News Column

The Health Care Bill has Become Law

May 13, 2010

By Rob Kuznia, Staff Writer

Weeks after passage of a historic health bill, Hispanic advocacy groups say the sweeping new law will generally bring much-needed benefits to Hispanics and businesses across America.

Those same groups, however, are raising concerns about how the health care reform bill will affect illegal immigrants who currently have coverage.

While it's been widely reported that illegal immigrants are left out of the newly signed health law, less talked about is how the new law could actually make things worse for insured illegal immigrants -- as opposed to merely maintaining the status quo.

The Patient Protection and Affordable Care Act will bring coverage to 32 million of the current 45 million uninsured Americans and cost roughly $850 billion over 10 years. But it could also cause many illegal immigrants to lose the coverage they have. And the number of illegal immigrants with coverage is surprisingly large.

The Pew Hispanic Center estimates that roughly 40 percent of the 11 million or so illegal immigrants residing in this country are insured, either because they purchased health coverage themselves or received it through their employers. The U.S. Hispanic Chamber of Commerce puts the estimate even higher.

"I don't think many people know that approximately 50 percent purchase coverage," Javier Palomarez, president and CEO of the chamber, told Hispanic Business magazine. "These folks are in jeopardy of losing what little coverage they have."

The bill that was signed into law March 30 not only prohibits illegal immigrants from receiving federal subsidies, it also -- to the chagrin of immigration-rights advocates -- bars them from purchasing insurance with their own money on the soon-to-be created statewide exchanges that will pool ratepayers to lower premiums.

To be sure, under the new law, illegal immigrants still will be able to purchase coverage out of pocket. It's just that, because their plans will be excluded from the exchanges, they could see the cost of their premiums skyrocket out of reach.

This is because the creation of the new exchanges could have the effect of draining current risk pools of almost everyone except the illegal immigrants, said Jennifer Ng'andu, deputy director for health policy project with the National Council of La Raza.

"I think you could say on some level that undocumented immigrants (with coverage) are the ones who will be worse off than before," she told Hispanic Business magazine.

Thus far, nobody knows exactly how the market is going to react, as the exchanges won't take effect until 2014.

"But many people are starting to anticipate drastic increases in health insurance costs," Ms. Ng'andu said.

Ultimately, fewer illegal immigrants getting coverage would translate into more people using emergency rooms or community health clinics for their health-care needs. These costs tend to ultimately be borne by ratepayers and taxpayers.

Elena Rios, M.D., president and CEO of the National Hispanic Medical Association, said the issue underscores the need for comprehensive immigration reform.

"I think this country needs immigration reform to allow unauthorized immigrants who live here and work here and pay taxes to be able to have certain services," she told Hispanic Business magazine.
Broadly Many Benefit

On a broad scale, though, many Hispanic groups are generally pleased with the new law.

With one in three of all U.S. Hispanics uninsured -- and at least 20 percent of Hispanic-American citizens and legal residents uninsured -- the population has more to gain than any other, Dr. Rios said. (About 15 percent of the entire U.S. population is uninsured.)

"It's a phenomenal step forward for the Hispanic community," she said.

Small Business Fares Well

Hispanic-owned businesses also stand to benefit.

With 98 percent of Hispanic-owned businesses employing fewer than 50 people, the legislation's effect on small business is of primary importance to many Hispanics.

Over the past decade, the meteoric rise of health care costs has significantly hampered the ability of small businesses to offer health benefits to their employees.

Since 2000, the proportion of small businesses offering health benefits has dropped more than 20 percent, from two-thirds to less than half. The bulk of that drop has occurred over the past three years.

The new law benefits small businesses in several ways, Mr. Palomarez of the chamber said. First, it allows them to purchase insurance through the exchange. Also, small businesses that opt out still stand to benefit, as most of their employees will qualify to purchase individual plans on the exchange, improving the ability of those businesses to stay competitive with larger companies.

Finally, and most immediately, all small businesses offering health benefits to their employees will qualify for tax breaks.

"They can avail themselves this year of essentially free money," David Ferreira, the chamber's vice president for government affairs, told Hispanic Business magazine.

Mr. Ferreira said one disappointment to the chamber is how the law requires businesses with more than 50 employees to provide coverage. The chamber had hoped that the threshold would be set at 100 employees -- or, better yet, dropped altogether.

But in terms of how the bill affects Hispanic-owned businesses, the difference between 50 employees and 100 employees is relatively slight, he added. While about 99 percent of all Hispanic-owned companies employ fewer than 100 people, about 98 percent employ fewer than 50.

"We're fighting over inches at this point," he said.

Other Benefits

The new law stands to benefit U.S. Hispanics in many ways, advocacy groups said. It comes with a huge prevention component, meaning, for instance, that doctors will have financial incentives to discuss healthy lifestyles with patients.

This is particularly beneficial for Hispanics, who suffer disproportionately from obesity, diabetes and heart disease, Dr. Rios said.

The new law also means doctors and nurses in many areas of the country will have to undergo cultural competency training, which could include taking Spanish classes or hiring translators.

"It exists now, but not like with the court system," Dr. Rios said. "The health care system has been light years behind. This is going to bring the system into the 21st Century."

As it is, she added, just 5 percent of the nation's doctors and nurses are Hispanic -- a percentage that the National Hispanic Medical Association would like to see grow.

The new law also increases to 26 the age in which young people can stay on their parents' plans. The current age varies from state to state, but in general coincides with the college years of middle-class families, which generally end around age 22, Dr. Rios said.

Also experiencing some improvements are the citizens of the U.S. commonwealth of Puerto Rico, which received about $1 billion to establish an exchange and provide more affordable care.

"In the end, we think there are key gains that give us a foundation to be able to extend affordable insurance to many Latinos and immigrants across the country," Ms. Ng'andu said. "The bill was by no means what we hoped to have, but it's something we believe sort of lays the foundation for a better health care system



Source: HispanicBusiness Magazine. All Rights Reserved.


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