How Will the Affordable Care Act Affect Asian Americans?

By Jenny Chen

Stan Tsai, a member of the board of directors of the Chinese Culture and Community Service Center (CCACC), has been following the Affordable Care Act closely – and he’s concerned about how much the Asian American community knows about what is going to happen come October 1.

“I went to the information meetings [for the Affordable Care Act] and I was the only Asian there,” he said in early September.

Tsai said that through his work in the community, the two words to describe how the Chinese American community feels about the ACA is “confused” and “scared.” They’re confused, he said in an email to Asian Fortune, because they don’t have enough information about the Affordable Care Act and how it will specifically affect them. They’re scared because they’re not sure if they have to pay more out of pocket expenses.

Tsai is not alone. Jason Chung, communications director for AAPI at the Republican National Congress, echoes this concern and says that the biggest problem facing the Asian American community is that not enough people know what’s going to happen. “The biggest challenge [the AAPI community] faces is the lack of information and how much [the law] will impact them,” Chung said.

This is unsurprising, since it seems like every day, there is a new report about what is or isn’t going into the Affordable Care Act. Even native English speakers are confused as to how the ACA will work. It has fallen upon individual states to educate their constituents about how the Affordable Care Act will affect them.

The level of education and preparedness varies widely across the United States says Suzanne Schlattman of Healthcare for All, a Maryland based nonprofit organization that educates the pubic on healthcare through grassroots efforts.

“Maryland is in a good position because it took initiative early on to take advantage of federal grants to educate the public…set up its own insurance exchange program,” Schlattman said. Her organization has been working specifically with faith-based organizations in the Korean and Muslim communities to educate them on the ACA, what it means, and how to enroll.

Dr. Kim is the Director and founding member of Korean Resource Center (KRC), a non-profit organization in Ellicott City that promotes health and wellness and helps people in need to obtain free medications. Dr. Kim hosted one a Health Ambassador trainings and helped translate some of Healthcare for All’s brochures into Korean. Kim said that although many of his constituents are scared and confused, the majority of them are excited about the changes in healthcare.

“Because of the tax credits, the total cost of healthcare will be much cheaper than in the past,” Kim said. Out of all the Asian American subgroups, the Department of Health and Human Services has identified Korean Americans as the most likely to be uninsured.

The cost of healthcare is an area of serious contention: community leaders such as Kim say that healthcare with inevitably be cheaper because of ACA, but others like Chung and other Republicans say that it will not. Who is right?

The truth of the matter is, says Dourakine Rosarion, special assistant to the Director of Health and Human Services in Montgomery County, we won’t know until Oct. 1, when the insurance companies will release their rates. Furthermore, the rates will vary from state to state. Maryland, a state which has been proactive in preparing for the ACA has created its own insurance marketplace called the Maryland Insurance Exchange, in which rates have been negotiated to be lower than they previously were at cost. The same is true for DC. Virginia, on the other hand, did not opt to create their own exchange and are instead, relying on the federal insurance marketplace, which may not be as developed or attractive as state created ones.

Furthermore, the Affordable Care Act has designed tax credits which will be applicable to more families and should make healthcare more affordable for families. Families earning up to 400% above the Federal Poverty level will now be eligible for tax credits to help pay for health insurance. This is a number higher than ever before in the past. However, the actual effect of these tax credits and the final cost of insurance remains to be seen.

On Sep. 25, the Department of Health and Human Services released a report that found the health insurance plans under the Affordable Care Act to cost slightly less than projections by the Congressional Budget Office. About 95 percent of uninsured people eligible for the Marketplace live in a state where their average premium is lower than projections. The report also found that state insurance exchange programs had over 50 participating insurance companies – a sign of healthy competition.

The White House has recognized the unique difficulties that the Asian American community faces in making the switch and has designed a series of in-language Google Hangouts for Asian Americans with limited English proficiency. These Hangouts will provide an opportunity for the Asian American and Pacific Islander (AAPI) limited English proficient (LEP) community to hear from the Administration officials about the new Health Insurance Marketplace and learn how to enroll in their language and will be conducted in Korean, Chinese, and Vietnamese. On Aug. 27, the White House Initiative for AAPI hosted their first Google hangout videochat in Korean.

