Transcript Health Care Reform - California Program on Access to Care

Health Care Reform
Including migrants and other
vulnerable populations
- Al Hernandez Santana, LCHC
Presenter Disclosures
Al Hernandez Santana
(1) The following personal financial
relationships with commercial interests
relevant to this presentation existed during the
past 12 months:
No relationships to disclose.
Latino Coalition for
a Healthy California
“The leading organized voice for policies, services, and conditions
to improve the health of Latinos”
Priority Issues
Access to Health Care
Focus: increase access to affordable, high quality, culturally and linguistically
appropriate care in a timely manner.
Health Disparities
Focus: prevent disease and injury and eliminate conditions that lead to health disparities
Community Health
Focus: build healthy communities by improving the social and physical environments
shaping health behaviors and outcomes
Three-Strategy Approach
Community Education
Research
Policy Advocacy
Learning Objectives
1. Recognize complexities
4. Articulate previously
2.
5.
3.
of federal immigration
law and allowable state
options to cover
immigrants.
Identify three reasons
for providing coverage.
List 3 programs or clinic
facilities that service
migrant and seasonal
workers.
failed efforts to cover
undocumented children
or adults in public health
insurance programs.
Assess the political
landscape that may bear
on future efforts to
include migrant
populations as part of
comprehensive reform.
California has high number of
immigrants and uninsured
• California has the largest
population of immigrants
of any state, about 10
million.
• The 2008-09 budget
approved many cuts to
health programs
immigrants rely on.
• Counties with highest
rates of uninsurance have
corresponding low rates
of employment-based
coverage.
Immigrants in U.S. Labor Force
Recent Mexican immigrant men have a
94% labor participation rate.
Mexican immigrant women labor force
rates are lower.
Low-wage industries rely heavily on
Mexican immigrant men.
Jobs filled by Mexican immigrants are the
least likely to offer health insurance.
Percent of non-fatal occupational injuries and illnesses among Latinos
resulting in days away from work, by type of injury (U.S. 1998-2000)
Source: UCLA, UC Berkeley Schools of Public Health, Health Initiative of the Americas
50
45
40
35
30
Sprains & Strains
All other
Cuts & Lacerations
25
20
15
10
5
0
Latina
Women
All
Women
Latino
Men
All Men
Legal Status of Immigrant Population, 2002
Source: Urban Institute estimates, Mar. ‘02 Current Population Survey
Undoc immigrants
Legal Temporary
Refugee arrivals
Legal Permanent
Naturalized citizens
26%
30%
5%
8%
31%
34.5 Million U.S. Total
Immigrants ‘R’ Us
Source: Public Policy Institute of California, and others
 One in four Californians is an immigrant, a higher
proportion than any other state.
 Most CA immigrants are from Latin America (56%) or
Asia (34%).
 About one in eleven workers in California is an
undocumented immigrant.
 Illegal immigrants often live in families with legal U.S.
residents.
 Growth has slowed in California, and second generation
U.S.-born children are outpacing immigrants as the
major source of Latino growth.
 Two-thirds of California adults favor some form of
legalization.
Health Insured Latinos by Annual Income, 2002
Source: The Pew Hispanic Center/Kaiser Family Foundation
100
90
80
70
60
50
40
30
20
10
0
89
71
55
Less than
$30,000 &
insured
$30,000 up $50,000 and
to $50,000
greater
Immigration Law and Welfare
Reform (PROWRA)
• Federal legislation restricts many immigrants,
particularly recent immigrants, from qualifying for
or enrolling in Medicaid and SCHIP.
• The passage of PROWRA in 1996 imposed
restrictions on immigrants’ eligibility for public
programs in federal welfare reform.
• The 2006 citizenship verification requirement for
Medicaid eligibility all reflect a widespread belief
that public benefit programs are a magnet for
undocumented immigrants. (UCLA Health
Research Brief, Jul.07)
A mishmash of programs, services
and health facilities
• Family PACT program
• Emergency Medi-Cal and
pregnancy services
• Child Health and Disability
Prevention program
• Vaccine for Children program
• Medically Indigent program
varies by county: MISP & CMSP
• Emergency Rooms
• Public hospitals, burn units,
trauma centers
• Expanded Access to Primary
Care: 330-FQHCs, Look-Alikes,
Free Clinics, Rural Health Clinics
Why provide insurance coverage?
Fairness
Egalitarian
Practicality
Legal order
Self interest
Public
health
outbreaks
Economy time loss
from work
Stopgap
inclusion,
push for
Reform
Social
contract
(e.g. Workers’
compensation)
Avoid harm