From left: Stephen Uy. King County Representative for the Governor’s Office; Dr. Bob Crittenden, Senior Health Adviser to the Governor; Gov. Jay Inslee; Diane Narasaki, executive director of ACRS. Photo credit: ACRS.

As uncertainty about the future of the Affordable Care Act (ACA) loomed over the other Washington, Washington state opened its health benefit exchange for online enrollment on Oct. 1 as planned.

Weeks before the launch, the state tapped into federal dollars — a $26 million budget — to roll out an aggressive ad campaign leading Washingtonians to the Exchange enrollment website. At a Sept. 20th roundtable discussion attended by Gov. Jay Inslee, local Asian Pacific American (APA) health advocates raised concerns that many APA immigrant and refugee populations who benefit from ACA provisions and  the health exchange will be difficult to reach.

“Many people in our community cannot access online resources. They don’t have the language ability or means to go online,” said Diane Narasaki, executive director of Asian Counseling and Referral Service (ACRS) and moderator of the discussion. “They’re going to need community organizations to help.”

Health advocates spoke to the Governor about specific access issues reflected in APA health disparities as well as opportunities to close the gap in access to health care with implementation of the ACA. Particular concerns were raised for those APAs joining the 247,000 estimated individuals in the state who are newly eligible for coverage as part of the ACA’s Medicaid expansion, where state outreach dollars will play a critical role in reaching the uninsured through community-based organizations. Major system changes should be built on a strong base of community health expertise, said Narasaki: “We want to try and ensure that any big system changes that go through don’t … have the unintentional effect of undermining the existing strong base of community-based, culturally competent and linguistically accessible care.”

Under the ACA, starting January 1, 2014, all health insurance plans must include 10 Essential Health Benefit categories, rounded out by mental health care and substance abuse services, among other types of care deemed standard. This could support a more integrated health care delivery system that ACRS and International Community Health Services (ICHS) partner to provide.

“We have noticed in pairing the mental health care with primary care we provide, that peoples’ well-being have improved dramatically,” said Narasaki. “The blood pressure that was too high is going down, body mass index that there was too much of is decreasing, blood sugar levels are improving.”

Higher per capita investment in social services have produced better health outcomes in other developed countries, too, an inverse trend of the U.S.’s, noted Hyeok Kim, executive director of InterIm Community Development Association and an adviser to President Obama’s Commission on Asian Americans and Pacific Islanders.

“As we move forward with ACA implementation, and we look at the literally millions of new people that are going to be receiving health benefits, we can’t forget the important role that social services, housing stability, plays in shoring up what will be their health outcomes,” said Kim.

Gov. Inslee, with his senior health adviser Bob Crittenden, took note of the concerns and opportunities presented. He responded with questions: “What would an integrated model look like? How would we embrace multiple carriers in health care reform —  to embrace mental health care within its realm, with our community mental health, with our jail population — integrating all these multiple systems?”

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