmented
• Lack of understanding
• Low-income
• Federal law (5-year waiting period)
• Documentation requirements

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ImmigrantBarriers to Health Care

• Non-citizens are more likely to be employed in
  small firms or self-employed
• Non-citizens are often employed in low paying
  jobs that do not offer insurance
• Colorado survey
• 80 did not receive health insurance benefits
• 80 did not get paid for sick days

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ImmigrantLack of insurance

• 50 of non-citizens who have been in the US lt5
  years are uninsured
• 43 of non-citizens who have been in the US 5
  years are uninsured
• Conclusion non-citizens are much more likely to
  be uninsured than their counterparts

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ImmigrantLack of insurance

• 21.3 (about 167,000) of non-citizens in Colorado
  are uninsured
• Compare to 15 of Coloradans are uninsured (_at_
  800,000)
• 8.2 have been in the US less than 5 years
• 13.1 have been in the US for more than 5 years

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ImmigrantFacts about Access to Health Care

• 13 of adult non-citizens rely on emergency room
  visits compared to 20 of uninsured citizens
• Low-income uninsured non-citizens rely on clinics
  and health centers for care more than their
  citizen counterparts

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ImmigrantFacts about Access to Health Care

• Uninsured non-citizens are two times more likely
  than citizen counterparts to go without
  preventive care.
• Drops significantly for those with insurance.
• 51 uninsured immigrant children lack a usual
  source of care (compared to 30 uninsured
  citizens)

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ImmigrantFacts about Access to Health Care

• 48 of uninsured immigrant children go a year
  without seeing a health care professional
  (compared to 38 citizen children)
• Per capita expenditures for non-citizens were
  1,797 compared to 3,702 for citizens
• Only one-fourth of health care expenditures for
  immigrants are reimbursed by public programs

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Health Care Access Undocumented and nonpermanent

• Undocumented immigrants and nonpermanent
  immigrants (student or temporary work visas) not
  eligible for public programs except emergency
  Medicaid
• Migrant health centers
• Some community health centers
• Fee for service

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Non-citizen Health Care Access Points

• Public Programs
• Clinics (FQHCs and others)
• Public Hospitals
• Health Departments
• Community Outreach Programs

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Asylees and Refugees

• Get Medical Assistance for first 8 months.
• Then eligible if low income for 7 years.
• Important to get LPR status because of 5 year
  bar.

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Medicaid Eligibility

• Children (assets test)
• 0-5 133 FPL
• 6-19 100 FPL (20,650 for a family of 4)
• 0-21 EPSDT
• Adults with children
• 37 FPL
• Pregnant women up to 133 FPL
• Disabled up to 225 FPL or on or would have
  qualified for SSI

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Emergency Medicaid

• Available to lawful and undocumented immigrants
  who meet all Medicaid requirements aside from
  immigration restrictions
• emergency medical condition means a medical
  condition (including emergency labor and
  delivery) manifesting itself by acute symptoms of
  sufficient severity (including severe pain) such
  that the absence of immediate medical attention
  could reasonably be expected to result in
• (A) placing the patients health in serious
  jeopardy,
• (B) serious impairment to bodily functions, or
• (C) serious dysfunction of any bodily organ or
  part.
• 42 USC 1396b(v)(3)(v)

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Childrens Basic Health Plan or CHP

• Eligible up to 205 FPL
• (Federal Poverty Level is 20,650 for a family of
  4)
• Children to 19 and pregnant women
• Modeled after private health insurance
• Immigrant eligibility
• Must be a qualified alien
• Subject to five year waiting period

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Access for Pregnant Women

• Presumptive Eligibility PE allows coverage
  while eligibility is being determined
• Studies show 3-4 saved for every 1 spent
• State prenatal program for legal immigrant women
• No five year waiting period
• Not necessarily permanent funding through tobacco
  money

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Colorado Indigent Care Program (CICP)

