Praise for Health Care Ruling Tempered by Medicaid Decision

Rallying for health care reform in Minnesota back in 2008. (Photo from AFL-CIO/Flickr, via Feet in 2 Worlds)

Since the Supreme Court upheld most of President Obama’s Affordable Care Act in a 5-to-4 ruling last Thursday, the ethnic and community press have digested the information and offered a range of different communities’ perspectives on the news.

Reported Colorlines: “The take home point of the ruling: The controversial ‘individual mandate’ to buy health insurance is constitutional, because the penalty for not doing so is a tax and the feds have the power to tax you.” Any way you look at it, Colorlines reports, people of color are at the center of this debate. The publication provided a breakdown of those uninsured by race/ethnicity, which gives an idea of which groups in particular lack health care.

As of the 2010 Census, 49.9 million people were living in the United States without health coverage. People of color have long been grossly overrepresented among those millions, particularly Latinos.

Percentage of race/ethnic group uninsured in 2010

Hispanic origin — 30.7 percent
Black — 20.8 percent
Asian — 18.1 percent
White, not Hispanic — 11.7 percent

Several publications pointed out that while the ruling may provide many more with health insurance, the Court’s decision on Medicaid will hurt many in low-income families.

Imara Jones, an economic justice contributor to Colorlines, writes that the Medicaid decision may further exacerbate racial inequality. This throws the long-term effect the Patient Protection and Affordable Care Act into doubt, she writes, “and the racial and economic inequalities at the very heart of the health care system stand to be reinforced.”

Blacks and Latinos are enrolled in Medicaid at twice the rate of whites, Jones writes, and the recession has pushed the total number of those enrolled to 60 million. With state governments released from the requirement to expand Medicaid, she writes, the future of poor blacks and Latinos is in limbo.

In helping to address the inequality at the heart of the current system, enlargement of Medicaid is key to saving American health care from itself.

The Affordable Care Act pays for that growth by transforming the health care delivery network from one centered on fragmented care—-where doctors are paid per procedure to treat symptoms—to one which rewards keeping people healthy over the course of their lives. Re-built on the principle of lifelong wellness, this new system would save $2-$3 trillion over 10 years. These savings are passed on to uninsured people in the form of new coverage.

By merely keeping people healthy, the law generates enough income to pay for 100 percent of new Medicaid enrollment for three years and 90 percent after that. It would also subsidize up to 95 percent of insurance cost for individuals who make too much to qualify for Medicaid.

But all of this presumes states join the effort and expand their Medicaid programs as asked. Given the political landscape, that’s an enormous presumption, and yesterday’s ruling robbed the federal government of meaningful leverage to force the issue.

Feet in 2 Worlds also addressed the Medicaid aspect of the Supreme Court’s decision, focusing on how it could affect immigrants.

Many immigrants, particularly those who are naturalized or have permanent legal residency (green cards), could potentially benefit from the expansion of Medicaid. It remains to be seen what insurance will be offered to those who live in states that opt out of the expansion.

Concerning undocumented immigrants, the publication adds, “One must not forget that the ruling has absolutely no bearing on the welfare of unauthorized immigrants, who are ineligible to participate in federal programs. Even if they are willing to pay out of pocket they will not have access to the health exchanges mandated by the law.”

As we have noted, taxi drivers are an example of a largely immigrant group that could benefit from the ruling, as they face an increased risk of health problems given their job behind the wheel — and over half are uninsured, reported Gotham Gazette.

In Women’s eNews, Samantha Kimmey also voiced concern about states opting out of federal funding for Medicaid expansion, arguing that it will hurt low-income women. Still, Kimmey noted, there are provisions in the Affordable Care Act that would improve health care for women.

For instance, it requires insurance companies to cover individuals with pre-existing conditions, which can include a previous Caesarean section, pregnancy while seeking coverage, and receiving treatment for domestic or sexual assault.

