As the U.S. Supreme Court debates the constitutionality of President Obama’s historic Patient
Protection and Affordable Care Act, Asian Americans, Native Hawaiians and Pacific Islanders have a big stake in the results. Why you should care about health care reform.
ISSUE: Summer 2012
DEPT: Beauty Kit
STORY: Regina Ip
It’s a story heard over and over again. You graduated college several years ago, but you’re one of the 50 percent of struggling college grads who is either unemployed or underemployed, according to an April 2012 Associated Press report. Unable to find a job in this tough labor market, you move back in with your parents.
On top of your mounting student loans, your stress levels are at an all time high. Soon, you start to feel sick. First, some migraines. Then, minor chest pain. You’re hesitant about seeing a doctor, which could set you back between $80 to $200. You couldn’t afford to pay that for one visit, let alone any medical treatment if it turns out you actually have a health problem.
In the past, you would have had to pay up. Health insurance companies could remove children as young as 19 from a parent’s health plan. But the Patient Protection and Affordable Care Act (“ACA”), the largest overhaul of the health care system in U.S. history, enacted on March 23, 2010, changed that. Now, you are one of 97,000 young Asian Americans, Native Hawaiians and other Pacific Islanders (collectively, “Asian Americans”) who are covered under your parents’ health plan until the age of 26, according to the Asian Pacific Is- lander Caucus for Public Health.
It’s just one of many health care reforms provided under the ACA, not the least of which include a provision that prohibits denial of coverage due to a pre-existing condition, as well as an individual mandate that will require every American to have health insurance. But the legality of the ACA has been challenged and soon the United States Supreme Court will render its decision on the law’s constitutionality. The Court’s decision is likely to have a major impact on Asian Americans, who face significant health disparities and suffer some of the lowest rates of coverage in the U.S. One in six Asian American adults and one in 10 children do not have health insurance, according to the Asian Pacific American Legal Cen- ter (APALC). This translates into almost 2.5 million Asian Americans who are uninsured (162,000 of which are Pacific Islanders). Compared to 13.3 percent of percent of the U.S. population) in 2010 are expected to more than double to 43 million, or 10 percent of the population, by 2050.
These statistics perhaps explain why Asian Americans are twice as likely than both non-Hispanic whites and African Americans to have not seen a doctor in the past five years, according to the Centers for Disease Control’s 2008 National Health Interview Survey. And yet Asian Americans face serious health disparities that include disproportionately high rates of certain types of cancer, heart disease and stroke. Three in 10 Asian Americans are living with asthma, diabetes or hypertension, according to the Asian Pacific Islander American Health Forum (APIAHF), a national organization that filed an amicus brief in the U.S. Supreme Court case. Asian Americans are also disproportionately affected by certain chronic diseases, like hepatits B, the leading cause of liver cancer. “Disparities are greatest for Asian American women, in particular,” given the low screening rate for cancer, says UCLA Public Health Associate Professor Ninez Ponce. “The importance of preventive services — pap tests, HPV vaccinations, mammography — those are really critical for Asian American women.”
Ponce, who specializes in cancer prevention and control research, says that the ACA expands health care access for the community. “These prevention services, part of the essential health package, also would not require co-pays or high deductibles. The cost of getting that would be virtually zero, which would mean no financial barriers for Asian American women.”
How the ACA Affects You
According to the APALC and APIAHF, some of the benefits under the ACA include:
Many previously uninsured individuals are benefiting from the ACA, including people with pre-existing or chronic conditions, small business owners and the elderly, says Elena Ong, the communication chair for the Asian Pacific Islander Caucus for Public Health, an affiliate of the American Public Health Association. In addition, Medicaid will be expanded in 2014, with as many as one in eight Asian Americans projected to gain Medicaid coverage, according to the APIAHF. In California alone, it is estimated that more than 140,000 Asian Americans would be eligible for coverage under an expanded Medi-Cal program. Ong says that already 2.6 million Asian Americans are now receiving preventive services without cost sharing — she herself did not have a co-payment for her physical examination, flu shot or mammogram last year, she adds.
In addition, there is the formation of statewide exchanges that allow consumers — who do not have employer-based health insurance — to buy affordable health insurance and receive premium subsidies for lower- income households.
Another benefit is the Small Business Health Options Program (SHOP) Exchanges, which will allow small business owners to purchase affordable health insurance for their employees. As a result, an estimated 1.5 million Asian American businesses in the country will be eligible for this benefit. Moreover, small businesses can take advantage of tax credits of up to 30 percent for providing health insurance for their employees. Up to four million small businesses are eligible for these tax credits, but many do not know about them. These changes are particular important to the Korean American community — one in four Korean Americans do not have health insurance because many are small business owners who cannot afford health insurance for themselves or their employees.
According to Kathy Lim Ko, president and CEO of APIAHF, the ACA also provides for improvements in health care quality. With more than 50 ethnicities and more than 100 different languages, the Asian American community’s diversity sometimes makes access to health care difficult. The ACA requires that insurers translate vital documents like benefits summaries into a number of languages, provide consumers with assistance over the phone and in person, and write materials in plain language so that documents are culturally and linguistically accessible. In addition, the ACA will help increase the number of Asian American health care workers who can provide culturally competent care.
To better inform Asian Americans on the benefits of the ACA, the APALC recently launched a health care initiative called the Health Justice Network. Launched in California, the state with the largest proportion of Asian Americans, the collaborative is part of APALC’s Health Access Project, the first grassroots program in the country to address the health care needs of Asian Americans. The project is made up of an initial network of 20 nonprofit organizations throughout California, including groups that serve the Chinese, Vietnamese, Korean, Filipino, Thai, Guam, Japanese, Cambodian, and Hmong communities.
“Many Asian Americans are deprived of access to health insurance and find that they are suffering from various illness, oftentimes without any recourse to health access,” says Stewart Kwoh, executive director of the APALC. “[The ACA] is a great opportunity to increase access to affordable, quality health care for the Asian American community, as well as other millions of Americans in the country.”
The Future of Health Care
“The ACA has provided quality, affordable medical care for millions of Americans,” said United States Congresswoman Judy Chu (D-CA) in a statement. “Thanks to this remarkable law, we no longer have to feel threatened by pre-existing conditions, the Medicare ‘Donut Hole,’ or lifetime dollar limits on medical coverage.”
Yet Kwoh is worried about the future of the ACA. “[The ACA] has many features — many of which are very positive — that may not be utilized by the Asian American, Native Hawaiian and Pacific Islander communities,” he says. “That would be a major tragedy.”
With the Supreme Court expected to render their decision on the constitutionality of the ACA by the end of June, the Asian American community will just have to wait and see if the ACA provisions will remain in effect.
Ong speculates that the Supreme Court will not vote in favor of the individual mandate portion of the ACA. “It was the least popular aspect of the Act, by both ends of the political spectrum,” she says. But whether the Court will uphold the rest of the ACA remains to be seen. “Frankly, it is premature to discuss the Court’s outcome.”
Meanwhile, “it is important to move forward with implementation,” says Ong, “as the need is still present.”