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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(303) 573-5669 x 313

earenales@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 <5 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 (@ 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 ProgramsClinics (FQHC’s and others) Public HospitalsHealth DepartmentsCommunity 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% FPL6-19 100% FPL ($20,650 for a

family of 4)0-21 EPSDT

Adults with children37% 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 patient’s 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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Children’s 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 determinedStudies 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:

What’s it About?

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Background: Our Healthcare System

Employer-Sponsored

54%

Uninsured 15%

Public Programs

26%

Private Individual

5%

(CO 57%)

(CO 19%)

(CO 7%)

(CO 17%)

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

(@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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78%

19%

0%

20%

40%

60%

80%

100%

2001 2002 2003 2004 2005 2006 2007

Health Insurance Premiums Workers' Earnings

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 @$25,000 a year on health insurance (that’s 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) Colorado’s 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 Insurer’s 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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What’s 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