TOWARD A NEW HORIZON: THE REMAINING UNINSURED & PROSPECTS FOR COVERAGE AND CARE January 23, 2014

Overview How does the ACA impact minority communities? Who is likely to remain uninsured? What are key barriers to insurance? What are potential pathways for coverage and care?

Impact on Minority Communities Projected to increase health insurance to 32 million individuals 6.8 million African-Americans eligible for Marketplace coverage 10.2 million Latinos eligible for Marketplace coverage Investments in prevention to address chronic disease

The Remaining Uninsured ACA ≠ universal coverage 26 million estimated to remain uninsured –Eligible and uninsured –Ineligible and uninsured Informal and structural barriers

The Remaining Uninsured

Medicaid Expansion Key coverage vehicle in ACA 2012 Supreme Court decision –26 expansion states; 25 non-expansion 5 million in “coverage gap” –disproportionate effect on minorities 2.6 million (53%) –South acutely affected TX, FL

Select Barriers to Insurance Immigration Status Affordability Language Access

Potential Pathways for Coverage and Care

State and Local Pathways Washington Apple Health for Kids Health insurance for children up to 300% FPL Eligibility depends on income, eligibility for other programs, but not immigration status Comprehensive benefits Over 500,000 currently enrolled

State and Local Pathways CareLink Financial assistance program Eligibility depends on income, eligibility for other programs, and Bexar County residency Members assigned PCP and medical home Benefits include preventive care, mental health, and prescriptions

Alternative Pathways Restaurant Opportunities Center United’s MD-Program Health care cooperative Pilot program launched in 2011 in Los Angeles Eligibility does not depend on income or immigration status $20 premium and $5 ROC-LA membership

Alternative Pathways Access to Healthcare Network (AHN) Coordinated network of providers Shared responsibility model Focuses on health care needs of those between100%-250% FPL Caters to those either statutorily ineligible or have legal opt-out of individual mandate

Alternative Pathways Binational or Cross Border Insurance Insurance products targeted to uninsured Mexican-born population living in the United States Sistems Medicos Nacionales, Salud con Health Net and Salud Mexico, Blue Shield Access Baja Mexican Social Security Institute (IMMS), Seguro Popular CA only demonstration site

Steven Lopez Senior Health Policy Analyst National Council of La Raza