The impact of health care reform        on immigrants         Steven P. Wallace, PhD      UCLA Center for Health Policy Re...
Percent Residents Born Abroad                                                 36.4                                        ...
Age-adjusted total per capita    health spending, 2008 dollarsStimpson, Wilson, Eschbach, Health Affairs 2010.doi: 10.1377...
Odds ratios*, health care access vs.U.S.-born Mexican Americas, CA                                 1.28    1.00 1.00 1.00 ...
No Usual Source of Care,               California, 2009                                                                   ...
Percent Uninsured Ages 0-64,              Calif. 2009                                                           41.9%     ...
Uninsured in CA byDocumentation Status, 2005           21.0%              3.0%     Undoc adults                       Undo...
Most insurance from work,              California 2009                                    61.8%        58.5%              ...
Calif. any insurance 2008:      Employed Mexican-born noncitizens ages 25-49        73.9                                  ...
Work coverage has declined:           Employed all noncitizens in U.S. ages 25-49                                      Per...
Work coverage has declined:   Employed Mexican-born noncitizens in U.S., 25-49     37.5 37.9 36.5Percent                  ...
CA work coverage declined:                    Employed all noncitizens ages 25-49    51.3Percent                          ...
CA work coverage declined:       Employed Mexican-born noncitizens ages 25-49            40.4                    40.5  per...
Main Elements of theReform Legislation affecting Working-Age Population*   *Most go into effect in 2014
Insurance CoverageWill reduce uninsured from 48 million to  21 million through :• Employer mandate• Individual mandate• Me...
Coverage (Employer           Mandate)• Employers with more than 50 employees  must provide coverage or pay penalty of  $20...
Uninsured employees by company    size & citizenship, Calif. 2009                     50.9%                               ...
Coverage (2)Individual mandate• Everyone w/o employer insurance must  buy coverage or pay a penalty  ($700/individual, $21...
% uninsured among Californians<age 65 with incomes133-400% FPL                                                            ...
Coverage (3)• Medicaid (low-income coverage)  expansion   • everyone covered whose income is less     than 133% of poverty...
% uninsured among Californians   <age 65 with incomes <133% FPL                                                           ...
Health Insurers…• Cannot turn away those w/a history of illness• Cannot charge more to those w/a history of  illness (olde...
Other access issues• Significant increase in funding for community  health centers (primary care)                         ...
8.5 Million in CA Use Clinicsas Usual Source of Care, 2009         1717,         20%                          US-born    1...
% using clinics among those with a usual       source of medical care, Calif.            79.2%                            ...
Other issues?• Undocumented residents• Mixed status families• Definition of “emergency” for Medicaid
Senate bill p. 292• (d) NO FEDERAL PAYMENTS FOR  INDIVIDUALS NOT LAWFULLY  PRESENT.—Nothing in this subtitle or the  amend...
Undocumented Immigrants, U.S. = 11.2 million, 2010        State                  Estimated #        California            ...
Mixed status families complicate   equitable health care, U.S.Children of Mexican immigrants      Children of NonLatino im...
Senate bill p. 126• (c) APPLICATION OF EMERGENCY  SERVICES LAWS.— Nothing in this Act shall  be construed to relieve any h...
But each state defines “emergency” -  Georgia does not cover dialysis
Adequate use of health care• Availability – are services located in the  community where immigrants live• Accessibility – ...
Summary• Health Care Reform (ACA) will greatly  improve access to care to immigrants   • More insured @ work, subsidies, M...