• Reimbursement for providers for uncompensated
  care to indigent population (not health
  insurance)
• Legal immigrants and migrant workers eligible
• Limited program
• Applies at certain hospitals and clinics
• Eligible at 250 FPL and cannot qualify for
  Medicaid or SCHIP
• Copay requirements based on income

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Old Age Pension Health and Medical Care Program

• Established by state Constitution provides up to
  699 per month to participants
• Provides limited health assistance for those
  receiving OAP grants
• Age 60 and above
• Not eligible for SSI or Medicaid
• Limited funding, 10 million/year
• Legal immigrants eligible

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Public Program Immigrant Eligibility5 year
waiting period

• Five year bar applies (must be in the US legally
  at least 5 years)
• Exceptions to five year bar include refugees,
  asylees, deportation withheld and certain other
  categories
• Must otherwise meet eligibility requirements for
  a program
• Applies to SCHIP, Medicaid

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Update5 Year Waiting Period

• CHIP Reauthorization Act 2009 allows states to
  eliminate the five year waiting period for
  pregnant women and children in CHIP and Medicaid
• Colorado has committed to doing this when funds
  are available

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Health Reform Whats it About?
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Background Our Healthcare System
Sources Urban Institute and Kaiser Commission
on Medicaid and the Uninsured estimates based on
the Census Bureau's March 2007 and 2008 Current
Population Survey (CPS Annual Social and
Economic Supplements).
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Health Reform Why now?

• Too many are uninsured
• 48 million uninsured in US
• More than 800,000 in Colorado
• 25 of Colorado children under 200 FPL (_at_40,000
  a year) are uninsured
• 45,000 Americans die each year because of lack of
  medical care (Journal American Medicine)
• 1 Coloradan dies a day because uninsured (IOM)

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Cumulative Changes in Health Insurance Premiums
and Workers Earnings, 2001-2007
Source Kaiser/HRET Survey of Employer-Sponsored
Health Benefits, 2001-2007 Bureau of Labor
Statistics, Seasonally Adjusted Data from the
Current Employment Statistics Survey, 1988-2007
(April to April).
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The Cost of Doing Nothing

• The cost of an individual insurance policy in
  Colorado will increase by 9 a year, between 2008
  and 2016, faster than anywhere else in the
  country. (New American Foundation Cost of Doing
  Nothing.)
• That means If we do nothing, by 2016 Colorado
  families will spend _at_25,000 a year on health
  insurance (thats 40 of median income)

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The Economy is Suffering

• Health care is more than 16 of GDP today, 17.7
  by 2012 (CBO)
• Colorados economy lost as much as 3.9 Billion
  in 2007, because of the poor health and shorter
  lifespan of the uninsured. (New American
  Foundation, Cost of Doing Nothing)

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Goals for National Reform

• Access to quality, affordable health care
• Stable coverage
• Stable costs
• Choice of providers and coverage
• Control over decision making
• Reduce the number of uninsured
• Improve health outcomes

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Health Insurance Reform- Risk Pooling

• Risk Pooling vs. Risk Rating

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How Reform Increases Risk Pooling

• Individual mandate
• Insurers required to issue
• No more health status rating
• No more gender rating
• Limits on age rating
• No pre-existing condition exclusions
• No caps

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Whats Affordable?

• Families under 200 FPL have almost nothing to
  spend on health care
• 25 of families are in debt at end of the month
• Families spending more than 5 of income make
  tradeoffs including on education/savings/childcare
  

See The Cost of Care Can Coloradans Afford
Health Care (Colorado Center on Law and Policy
2009)
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What will it look like?

• Everyone has to have insurance (but not
  undocumenteds)
• Medicaid is the base
• After that subsidies for private insurance up to
  400 FPL (88,000 family of four)
• Public option?

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Issues for Immigrants

• Undocumenteds not included
• 5 year bar how hard will it be to get help?
• Refugees and asylee rules likely to stay the same