There is a disconnect however, much of the information however, is online. “Most first generation immigrants get their information in print,” said Dr. Kim.

To that point, Jeannina Perez, a fellow at MomsRising.org, an activist organization representing mothers, said urged second generation immigrants to get educated about the new healthcare law and pass that information on to their parents and family members. “I’m speaking as a Latina and I know that in my community, that’s how it works,” Perez said.

Maryland is also actively working to supplement the issue by hiring navigators and assisters to talk to people face-to-face about their individual needs and walk them through the insurance buying process.

Betty Lam, chief of community affairs at the Department of Health and Human Services of Montgomery County says that Montgomery County, as the county with the largest AAPI residents in the area, has made a special effort to recruit in-language navigators and assisters to provide in-person assistance for immigrants who are enrolling. while initially, it was difficult to get enough Mandarin and Vietnamese speaking navigators and assisters, but now they are doing “quite alright.” Lam says that the Asian languages not represented by actual native speakers will be represented through translators over the phone.

In Frederick County, Md., Elizabeth Chung, Executive Director of Asian American Center for Frederick and head of Minority Outreach and Technical Assistance for Frederick County, has been spearheading the effort to reach out to Asian Americans and get them enrolled. In a Sept. presentation to the American Society for for Quality (ASQ), Chung outlined plans for organizations that are conducting outreach for healthcare reform. On Oct. 5, the Asian American Center for Frederick will be hosting its Health Fair, which will educate visitors on how to sign up for insurance through the Md. health connection.

Chung says that the issue of equal healthcare access is one near and dear to her heart. “My dad had to go to China to die,” she said. Her mother has also been diagnosed with cancer – something that is becoming more and more common among Asian Americans. “But,” Chung said in her presentation to ASQ, “[Asian Americans] were 1.4 times more likely to be without health insurance, not able to afford to see a doctor than their White counterpart[s].”

Update Sept. 26: According to staff at DC Health Link – DC premium costs will not be available until Nov.1 due to technical difficulties. The website will still open on Oct. 1 as planned but specific costs of insurance plans will not be made public until Nov. 1.

What Does the Affordable Care Act Mean for Individuals and Families?

Starting this year, the Affordable Care Act (ACA) requires by law that all individuals must have health insurance. Those who do not have health insurance will be subject to a fine of $95/person per year that will increase every year.

“It’s a move toward more preventative health care rather than sick care,” said Dourakine Rosarion, special assistant to the department of health and human services director of Montgomery County, Maryland.

Under the Affordable Care Act, all insurance companies must cover the “10 Essential Health Benefits” which include: immunizations; preventive care and screenings for infants, children and adolescents; screening for gestational diabetes; HPV DNA testing; counseling for sexually transmitted infections; counseling and screening for HIV; contraceptive methods; breastfeeding support, supplies and counseling; and screening and counseling for interpersonal and domestic violence.

In addition, insurance companies are prohibited from denying coverage or changing rates based on pre-existing conditions. The rates will be based solely on age.

If you already have health insurance, either privately or through an employer, nothing changes. However, you can shop around starting Oct. 1 and check out the potentially cheaper plans on either on the state’s insurance marketplace or the federal insurance marketplace. In Maryland, the Maryland Health Connection is a marketplace of insurance companies that the Maryland Insurance Administration created. Insurance companies within the Maryland Health Connection (www.marylandhealthconnection.com) have agreed to keep their rates competitive. Residents of the District of Columbia can shop on the DC Health Link (www.dchealthlink.com) and residents of Virginia can use the federal health insurance marketplace (www.healthcare.gov).

There are many levels of coverage available for insurances within the exchanges, and these are called bronze, silver, gold and platinum. For a bronze plan, the insurance would cover 60 percent of all health care costs for an average person; the individual would be responsible for paying 40 percent of the costs. For the silver plan, insurance would cover 70 percent of all health care costs and for the gold plan, insurance would cover 80 percent of health care costs. For a platinum plan, an average individual would pay 10 percent out-of-pocket for their covered benefits and the insurer would pay 90 percent. While the premium that you must pay for a lower level insurance is lower, the out-of-pocket cost for each healthcare visit will be higher. Thus, the level of insurance that you decide to purchase depends largely on how often you anticipate visiting the doctor.

