News Column

All Eyes on Healthcare Reform

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With one in three U.S. Hispanics lacking health insurance, it's little wonder recent nationwide surveys show that the Hispanic population considers healthcare reform to be the No. 1 issue of the day surpassing even immigration reform and the economic downturn. Now, with a historic effort underway on Capitol Hill to merge two recently approved health bills the House's in November and the Senate in late December the implications for Hispanics are monumental.

Both bills seek to significantly boost the rate of insured Americans, currently at 83 percent. The Senate plan would expand that coverage rate to 94 percent; the House plan, 96 percent. Put another way, the bills would reduce the number of uninsured people in the United States now standing around 46 million by between 31 million and 36 million. "I think it's a phenomenal step forward," Dr. Elena Rios, president and CEO of the National Hispanic Medical Association, told HispanicBusiness Magazine. "It's really a big opportunity for this country to start decreasing the cost of healthcare."

But Hispanic advocates are far from sanguine. As lawmakers in Washington D.C. gear up for a grueling effort to reconcile the gargantuan bills, major concerns still loom for Hispanic groups. Their worries are numerous, but in general, Hispanic groups tend to be less enthusiastic about the Senate bill. Take the politically thorny issue of illegal immigration. Currently, the Senate bill prohibits illegal immigrants from purchasing with their own money (and no government subsidies) health plans on a proposed national insurance exchange. An insurance exchange is a large pool of people that contracts with insurers to lower risk and therefore reduce the premiums of the customers.

"Individuals who have the money ought to be able to purchase any product they need," said David Ferreira, vice president for government affairs at the U.S. Hispanic Chamber of Commerce.

"In our country, you don't prohibit somebody from buying bread based on immigration status." Health insurance, he added, should be no different. In contrast to the Senate's ban which also applies to legal residents of the U.S. Commonwealth of Puerto Rico the House version allows illegal immigrants and citizens of Puerto Rico to participate in the exchange. Both bills, however, include language prohibiting those groups from receiving federal subsidies.

And then, of course, there is the political hot button of the public option. As is, the Senate bill includes no government-run health plan, while the House bill does. "I think the public option would be a very viable mechanism," said Castulo de la Rocha, CEO of AltaMed Health Services, a network of community health centers for the poor in Southern California. "I'm always interested in assuring there are multiple options that people have choice."

Also troubling to many Hispanic organizations is how neither bill deletes the current five-year ban on newly documented immigrants from enrolling in Medicare or Medicaid.

Meanwhile, for all the noise in the media about sweeping issues, such as illegal immigrants and the public option, in many cases it is the lesser-known potential changes that offer a more concrete illustration of what a post-reform world would look like.

Both bills, for instance, would not only drastically reduce the number of uninsured Hispanics, but also dedicate loads of money to preventative care a key issue for Hispanic advocacy groups. They also would expand the safety net for the poor and take measures to increase the woefully low numbers of Hispanic doctors and nurses.

To address a culture gap that tends to separate physicians from Hispanic patients, the House bill would require interning doctors to log a certain amount of hours in clinics. As is, they need only train at hospitals.

"Training at the UCLA hospital is very different than being in a community clinic in East L.A.," Ms. Rios said. "The idea is to train doctors to be more responsive and to be more culturally competent."

The bills would also nearly double the budgets of federally funded community health centers serving the poor. These centers are typically located in urban areas and isolated rural areas, and cater to the uninsured and under-insured. Oft en, they treat illegal immigrants.

The proposal is to add at least $2 billion a year for half a decade to the current $2.5 billion annual allotment for the nation's community health centers.

If approved, the extra money would come in especially handy for struggling states like cash-starved California, which last year alone was forced to slash its budget for primary care for the working poor by a staggering 30 percent.

"The truth is, the last year and a half to two years have been extremely challenging," said Mr. De la Rocha of AltaMed, the network of community health centers in Southern California.

"We're talking double-digit unemployment rates. In some places where we are working, it's in the 20th percentile."

The task of melding the bills could occur with surprising speed. In early January, Democratic lawmakers discussed the possibility of forgoing a formal conference committee process in favor of a short-cut in which the leaders of the two chambers negotiated changes, then sent the proposed bill for approval to the House and Senate.

Also paying close attention to the wrangling on Capitol Hill is the U.S. Hispanic Chamber of Commerce, which represents 200 regional Hispanic chamber organizations across the nation.

The chamber's main aim is to help Congress find a way to curtail costs to small businesses.

While the systemic costs of healthcare are skyrocketing at roughly 7 percent a year, premiums are soaring at an even faster 9 percent annually, said the chamber's Mr. Ferreira.

"It is not unheard of that a business has to pay nearly double what they paid just a year before to provide health insurance for their workers," he told HispanicBusiness magazine. "Bad stories abound about how small businesses are being drained of their resources."

The solution, Mr. Ferreira said, is to create exchanges in which small businesses can participate. On this measure, he is thus far satisfied with both the approved House and proposed Senate bills.

However, those exchanges, if approved, wouldn't be put in place until at least 2015. In the meantime, if a new law passes soon, small businesses offering health benefits to their workers will immediately qualify for tax credits, Mr. Ferreira said.

On the other hand, the penalties for failing to provide coverage would be severe.

Under the Senate version, businesses with more than 50 employees that opt not to provide coverage would pay a fee of $750 for each employee. Under the House bill, non-small businesses that fail to provide coverage would pay a fee of 8 percent of their payroll.

All told, while few Hispanic groups view the House and Senate bills as ideal, advocates say both versions represent a major milestone in American history.

"The truth of it is, when I first started working at what used to be called the East L.A. Barrio Free Clinic, there was a huge line of people waiting to receive care," Mr. de la Rocha said. "I've been working for 32 years to shorten that line. I think we finally have a way that the line will be dramatically impacted."