Mr. Tran owns a small business making enough to employ himself, his wife and two employees, but not enough to provide health insurance.  When he was injured, he deferred other bills and paid to be seen at an urgent care clinic.  Mr. Tran is a fictional example of a real world problem. For community entrepreneurs, choices about healthcare are difficult.

“See the doctor or take care of it myself?  “Buy medicine or pay rent?” “Follow doctor’s orders on what to eat or eat what I can afford and keep my lights on?”

Poverty, lack of health care coverage, and poor health are linked.  More than 54 million adults — almost 20 pecent of the U.S. population — struggle to pay medical bills. A June 2013 CNBC report indicates health care bills were the main cause of bankruptcies in the country, affecting nearly two million people.

Deferring medical attention and lack of knowledge or access to preventative care are reasons for health care disparities affecting Asian Americans, Native Hawaiians and Pacific Islanders. REACH Coalition, working for racial and ethnic health equity, reports that 15 million Asians live in the United States.  Cancer accounts for 27 percent of deaths among Asian men.  They are twice as likely to die from stomach cancer as their white counterparts. Asian Pacific American women are likelier to die of cervical cancer because their diagnosis is often late-stage. Native Hawaiians and Pacific Islanders have twice the rate of diabetes as Caucasians. With early screening and prevention, these diseases can be treated, and health care costs associated with these and other diseases can be significantly reduced.

But it will not happen without health care coverage and access to care. Asian Americans are uninsured at 18 percent compared to white Americans at 11 percent.  Rates vary among Asian communities, with Southeast Asians least likely to have health care coverage.

The 2010 Affordable Care Act (ACA) can change these statistics. A key goal of the ACA is to eliminate racial disparities in health care. The ACA requires everyone eligible to have health care coverage and provides assistance to many who cannot afford it. While many Asian Pacific Americans will be eligible for subsidies to purchase insurance or through Apple Health for Kids (Medicaid expansion), some will not. For example, residents from Micronesia, Palau or the Marshall Islands will not be eligible for Apple Health, but can purchase insurance through the on-line Exchange.

Lawfully residing adult immigrants here for less than five years will not be eligible for Medicaid, but if they are applicable tax payers, they would also qualify for tax subsidies to purchase insurance on the Exchange. Pregnant women who are undocumented immigrants and undocumented children will still be eligible for State Only medical assistance. Otherwise, undocumented immigrants will not be eligible for Medicaid, nor subsidies to purchase insurance on the Exchange.

Effective October 1st, Washington HealthPlan Finder (www.wahbexchange.org) will launch a new way to find, compare and enroll in health insurance online or through their call center.  Customer support is available in multiple languages, including Vietnamese, Simplified Chinese, Cambodian, Korean and Laotian. However, many uninsured people will still have computer literacy and language barriers to online enrollment.

In King County, Public Health is the lead organization to help people to enroll. Assister organizations, working with Public Health, will lower the barriers. Assister organizations like Asian Counseling and Referral Service (ACRS) and International Community Health Services (ICHS) will have trained and certified staff to help people during open enrollment between October 1, 2013 and March 31, 2014.

These bilingual and bicultural assisters will help people navigate the system.  People will be able to access not only new commercial insurance products, but also access public insurance through expanded Apple Health for Kids (Medicaid) available under the ACA. Upon enrollment, people will have health care coverage and be better able to get the care they need.

This new system of care and insurance portal will be an imperfect but significant step toward reducing health disparities, achieving racial health equity, reducing the cost of health care and improving health.

To get help enrolling for health insurance from ACRS, call 206-695-7600 or ICHS at 206-788-3700.

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