The main factors in calculating a subsidy are income, number of people in your household and cost of coverage in your area. You can qualify for this subsidy if your income is less than 400 percent of the federal poverty level, which is about $46,000 for an individual and $94,000 for a family of four in 2013. These subsidies only apply to insurance plans bought through the Maryland Health Exchange. According to the Congressional Budget Office, six out of the seven million people expected to enroll in the first year of the marketplace will be eligible for subsidies.

Children up to age 26 can stay on their parents’ plans. If you have Medicare, the ACA will not affect you.

For those that want one-on-one assistance to determine what insurance plan works best for them, the Health Insurance Commission has trained several “Assisters” and “Navigators” who will be traveling the area, providing help and guidance. To find out when they will be in your area, visit http://capitalhealthconnection.org/calendar (Maryland).

For a list of partner organizations in DC with trained navigators, visit: http://hbx.dc.gov/release/dc-health-link-chooses-35-dc-based-groups-help-people-enroll-health-coverage

What the ACA means for medical care professionals?

There are a lot of unknowns about the Affordable Care Act and how it will affect physicians. But there is one thing that is certain – the increase in insured will increase the demand for general care physicians.

“In Maryland, the uninsured are already being seen through the all-pay system, but they are being seen in emergency rooms and mid-level care,” said Gene Ransom President and CEO of the Maryland state medical society, MedChi. “Because of the Affordable Care Act we can expect to see a shift in demand from the hospital to general care physicians.”

Ransom says that the transition will be tough, but like all change, will happen one way or another. “We’ll need more physicians but it takes a long time to make a physician,” Ransom said.

Dourakine Rosarion Special Assistant to the Director of Montgomery County Health and Human Services says that to meet the increased demand for patients, Maryland is exploring the possibility of opening more clinics, including at schools during off hours, to see community members as their needs arise.

Suzanne Schlattman from Healthcare for All, a nonprofit organization that educates the public on health reform through outreach activities, also says that physicians should expect an increase in patients coming in with questions about Obamacare and how it will affect them. To prepare, physicians should have a basic understanding of how the law will affect their patients, Schlattman said. A good resource to get more information is the Maryland Hospital Association and MedChi.

Perhaps the biggest good news about the Affordable Care Act, said Ransom is for those physicians seeing Medicaid patients. Under the Affordable Care Act, more patients will qualify for Medicare and doctors will receive more for their Medicaid services. ” If you haven’t covered Medicaid before,” said Ransom “This might not be a bad time to look at it. It’s a much better deal than in the past.” According to the Kaiser Family Foundation, the ACA extends Medicaid eligibility to adults with a household income less than or equal to 138% of the Federal Poverty Level. In addition, providers with a specialty designation of family medicine, general internal medicine or pediatric medicine will be eligible for increased rates at parity with Medicare for specified Evaluation and Management (E&M) and Vaccine Administration services.

How Will the ACA Affect Small Businesses?

Contrary to rumors, the ACA does not require small business employers to provide health insurance for their employees.

Only businesses that employ 50 or more full-time employees will be required to provide health insurance for their employees. However, this may be a good time for all small business owners to consider offering health insurance for their employees if they do not already do so.

“There are more reasons for businesses to offer health benefits than ever before-more options, better coverage and better rates. All these changes point to healthier, more productive employees and a healthier bottom line,” said Suzanne Schlattman of Healthcare For All. Schlattman cited Massachusetts as an example of a case in which healthcare reform has encouraged more employers to offer healthcare coverage for their employees. Massachusetts adopted a healthcare reform law in 2006 under Governor Mitt Romney and the Affordable Care Act is modeled largely after the provisions in the Massachusetts law.

Small businesses and purchase healthcare plans for their employees under the Small Business Health Options Program (SHOP) Marketplace starting Oct. 1. Plans bought during open season will take affect Jan. 1.

