JACL'S INVOLVEMENT IN HEALTH CARE REFORM
The JACL has been an advocate of the recent Health Care Reform through its involvement with the National Coalition on Health Care, the Health Task Force of the Leadership Conference on Civil Rights (LCCR) and National Council of Asian Pacific Americans (NCAPA) Health Committee. Since 2008, the JACL has run the Daniel K. Inouye fellowship, which provides an opportunity for emerging AAPI leaders to work on key legislative initiatives pertaining to health-care and social justice. The JACL has also received a grant from the Asian and Pacific Islander Health Forum (APIAHF) as part of the Health Through Action National Civic Engagement grant. These grants are used solely to carry out activities to support national organizations which work to engage their members, constituents, and communities in health advocacy and health care reform.
2009-2010 Inouye Fellow Jean Shiraki with Senator Inouye.
HEALTH CARE REFORM
After a long legislative battle, the Health Care and Education Affordability Reconciliation Act was passed by both the US Senate (56-43) and the House of Representatives (220-207) and signed into law by President Obama on March 30, 2010. The bill amends the Patient Protection and Affordable Care Act which was signed earlier in the year. The reconciliation legislation includes not only health care measures, but also provisions to reconstruct and expand student loan programs such as the Pell Grants. The Affordable Care Act passed by Congress and signed by President Obama will prove greater family savings and increased quality health care.
With Health Care Reform legislation passed, the JACL and other civil rights organizations are turning their attention to implementation, to ensure that AAPI communities benefit from the new measures that have been put in place. The National Council of Asian Pacific Americans (NCAPA) Health Committee has proposed the following priorities for implementing health reform:
- Ensure in-language and community-based approaches to outreach and assistance for limited-English proficient stakeholders, including immigrant small business owners and workers.
- Inform legislators of the impact of federal budgetary gaps in ensuring subsidized coverage of all state residents in low-income programs such as Medicaid, CHIP and Medicare, including those who would be excluded from care as a result of five-year waiting periods.
- Department-wide Action: Develop guidance for all Department of Health and Human Services (HHS) data collection agencies, to ensure uniform and consistent collection of data on Asian Americans, Native Hawaiians and Pacific Islanders. The guidance would more effectively disaggregate census data and cover uniform consistent collection of statistically adequate data on sexual orientation and gender.
- Suggested Agency Action: Designate a high level Centers for Medicare and Medicaid Services (CMS) official charged with addressing racial and ethnic disparities in Medicaid, CHIP and Medicare programs; implement National Center for Health Statistics (NCHS) methodologies and models to improve data collection of smaller subgroup populations, with special emphasis on Native Hawaiian and Pacific Islander communities, for its health surveys.
- Department-wide Action: Update and provide resources to implement the HHS Language Access Plan, which encourages all health care organizations and individual providers “to make their practices more culturally and linguistically accessible,” including the use of race, ethnicity, and language data in program assessments and incorporation of these data into health records and organizational management systems (HHS, 2007).
- Suggested Agency Action: Translate AHRQ’s Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys into additional languages and add questions related to satisfaction with interpreters; initiate HRSA support for programs that increase the numbers of bilingual providers, community health workers and trained interpreters including immigrant and refugee health professionals who are not licensed to practice in the United States.
Equitable Treatment of Immigrants
- Department-wide Action: Issue guidance to all HHS recipients regarding HHS services that are “necessary for the protection of life and safety” under the Attorney General Order, January 2001, and the Personal Responsibility and Work Opportunity Act (PRWORA). These services, including prevention and immunizations, should be provided with no immigration restrictions or verification of status. The Guidance should also remind HHS recipients of other programs that are not considered “federal public benefits.”
- Suggested Agency Action: Finalize the April 8, 2009 proposed criteria for applying Advisory Committee on Immunization Practices (ACIP) recommended vaccines for vaccination of immigrants, and remove the HPV vaccine from the list of requirements.
Reduce Health Disparities
- Department-wide Action: Promote a comprehensive public health approach which recognizes that positive health outcomes and elimination of disparities must be addressed within all HHS agencies and across all federal Departments to include primary health, mental health, substance abuse, housing, education, immigration, and labor and other related fields across the life span.
