Like most communities of color, Asian Pacific Islanders continue to experience worse access to health care than their white counterparts. Immigrants are more likely to work at low-paying jobs and have decreased access to employer-sponsored health coverage.

The Patient Protection and Affordable Care Act enacted in 2010 by Congress and recently upheld by the Supreme Court extends health coverage to many of the millions who would otherwise remain uninsured. How will the new health reforms affect the API community in King County?

In King County, according to the most recent data, about 12 percent of Asians are uninsured, while the rates in Pierce County are much higher at 18 percent. Although people of color represent one-third of the total U.S. population, they comprise more than half of the uninsured.

“Unfortunately, recent immigrants will see limited benefits from the Affordable Care Act,” said Teresita Batayola, chief executive officer of the International Community Health Services. “Those who are here legally have to be here for five years to benefit from Medicaid programs unless they are pregnant women and children.”

“Some could benefit from participating in the health insurance exchange once it is established,” she said. “Theoretically, the exchange will have insurance plans available for all income ranges but recent immigrants will not be able to get subsidized coverage.”

Those who already have coverage will see some improvements, such as no deductible or copays for preventive services and coverage of young people up to 26 years old, Batayola said. “Immigrant benefits are equal to everyone’s benefits if they can afford health insurance on their own or have health insurance through their employer.”

They include free preventive care for seniors, tax rebates for small businesses, no lifetime dollar limits on benefits, elimination of the prescription “donut hole” coverage gap for the more than one million Washington seniors on Medicare, federal review of unreasonable increases in health insurance premiums, and expanded coverage for early retirees.

Families will also benefit from other provisions of the law, such as the option to cover adult children on a parent’s policy until the age of 26, said Susan Allen, director of the Northwest Center for Public Health Practice and Associate Professor at the University of Washington School of Public Health.

“Under the new law, organizations providing medical care will be required to put more effort into preventive services and coordination of care, which should improve the care received by everyone, with particular benefit for families with lower education, with limited English skills, or with particularly complex medical situations,” Allen explained.

The new law allows individuals with incomes above 133 percent of the federal poverty level to purchase coverage through a newly-created health exchange if employer-sponsored coverage is not available. The Affordable Care Act expands Medicaid eligibility to include most individuals with incomes up to that level, including men and childless adults.

“Also, the lifetime limits on how much medical care a person can get will no longer be allowed,” Allen said. “Currently wealthy families can tap into their own resources at that point, but families without lots of wealth can face very difficult situations if an insurance company decides that they have hit the limit of coverage for someone with complex cancer or with mental illness, for example.”

Undocumented immigrants are likely to face continuing hurdles getting assistance to reduce the costs of health insurance, according to Allen.

“One of the compromises that was made in getting support to pass the Affordable Care Act in Congress was that undocumented immigrants are not deemed to be covered under the terms of the Act. There is some question whether because of how the law might be implemented, they may end up required to get insurance but will not be eligible for the subsidies to reduce the costs. But no one is sure at this point. It is clear that persons who are not legal residents of the U.S. are specifically excluded.”

Under the new law, legal immigrants will remain eligible for Medicaid, but will continue to be barred from enrolling in Medicaid during their first five years of residence in the U.S. The new law does not allow undocumented immigrants to enroll in Medicaid or receive premium credits or cost-sharing subsidies for coverage through the health insurance exchange.

Allen remains hopeful that communities of color may yet benefit from the ACA. “The actual impact could depend to some extent on the details of how it is implemented,” she said. “So there may be many other components that will turn out to be very important as well for communities of color and for immigrants.”

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