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Latinos_ Health Care Law and Beyond.ppt


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									       Health Care Law and Latinos

Victoria Sorlie-Aguilar
Family Physician
Oxnard, California

March 2011
   In the Exam Room:
    Adela’s Story
   Adela’s Story after the
    Affordable Care Act
   What about the
                 Adela’s Story

A Day in the Life of the Uninsured: California Academy of Family
Physicians Magazine October 2008
           Before ACA: ER care
   Adela is beautiful 53 year-old Latina who had no
    idea she had elevated cholesterol, hypertension
    or diabetes until the day she landed in an E.R
    with stroke symptoms.
   Right arm went limp and she couldn’t speak
    Before ACA: No medical home
   Head CT was interpreted as normal
   She was diagnosed with TIA (transient ischemic
    attack), hypertension, diabetes and discharged
    from the hospital ---and told to follow-up with
    her primary care doctor
    Being your average divorced mom and working
    full-time to make ends meet; she had no health
    insurance much less a primary care doctor.
     Before ACA: fragmented care
   At the clinic she was tearful. Adela had been
    referred to physical therapy for arm pain and had
    been scheduled a pap smear at my clinic.
    “But what is wrong with my arm?”
   ER report reads “transient ischemic attack”
    which implies that the attack was temporary or
   But in the clinic Adela’s speech is slurred as if
    she’s intoxicated. Her daughter who
    accompanied her adds “she doesn’t usually
    sound like that” Adela nods frustrated.
   Today’s Physical Exam (Prevention) reveals
    there is a problem with her balance and
   Likely she has had a small stroke often hard to
    find on CT scans.
              Fragmented Care
   Adela is confused, “I’ve been healthy for all
    these years…”
   Adela’s last visit with a doctor was four years
    ago for a pap smear only. (free for all low
    income women under the BCDP program)
   Weeks later, an MRI of her head confirms the
    diagnosis: Brainstem stroke!
An ounce of prevention
worth a pound of cure
   Hypertension: the “silent killer”
    High Cholesterol: You can’t feel it until it’s
    already done damage
   Diabetes: no symptoms until advanced
   All easily diagnosed with routine visit and labs
   Adela is a tragic example of why we need ACA
      Without Health Reform LAW
    14% of Hispanics have been
     diagnosed with Diabetes
     compared to 8% whites
    Many with diabetes remain
     undiagnosed especially those
     without access to health care

    If current trends continue 1 in every 2 minority
    children born today will develop type 2 DM at
    some point in their lives!
    Center for American Progress “Easing the Burden 2010”
A new dawn…life after ACA
         2010 Insurance Reforms
    Establish a temporary national high-risk pool to
    provide health coverage to individuals with pre-
    existing medical conditions. (Effective 90 days
    following enactment until January 1, 2014)

   Adela: with stroke, DM, HTN, Chol, and limited
    choices can join the Hi Risk Pool in California
2010 Insurance Reform
   Require qualified health plans to provide at a
    minimum coverage without cost-sharing for
    preventive services, recommended
    immunizations, preventive care for infants,
    children, and adolescents, and additional
     preventive care and screenings for women.
   Adela’s PAP, mammogram, physicals, approved
    disease screening is INCLUDED with her
    insurance, not extra!
   Adela would get regular complete physicals plus
   Her primary doctor would notice her elevated
    blood pressure and screen her for diabetes and
    cholesterol when she was 35. They would find
    her cholesterol and blood sugar too high.
   Her primary doctor would start 3 simple
   Adela never suffers a preventable stroke!
2011 Medicare Changes
   Improve access to care by increasing funding by
    $11 billion for community health centers and by
    $1.5 billion for the National Health Service Corp
   Provide a 10% Medicare bonus payment to
    primary care physicians, and to general surgeons
    practicing in health professional shortage areas.
   Adela chooses a clinic in her rural town, there
    are plenty of doctors and she gets an
    appointment when she needs it, NOT 3
    MONTHS later!!
    2014 State-Based Health Exchange
   Create state-based Health
    Exchanges through which
    individuals and small businesses
    with up to 100 employees can
    purchase qualified coverage.
   As a fulltime worker whose job
    doesn’t offer health insurance.
    Adela shops for insurance in
    her states “health exchange”.
    2014 ACA: Reduces out-of-pocket limits for those
            with incomes up to 400% FPL

   100-200% FPL: $1,983/individual
                   $3,967/family in 2010
    200-300% FPL: $2,975/individual
                   $5,950/family in 2010);
    300-400% FPL: $3,987/individual
                   $7,973/family in 2010)

   Adela can afford to purchase insurance.
2014 Insurance Reform
Require guarantee issue and renewability and
allow rating variation based only on
 Age

 Premium rating area

 family composition

 and tobacco use

 Adela can not be dropped from her plan or have
  her premium skyrocket for having diabetes or a
     What about the undocumented?
    Reform Law: does not
     cover the undocumented
    Only emergency
    Many counties don’t
     cover undocumented
     in indigent programs

Mexican Immigrants
   Over 2/3 of Mexican immigrants working in
    jobs that are heavily reliant on Mexican
    immigrants have no medical insurance coverage
   Only 5% of employed Mexican immigrants are
    covered by Medicaid and other public insurance

      California has the largest population of
        Migrant/Seasonal Farm workers

   1990 CA 1,362,534 TX 500,138 FL 435,373
   2000 CA 1,302,797 TX 362,724 FL 286,725

    1990 Atlas of Migrant and Seasonal Farm workers NCFW
    2000 Farm worker Enumeration Study NCFW
    Farm work accounts
    for 13% of all
    workplace fatalities,
    making it one of the
     most dangerous
    occupations in the

Where do the undocumented receive care?
    Safety Net Providers
    Public/ Non-Profit Hospitals
    Community Health Centers (41%) non-citizen,
     non-legal permanent resident Hispanics state
     that their usual provider is a community clinic or
     health center. (US DHHS 2008)
    County Clinics
    Sliding Scale, Fee for Service, Family Pact,
     BCDP (limited scope)
   Safety Net: Community Clinics
   78% of primary care visits at community clinics
   were made by safety net patients
   (56% Medi-Cal or Healthy Families)
   (22% by uninsured/indigent)
   6% Private Insurance

California Healthcare Foundation Safety Net Facts and Figures 10/2010
                    ACA and Latinos
   Funding to establish more Community Health
    Centers (where uninsured go for care)
   Funding to National Health Service Corp (more
    docs practice in shortage areas)
   Funding for Teaching health centers: Primary
    care residencies in community based clinics
    (more clinic docs trained)

    Easing the Burden: Center for American Progress December 2010
                     ACA and Latinos
   Initiatives to increase health workforce diversity:
    scholarships/assistance to disadvantaged students who
    commit to work with underserved
   Grants to states, hospitals, public health depts, clinics
    to promote to use of community health workers in
    medically underserved areas (peer outreach)
   Support for development of cultural competency
    curriculum in health professional schools

    Easing the Burden: Center for American Progress December 2010
   A Day in the Life of the Uninsured: California Academy of Family
    Physicians Magazine October 2008
   KFF Health Reform Timeline: www.kff.org/healthreform/8060.cfm
   Easing the Burden Center for American Progress
   Migration Health And Work Facts Behind the Myths:
    October 15, 2007 - University of California, et al HIA
   California Health Care Foundation:
    Safety Net Facts and Figures October 2010
   National Center For Farm worker Health: www.ncfh.org
   U.S. DHHS Health Centers Americas Primary Care Safety Net

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