Last week, the Kaiser Family Foundation (KFF) released a new issue brief examining health coverage by race and ethnicity under the Affordable Care Act (ACA) and its impact on disparities in health coverage. The KFF analysis found that non-elderly people of color have experienced larger coverage gains than non-elderly white people since the implementation of the ACA. According to KFF data, national uninsured rates decreased by 9 percentage points for Hispanic/Latino people, 7 percentage points for Asian people, and 5 percentage points for non-Hispanic Black people from 2013 to 2015 compared to 4 percentage points for white people.
People of color in New York State have experienced similar gains in coverage under the ACA. According to data from the United States Census Bureau, uninsured rates in New York State decreased by 10.2 percentage points for American Indian/Alaskan Native people, 7.3 percentage points for Hispanic/Latino people, 6.3 percentage points for Asian people, and 4.9 percentage points for non-Hispanic Black people from 2013 to 2015 compared to 3.3 percentage points for white people. The only group that did not experience these comparatively larger coverage gains was the Native Hawaiian/Other Pacific Islander population.
This an important step forward in the reduction of health coverage disparities. However, the KFF brief warns that even with the larger coverage gains, people of color are still more likely to be uninsured than white people. Nationally, people of color accounted for more than half of the 28.5 million remaining uninsured in 2015.
Targeted outreach and enrollment efforts to reach the remaining uninsured, many of whom are eligible for coverage as well as financial assistance, could augment these coverage gains and continue the progress toward health coverage equity that has already begun under the ACA.
The NY State of Health’s (NYSOH) 2016 Open Enrollment Report shows that increased efforts to reach Limited English Proficient populations are making progress. This year, 20 percent of NYSOH enrollees indicated a language other than English as their preferred language compared to 18 percent in 2015. This increase is an important reflection of the diversity of our state.
To encourage outreach, NYSOH made consumer education materials available in 23 languages other than English, including five additional languages that were not available in 2015: Burmese, Karen, Somali, Swahili, and Tigrinya. NYSOH’s Customer Service Center also provided assistance to consumers in 93 languages other than English with an average of 20 percent of all calls to the Customer Service Center each month were answered in a language other than English compared to only 14 percent in 2015. Additionally, Navigators provided assistance in 37 languages other than English.
Gaps in information remain about New York’s diverse immigrant communities and their experiences enrolling in coverage through the NYSOH. Although this year’s Open Enrollment Report provides great information about enrollment for seven languages: Chinese, English, French, Haitian Creole, Italian, Korean, Spanish, and Russian, the report does not provide insight into whether callers in additional languages were able to enroll after reaching the call center. The NYSOH Navigator program funds enrollment but not outreach activities. Last year, HCFANY urged the State to provide dedicated outreach funding to small community-based organizations that best know difficult to reach immigrant rural populations.
Once again New York is leading the nation as one of only two states to implement a Basic Health Plan (BHP). As of January 31, 379,599 New Yorkers enrolled in comprehensive, affordable coverage through the New York’s BHP, branded the Essential Plan, which launched in 2016. A few weeks ago, the NY State of Health (NYSOH) released its report on the third open enrollment period, which ran from November 1, 2015 through January 31, 2016. HCFANY is excited to see so many consumers gaining access to health care through the EP in its first year.
The EP is meeting an important need for consumers in New York, particularly for those with incomes between 138 and 200 of the Federal Poverty Level (FPL). Before the implementation of the Essential Plan, individuals at this income level would only have been eligible to purchase Qualified Health Plans (QHP) with financial assistance, and many continued to face financial barriers to coverage. With the EP, low- and moderate income individuals can now receive coverage comparable to that of a QHP for a premium of $0 or $20 and no annual deductible. The average consumer saves over $1,100 compared to QHP coverage. This increased affordability has resulted in high enrollment levels for EP eligible individuals. According to NYSOH’s open enrollment report, 98 percent of individuals determined to be eligible for the Essential Plan enrolled compared to only 58 percent of individuals eligible for QHP.
Essential Plan coverage is also available to individuals under age 65 with incomes below 138 percent of the Federal Poverty Level (FPL) who are lawfully present in the United States, but have not met the five-year bar to qualify for Medicaid as well as lawfully present immigrants with incomes 138 to 200 percent of FPL.
Like Medicaid and Child Health Plus, individuals and families eligible for the EP can enroll throughout the year.
To enroll or learn more about the Essential Plan, contact NYSOH at (855)-355-5777 or www.nystateofhealth.ny.gov.You can also get free one-on-one help from a Navigator or Certified Application Counselor, certified by NY State of Health, who serves your area at http://info.nystateofhealth.ny.gov/IPANavigatorMap. Or contact Community Health Advocates at (888)-614-5400 or http://www.communityhealthadvocates.org/.
Guest blog by Max Hadler, Health Advocacy Specialist at The New York Immigration Coalition
Despite the major health care coverage gains achieved under the Affordable Care Act, more than 450,000 New Yorkers remain uninsured because their immigration status makes them ineligible for affordable coverage. As a result of the continued failure to approve federal immigration reform or lift health coverage restrictions on many groups of immigrants, it continues to fall to state and local governments to pick up the slack. Health Care For All New York has responded to the dire lack of coverage options for immigrants by launching the Coverage 4 All campaign under the leadership of two of the coalition’s member organizations, Make the Road New York and the New York Immigration Coalition.
The campaign’s mission is to obtain affordable coverage options for all New Yorkers, regardless of immigration status. A shorter-term goal is to expand coverage to a smaller group of immigrants who are “permanently residing under color of law” (PRUCOL). These are people whose presence in the U.S. is known and may be unauthorized, and who have received confirmation from the federal government that it has no intention of deporting them. In New York, immigrants who are PRUCOL are eligible for state-funded Medicaid when they meet the income requirements (less than $16,242 annual income for a single person). However, the same people are not currently eligible for the Essential Plan, New York’s low-cost, comprehensive coverage program for low-income residents whose incomes are too high for Medicaid (up to $23,540 annually for a single person). This restriction runs counter to New York’s history of providing coverage to many immigrants who are excluded from federally-funded programs.
Most immigrants who are PRUCOL are young adults who grew up in the U.S. and have Deferred Action for Childhood Arrivals (DACA) as a result of President Obama’s 2012 executive order providing them two-year work authorizations and a reprieve from deportation. These young people are encouraged to work as a result of their DACA status but are then faced with a dearth of affordable coverage options when their incomes increase beyond the Medicaid threshold because they are ineligible for the Essential Plan and prohibited from accessing tax credits through the New York State of Health insurance marketplace.
To begin to remedy these coverage gaps, the New York State Assembly is working to expand Essential Plan eligibility to include immigrants who are PRUCOL. The Assembly included $10.3 million in its 2016-17 budget to provide this coverage, but the funding was ultimately cut in budget negotiations. Assemblymembers Richard Gottfried and Marcos Crespo have since introduced legislation that would expand Essential Plan eligibility to include immigrants who are PRUCOL. Bill A10054 was successfully voted out of the Assembly Health Committee on May 17 and is now awaiting a vote by the Ways and Means Committee. HCFANY has submitted a memorandum of support for the bill. Others are encouraged to submit their own memorandums and to borrow language from the HCFANY memo as needed. Please contact me at the New York Immigration Coalition if interested in registering your support (firstname.lastname@example.org).