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:

• Children may be covered under their parent’s health insurance plan until age 26. As a result, 97,000 Asian Americans have gained coverage.
• Various preventive care services — such as cancer screening tests, flu shots and mammograms — must be provided without any cost or co-payments by the patient. About 2.7 million Asian Americans with private insurance have been affected by this.
• Insurance companies can no longer deny coverage to individuals with pre-existing or chronic conditions, nor can they rescind coverage by searching for errors or other technicalities on a customer’s application.
• There are no more lifetime dollar limits on insurance coverage. More than 12 million Californians now have increased coverage without lifetime limits.

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.”

One woman’s fight for health care reform takes a very personal turn.

ISSUE: Spring 2010

DEPT: My Story

STORY: Veronica De La Cruz

Veronica De La Cruz, right, with her brother Eric.

On July 4, 2009, I lost my brother and only sibling Eric Alexander De La Cruz. He passed away while awaiting a heart transplant. Five years ago, he was diagnosed with severe dilated cardiomyopathy, a weakening of the heart that prevents it from pumping normally. Since then, we had tried to get Eric insurance coverage that would allow him to get the treatment he needed, but no private insurer would offer him insurance because of this preexisting condition.

My brother and I grew up in Northern California and, though we were a couple years apart, we were always very close. As kids, we spent all our time on the ice at the local rink. Eric played hockey, while I trained as a figure skater.

As adults, we remained best friends, talking and joking on the phone or over email. We loved trading music and would always keep each other up to date on what was happening in the world of hockey or figure skating. Eric loved the Anaheim Ducks, and it would crush him if they didn’t win. He was a talented artist, music producer and designer. His love was a constant reminder that there was more to life than work.

When Eric’s heart condition was diagnosed, our lives changed forever. In May 2009, his kidneys began to fail and doctors told me only a heart transplant would save his life. Since he was young and otherwise healthy, I thought our chances were excellent. But Eric did not have the luxury of insurance coverage provided through his employer, a small Web design firm that only employed seven people. His only insurer, state Medicaid, wouldn’t cover the out-of-state operation Eric needed. And he was denied federal Medicare — twice.

Eventually, when we finally did get federal coverage for Eric, the hospital still demanded private supplemental insurance to help cover the huge expenses. And the rub? Insurance companies won’t sell supplemental insurance policies to those with pre-existing conditions, so we were right back to square one. We were told we might still have to come up with nearly a million dollars.

Medical bills have bankrupted our family. My mother even shared her own heart medication with Eric when he couldn’t afford it. With Eric’s health deteriorating, and feeling desperate, I began relying on the kindness of strangers.

In May, I started talking about Eric on Twitter. To my amazement, complete strangers started to come together in support. Within a week, hundreds of donors had raised $6,000 and Eric’s cause was being promoted by celebrities like Demi Moore, Alyssa Milano and P. Diddy. Those willing to champion Eric’s fight for his life soon numbered in the thousands. Popular bands Nine Inch Nails and Jane’s Addiction, as well as professional skateboarder Tony Hawk, helped put fundraising into overdrive. Altogether, Eric’s Twitter Army raised nearly $1 million in a matter of weeks.

In June, Eric was moved to a California hospital, where he was put at the top of the heart transplant list. It was a happy time for us and we were busy planning for the future. We were looking forward to doing normal things together, like walking his dog Chance and finally getting on the ice again. And every day, I took time to assure him that everything was going to be OK.

But sadly enough, doctors informed me the fight would be hard. In fact, they pulled me aside to say, “You guys got here two years too late.” They explained that Eric’s battle for a heart should have started two years earlier — back when we were trying to secure insurance coverage and one by one each insurance company was saying no. The day my brother passed away I promised him I would do two things: take care of Mom and his dog, and try my hardest to change the health care system. I sat by his bedside crying, promising that I would do everything within my own power to make sure that no one suffered again needlessly, the way he did.

Still deeply mourning my brother, I’ve been trying to fulfill those promises. I’ve made multiple trips to Washington, D.C. to lobby Congress for health care reform, arguing that coverage must be available to all, even to those with preexisting conditions, and that insurance companies must be prohibited from dropping sick patients. I’ve spoken at rallies across the country, sharing Eric’s story, illustrating the urgent need for change. I’ve been working with young patients who have found themselves in similar positions as Eric’s, the latest being a man in his 30s whose insurance provider, AETNA, has refused to cover the cost of his transplant. I only hope the work that I do will one day put an end to the unconscionable practices seen from insurance companies like AETNA, among others.

My brother’s inability to get adequate health insurance has had a devastating impact on my life. It’s broken my mother’s heart and has sent the lives of other friends and family members into a tailspin. Being excluded from the health care system because of a pre-existing condition robbed my only sibling of his fair chance at life, and it robbed all of us of his gifts, talents and love.

Health care reform may come too late for Eric, but I hope it will come in time to help thousands of other families who may otherwise also lose loved ones simply because private insurance companies choose to turn away the sick. Helping to bring about the day when everyone has the right to health insurance will be my brother Eric’s greatest gift, so please, do your part.

Log on to EricsLaw.com and sign the petition. Contact your elected officials and the President and tell them that you support health care reform, which is urgently needed now. Health care is a basic human right, and should no longer be looked at as a privilege.