To get your OWN data on immigrant health go            to www.chis.ucla.edu
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The Impact of Health Care Reform on Immigrants

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Steven P. Wallace, PhD
UCLA Center for Health Policy Research & UCLA School of Public Health

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The Impact of Health Care Reform on Immigrants

  1. 1. The impact of health care reform on immigrants Steven P. Wallace, PhD UCLA Center for Health Policy Research & UCLA School of Public Health swallace@ucla.edu
  2. 2. Percent Residents Born Abroad 36.4 LA 36.1 35.6 24.8 CA 22.7 27.3 26.9 19.6 22.1 26.3 15 15.3 21.7 18.4 13.5 10.7 19 8.9 15.1 13.4 10.4 10.8 11.7 12.8 10.9 11 12.4 12.5 8.8 7.5 6.6 7.4 US 6.2 8 4.81900 1910 1920 1930 1940 1950 1970 1980 1990 2000 2005 2009Source: U.S. Census and ACS
  3. 3. Age-adjusted total per capita health spending, 2008 dollarsStimpson, Wilson, Eschbach, Health Affairs 2010.doi: 10.1377/hlthaff.2009.0400
  4. 4. Odds ratios*, health care access vs.U.S.-born Mexican Americas, CA 1.28 1.00 1.00 1.00 1.06 1.00 0.82 0.83 0.83 0.70 0.75 0.700.73 0.52 0.50 US Born Naturalized Green card Undocumented US Born NL MexicanAm white Usual source of care MD visit ED visit* Adjusted for sex, marital status, health insurance, age, education, employment,federal poverty level, location of residence, and self-reported health status.Source: CHIS 2003 in Arch Intern Med, Vol 167, Nov 26, 2007, p 2354
  5. 5. No Usual Source of Care, California, 2009 47.4% 43.4% Insured Uninsured 36.4% 21.6% 7.7% 9.0% US Born Naturalized citizen NoncitizenSource: California Health Interview Survey, 2009
  6. 6. Percent Uninsured Ages 0-64, Calif. 2009 41.9% Mexican 31.3% All others 25.2% 14.8% 12.9% 11.9% US Born Naturalized citizen NoncitizenSource: California Health Interview Survey, 2009
  7. 7. Uninsured in CA byDocumentation Status, 2005 21.0% 3.0% Undoc adults Undoc kids Citizens/LPR 76.0%
  8. 8. Most insurance from work, California 2009 61.8% 58.5% Employment Private purchased 32.3% 6.7% 7.8% 3.4% US Born Naturalized citizen NoncitizenSource: California Health Interview Survey, 2009
  9. 9. Calif. any insurance 2008: Employed Mexican-born noncitizens ages 25-49 73.9 288,449 65.3 % insured # employed 198,821 47.7 48.6 45.7 151,963 143,157 43.3 125,120 41.8 83,291 34.6 73,336 68,407 32.8 33.6 63,344 51,339 Prof-Exec Sales Admin Priv HH-Prot Sgv Farm Repair Mach opr Trans Labor Overall 42.7% haveSource: Current Population Survey, 2009 any coverage
  10. 10. Work coverage has declined: Employed all noncitizens in U.S. ages 25-49 Percent with health insurance from job 52.7 51.4 49.8Percent 46.8 46.9 46.9 45.3 46.1 44.8 2000 2002 2003 2004 2005 2006 2007 2008 2009Source: Current Population Survey
  11. 11. Work coverage has declined: Employed Mexican-born noncitizens in U.S., 25-49 37.5 37.9 36.5Percent 32.3 31.2 31.7 30.4 28.9 29.3 2000 2002 2003 2004 2005 2006 2007 2008 2009Source: Current Population Survey
  12. 12. CA work coverage declined: Employed all noncitizens ages 25-49 51.3Percent 48.6 45.9 45.8 43.4 42 41.9 42.8 38.5 2000 2002 2003 2004 2005 2006 2007 2008 2009Source: Current Population Survey
  13. 13. CA work coverage declined: Employed Mexican-born noncitizens ages 25-49 40.4 40.5 percent 37.2 36.3 33.2 32.2 32.8 31.8 30 2000 2002 2003 2004 2005 2006 2007 2008 2009Source: Current Population Survey
  14. 14. Main Elements of theReform Legislation affecting Working-Age Population* *Most go into effect in 2014
  15. 15. Insurance CoverageWill reduce uninsured from 48 million to 21 million through :• Employer mandate• Individual mandate• Medicaid (Medi-Cal) expansion• + Community health center expansion
  16. 16. Coverage (Employer Mandate)• Employers with more than 50 employees must provide coverage or pay penalty of $2000/employee. • Tax credit to small employers that pay at least 50% of health insurance costs; <25full-time workers • average annual wage < $50,000