If you have fewer than 25 full-time equivalent employees making an average of about $50,000 a year or less, you may qualify for a small business health care tax credit. Starting in 2014, the tax credit is worth up to 50% of your contribution toward employee premium costs (up to 35% for tax-exempt employers). This will make the cost of providing health coverage lower. However, the small business health care tax credit is available only if you get coverage through SHOP.

Businesses that employ over 50 full-time employees can opt out of providing health insurance by paying an “Employer Shared Responsibility” fee ranging from $2,000 to $3,000. (More information can be found at https://www.healthcare.gov/what-is-the-employer-shared-responsibility-payment/) The health insurance that a business provides must be competitive with the ones offered in the state’s insurance exchange.

How will the ACA affect immigrants?

Naturalized citizens and lawfully residing immigrants who have been in the US for more than 5 years will have the same opportunities to obtain more affordable health insurance coverage as native-born citizens under the ACA: those with incomes below 138 percent of the FPL will be eligible for Medicaid and those with incomes between 138 and 400 percent of the FPL that lack access to “affordable” employer-sponsored coverage will qualify for subsidized coverage under the new exchanges. According to the Department of Health and Human Services, the ACA is expected to lead to substantial reductions in uninsured rates among these immigrant groups.

Unauthorized immigrants will not be eligible for Medicaid or CHIP coverage or for exchange subsidies under the ACA and will not be permitted to purchase unsubsidized coverage through the exchange. They are not subject to the mandate and are excluded from temporary high-risk pools but will remain eligible for emergency care under Medicaid, if they would otherwise meet the eligibility criteria for Medicaid.

Source: ASPE ISSUE BRIEF

The Affordable Care Act:
Coverage Implications and Issues for Immigrant Families, April 2012, Prepared by the Urban Institute under contract with the Office of the Assistant Secretary for Planning and Evaluation. Authors: Genevieve M. Kenney and Michael Huntress http://aspe.hhs.gov/hsp/11/ImmigrantAccess/Coverage/ib.shtml#targeted

Resources

Handy checklists, flowcharts, chats, and phone numbers at:

www.healthcare.gov

Maryland Insurance Exchange

http://www.marylandhealthconnection.gov

DC Insurance Exchange

http://hbx.dc.gov

Virginia/Federal Insurance Exchange

healthcare.gov

Healthcare for All

(Md. based nonprofit educating the public on health care)

www.healthcareforall.com

Advanced Patient Advocacy

(Va. based nonprofit awarded federal Navigator assistance grant)

www.aparesults.com

Kaiser Family Foundation

(Animated videos that break down how Obamacare will affect you…among other useful resources)

http://kff.org/health-reform/video/youtoons-obamacare-video/

Feedback

Representatives from Health and Human Services have noted that the best way to insure that this new healthcare system works for everyone is for users to give feedback – both good and bad. Here are some ways you can give feedback courtesy of Anand K. Parekh, M.D., M.P.H., Deputy Assistant Secretary for Health (Science and Medicine) at the U.S. Department of Health and Human Services:

·One way you can provide feedback is to look for the little “Was this helpful?” box on the bottom of most pages on healthcare.gov and provide feedback that way. You can also call us 24/7: 1-800-318-2596 or (TTY: 1-855-889-4325)

·To participate in an online chat, also available 24/7, just look for the blue box on the lower right hand corner on most pages of our site.

Share your thoughts with @HealthCareGov on Twitter

· Leave a comment or share our content on Facebook

· Share or comment on a HealthCare.gov video on YouTube

Asian Fortune’s Quick and Dirty Guide to October 1st

1. Do you have health insurance?

YES

Call you insurance company and ask if it will be grandfathered.

If yes, you can stay with your existing insurance company

OR

Ask your employer if they provide health insurance

If yes or no, you can

Shop in the health exchange for a better, more suitable insurance package

Provide feedback to HHS about your experience and suggestions

If NO, you do not have healthcare

– On Oct. 1 visit your state’s insurance exchange website and compare plans. You may enroll online, in-person, or over the phone.

– If you are confused, contact your state’s health and human services to see when they have navigators/assisters available to provide in-person help.

– Ask about your eligibility for Medicaid Coverage

NOTE: The ACA does NOT affect those already covered under Medicare.