Under the law, women cannot be charged higher premiums than men of the same age. In states where it is legal – 14 states ban or limit “gender rating” on the individual market – 90 percent of the best-selling plans charge a 40-year-old woman more than a 40-year-old man. Even when insurance is obtained through an employer, in fact, organizations that employ mostly women face higher premiums.

Health reform also requires plans in the individual insurance market to cover maternity care, which only about 13 percent of such plans did in 2009.

Feet in 2 Worlds also posted an editorial by Victor Landa, that originally appeared in NewsTaco, on how the health care ruling will affect Latinos. With nearly 42 percent of the mostly young Latino population living without health insurance (this higher percentage, as opposed to the 30.7 percent amount from the 2010 Census mentioned above, comes from a 2009 Gallup poll) the Affordable Care Act will have a large impact, providing many low-income Latinos with access to affordable health care. But, Landa asks, will this ruling influence the election in November?

Probably not as much as the SB1070 ruling may have in the Latino community. In the immediate aftermath of the Supreme Court’s ruling on immigration President Obama’s approval rating among Latinos increased by at least five points and now stands at 67%. It’ll be hard to beat that. And as much as this sounds like a political hot point for the election, I don’t think it will be. The President will tout his accomplishment on the stump, and Romney will make it a campaign plank, but I’d bet a stack of dollars that the GOP will try to avoid this issue from now on because it’s a losing issue for them and because the American public is already tired of it – voters in particular have had enough.

Still, it’s hard to accurately predict how the ruling will play among Latinos in the voting booth, Landa writes.

So overall, this law looks to be good for Latinos, but we won’t see the effects of it before November. And while this ruling may help rile the partisans on both political camps, it may do little to move the needle among the undecided, and among Latino voters in key swing states. Unless the campaigns manage to convince Latinos and the undecided middle, and that’s going to take some fancy message making.

The Department of Health and Human Services’ Office of Minority Health provides a further breakdown of Latinos without health insurance according to background. Numbers here come from the 2010 Census:

Those without health insurance coverage varied among Hispanic subgroups: 33.6 percent of Mexicans, 14.9 percent of Puerto Ricans, 23 percent of Cubans and 42.4 percent of Central Americans. In 2010, 30.7 percent of the Hispanic population was not covered by health insurance, as compared to 11.7 percent of the non-Hispanic White population.

As we have noted, for some New York City Latino immigrants without health insurance, bodegas have become a pharmacy of last resort when it comes to purchasing under-the-counter prescription medicines.

OurChinatown laid out what the health care decision means for Asian-Americans. According to the online publication, a study by The Commonwealth Fund — an advocacy group for a “high performing health care system” — found that Asian-Americans, like blacks, Latinos and Native Americans, “receive less adequate and less intensive health care than whites,” and are also less likely than white patients to trust their doctor. And it’s not just a lack of health insurance that creates problems among the Asian-American community, but also language and cultural barriers.

Two million Asian Americans do not have insurance, and one in five Asian Americans between the ages of 18 to 64 report having no health insurance or being uninsured at some point.

Even the Asian Americans who do have health care, and actively seek it, face many cultural and linguistic barriers that may discourage them from demanding quality care.  In most cases, Asian Americans with limited English proficiency have difficulties in understanding the health care system and communicating with health care providers. Many Asian Americans believe that their doctors do not understand their culture and values and are therefore less likely to rate their care highly and be confident about their care compared to the overall population.

Health concerns reported on by Asian-American publications have included suicides and mental health issues among Chinese seniors and an increase in reported cases of AIDS among Asians-Americans. In Queens, the Korea Times reported last October, a disproportionate percentage of Korean-Americans have no insurance, compared with Koreans and Asians across the country.

Jewish organizations meanwhile praised the Supreme Court ruling, reported The Jewish Daily Forward. Among them, Rabbi David Saperstein, director and counsel of the Religious Action Center of Reform Judaism, who was “elated.”

Reform congregations, he said, have been “at the forefront of advocacy on behalf of health insurance reform in their states and at the national level.” He cited the medieval scholar Maimonides, noting that he “placed health care first on his list of the 10 most important communal services that a city should offer its residents.”

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