  17. 17. Uninsured employees by company size & citizenship, Calif. 2009 50.9% US-born Naturalized Noncitizen 26.7% 20.5% 20.9% 21.6% 14.6% 12.9% 14.9% 11.2% 7.4% 8.3% 4.3% 1-49 50-99 100-999 1000+ Firm SizeSource: California Health Interview Survey, 2009
  18. 18. Coverage (2)Individual mandate• Everyone w/o employer insurance must buy coverage or pay a penalty ($700/individual, $2100/family), unless insurance cost exceeds 8% of income• Income-based subsidies to uninsured • sliding scale up to 400% poverty level
  19. 19. % uninsured among Californians<age 65 with incomes133-400% FPL 39.6% 19.0% 15.4% 8.7 million 1.7 million 1.3 million US-born Naturalized NoncitizenSource: California Health Interview Survey, 2009
  20. 20. Coverage (3)• Medicaid (low-income coverage) expansion • everyone covered whose income is less than 133% of poverty level • eliminates link to families with children, i.e. singles & couples w/o kids will qualify
  21. 21. % uninsured among Californians <age 65 with incomes <133% FPL 43.8% 30.8% 20.8% 1 million 273,000 1.1 million US-born Naturalized NoncitizenSource: California Health Interview Survey, 2009
  22. 22. Health Insurers…• Cannot turn away those w/a history of illness• Cannot charge more to those w/a history of illness (older people can be charged maximum of 3 times that of younger person)• Cannot terminate coverage• Must renew coverage• Return at least 80% of premiums in the form of health service benefits 24
  23. 23. Other access issues• Significant increase in funding for community health centers (primary care) 25
  24. 24. 8.5 Million in CA Use Clinicsas Usual Source of Care, 2009 1717, 20% US-born 1241, Naturalized 15% Non-citizen 5,506, 65%
  25. 25. % using clinics among those with a usual source of medical care, Calif. 79.2% insured uninsured 59.5% 60.4% 57.6% 45.4% 41.9% 35.4% 12.9%Imm MexAm, in US Immg MexAm, in US Born US Born NL White <10 yrs US 10+ yrs MexicanAm Source: California Health Interview Survey, 2009
  26. 26. Other issues?• Undocumented residents• Mixed status families• Definition of “emergency” for Medicaid
  27. 27. Senate bill p. 292• (d) NO FEDERAL PAYMENTS FOR INDIVIDUALS NOT LAWFULLY PRESENT.—Nothing in this subtitle or the amendments made by this subtitle allows Federal payments, credits, or cost-sharing reductions for individuals who are not lawfully present in the United States.
  28. 28. Undocumented Immigrants, U.S. = 11.2 million, 2010 State Estimated # California 2,550,000 Texas 1,650,000 Florida 825,000 New York 625,000 New Jersey 550,000 Illinois 525,000 Georgia 425,000 Arizona 400,000 North Carolina 325,000 Maryland 275,000 Washington 230,000 Source: http://pewhispanic.org/files/reports/133.pdf
  29. 29. Mixed status families complicate equitable health care, U.S.Children of Mexican immigrants Children of NonLatino immigrants 14.9% 25.7% 47.1% 25.3% 59.8% 27.3% Citizen parents Citizen parents 1-citizen parent 1-citizen parent Noncitizen parents Noncitizen parents
  30. 30. Senate bill p. 126• (c) APPLICATION OF EMERGENCY SERVICES LAWS.— Nothing in this Act shall be construed to relieve any health care provider from providing emergency services as required by State or Federal law, including section 1867 of the Social Security Act (popularly known as ‘‘EMTALA’’).
  31. 31. But each state defines “emergency” - Georgia does not cover dialysis
  32. 32. Adequate use of health care• Availability – are services located in the community where immigrants live• Accessibility – can immigrants afford the care; are the hours of service appropriate• Acceptability – do the immigrants have confidence in the provider, can they communicate
  33. 33. Summary• Health Care Reform (ACA) will greatly improve access to care to immigrants • More insured @ work, subsidies, Medicaid • Improved access to community health centers • Availability & acceptability changes unclear• Undocumented immigrants remain vulnerable
  34. 34. To get your OWN data on immigrant health go to www.chis.ucla.edu

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