- Suggested Agency Action: Identify Asian, Native Hawaiian, and Pacific Islander subpopulations that are underrepresented in health and behavioral health professions and include them in Health Resources and Services Adminstration’s (HRSA) Bureau of Health Professions programs for “underrepresented minorities”; provide resources to improve current health and behavioral health workforce at all levels through recruitment, ongoing training, and supervision and support of providers from the underrepresented populations that reflect the cultural and language needs of AAPI populations; increase Office of Minority Health (OMH) funds for community capacity building grants targeting emerging and/or isolated communities (i.e., newly arrived or part of a geographically emerging community) to support the efforts of these communities to address local health and health care needs.
Strengthen the Administration’s Commitment to Minority Leadership and Civil Rights Enforcement
- Department-wide Action: Re-establish the Department-wide Asian American and Pacific Islander Initiative, including the Intra-agency Coordinating Council staff with the principals of various HHS agencies, to develop a plan to increase participation of AAs and NHPIs in HHS programs; elevate the Director, Office for Civil Rights, to Assistant Secretary level.
- Suggested Agency Action: Designate high-level officials charged with reducing racial and ethnic health disparities at CMS, HRSA, and Substance Abuse and Mental Health Services Administration (SAMHSA).
Here is a breakdown of the changes implemented by the new legislation
Effective Immediately upon Enactment
- Small businesses will be provided tax credits of up to 35% of premiums to make employee coverage more affordable
- Seniors will be provided a $250 rebate to Medicare beneficiaries who hit the drug prescription "donut hole" in 2010
Effective After 90 Days
- For families who are uninsured and could not receive insurance due to pre-existing conditions, they will have access deemed through a temporary high risk pool
Effective After 6 months
- No health plans will be able to deny coverage to children with pre-existing conditions (beginning in 2014, this will apply to all)
- Health plans will be required to allow young persons to be under their parents' insurance plan until their 26th birthday.
- Health plans will be banned from dropping people from coverage when they are sick
- Health plans will be banned from placing lifetime caps on coverage
- There will be tight restrictions on new insurance plans' use of annual limits to ensure access to needed care. These tight restrictions will be defined by HHS
CHILDREN'S HEALTH INSURANCE PROGRAM (CHIP)
The JACL applauds President Obama’s signing of the Children’s Health Insurance Program (CHIP) on February 4, 2009. A year before Health Care Reform was signed, CHIP went into effect on April 1, 2009, providing federal matching funds to states to provide health insurance for children from families which do not qualify for Medicaid but who cannot afford private medical insurance. In 2007, CHIP covered approximately 5 million children and the reauthorization and expansion of this program will benefit what is projected to be millions more while preserving the coverage of the past CHIP recipients. The bill, which Congress sent to the President to sign, includes the Immigrant Children’s Health Improvement Act (ICHIA), which extends coverage to low-income, lawful residing pregnant women and immigrant children.
RELEASE OF AAPI ISSUES FOR AMERICAN JOURNAL OF PUBLIC HEALTH
The Asian Pacific Islander American Health Forum (APIAHF), W.K Kellogg Foundation, and the American Public Health Association held a joint briefing on May 6, 2010 to discuss "Beyond Reform: Health Concerns and Disparities for America's Fastest Growing Populations." The briefing, held during Asian Pacific American month, celebrated the release of the first American Journal of Public Health dedicated solely to Asian American, Native Hawaiian, and Pacific Islander health issues. Congresswoman Judy Chu; Congressman Mike Honda; Dr. Howard Koh, Assistant Secretary for Health at US Department of Health and Human Services; John Ruffin, Director of the National Center on Minority Health and Health Disparities; Gail Christopher, VP for Programs at the W.K Kellogg Foundation; and Dr. Mary Northridge, Editor in Chief of the American Journal of Public Health, were among the distinguished guests who spoke during the panel discussions.
The speakers were passionate and excited for the journal release and optimistic about moving forward in addressing Asian American Pacific Islander (AAPI) health issues. A major challenge for the AAPI community is adequate data collection. Through measures such as working with local community partners and having more AAPI researchers involved in the field, data collection for the AAPI community is improving. Accurate data will help dispel the “model minority” myth that posits the AAPI community does not have major health problems or needs. Recent research has shown that Asian-born women in the United States suffer death rates from breast cancer four times that of US-born Asian Americans. Proper data collection and disaggregation is essential to acquiring this type of information in order to properly address the needs of our community. The JACL congratulates APIAHF along with their partners for this their efforts and accomplishments.