Impact of the Affordable Care Act on the Latino Community National Hispanic Medical Association Meeting Steven Weinberger, MD, FACP Executive Vice President and CEO American College of Physicians

Important baseline statistics  >50 million Hispanics in US (17% of total US population)  Fastest growing racial or ethnic population in US  By 2050: anticipated 30% of total population  Currently: Hispanics have highest uninsured rate among racial/ethnic groups (~1/3 lack coverage) Source: Kaiser Family Foundation

Additional important statistics  Hispanics are a younger population than non-Hispanic Whites  47% of Hispanics are <26 years old (compared with 30% of non-Hispanic Whites)  3 times less likely than non-Hispanic Whites to be >65 years old (6% vs. 18%)  76% of all Hispanics and >90% of Hispanic children are US citizens Source: Kaiser Family Foundation

Income/employment statistics  Non-elderly Hispanics as likely as non-elderly, non-Hispanic Whites to have a full-time worker in the family, but more likely to be in low-wage blue-collar jobs and to have low family income  More than half (53%) of non-elderly Hispanics employed in agriculture, service, or construction industries  1 out of 3 Hispanics have family income below poverty level (compared with 1/7 non-Hispanic Whites) Source: Kaiser Family Foundation

Insurance coverage statistics  Hispanics tend to be employed in jobs that do not offer employer-sponsored insurance  When offered, often not affordable  Hispanics account for ~1/3 of total non- elderly uninsured  2011 data: 15.5 million uninsured non-elderly Hispanics (~12.6M adults, 3M children)  7 in 10 uninsured Hispanics are in families with at least 1 full-time worker Source: Kaiser Family Foundation

More insurance coverage statistics  Hispanics ~half as likely as non-Hispanic Whites to have private health insurance (39% vs. 71%)  Hispanics >twice as likely as non-Hispanic Whites to be uninsured (32% vs. 13%)  Medicaid  Covers >1/2 Hispanic children  Much more limited role for adults Source: Kaiser Family Foundation

Opportunities provided by ACA  Medicaid expansion: initial plan for expanding eligibility to incomes up to 138% of poverty level  Supreme Court ruling: expansion a state option  Purchase of insurance through health insurance exchanges  Premium tax credits available to help moderate income individuals pay for coverage Source: Kaiser Family Foundation

Impact of ACA on Hispanic coverage  Nearly all uninsured Hispanics would qualify for either Medicaid expansion or tax credits  57% have income below Medicaid limit  Additional 38% could receive tax subsidies to purchase coverage through exchanges  But… non-citizen Hispanics face eligibility restrictions  46% of uninsured Hispanics are non-citizens (lawfully present or undocumented immigrants) Source: Kaiser Family Foundation

Lawfully present immigrants are…  Subject to 5-year waiting period before eligible for Medicaid and CHIP  ~1/2 states have eliminated waiting period for lawfully present children and pregnant women  These eligibility restrictions remain in place under ACA  Able to purchase coverage on exchanges (and receive tax credits) without a waiting period Source: Kaiser Family Foundation

Undocumented immigrants are…  Ineligible for Medicaid now  Ineligible for Medicaid under ACA  Ineligible for premium tax credits under ACA  Prohibited from purchasing exchange coverage at full cost Note: states may provide state-funded coverage to documented or undocumented immigrants, but without federal matching funds Source: Kaiser Family Foundation

Numerical impact of ACA on coverage of pre-ACA uninsured population <65 y.o. Uninsured population Before ACA: millions (percent) After ACA: millions (percent) Change: millions (percent) White23.1 (19%)10.8 (6.5%)-12.3 (-7.4%) Black7.4 (21.6%)3.4 (9.8%)-4.0 (-11.8%) Hispanic16.0 (33.3%)10.1 (21.1%)-5.9 (-12.2%) Asian/other3.7 (18.5%)2.1 (10.4%)-1.6 (-8.2%) TOTAL50.3 (18.7%)26.4 (9.8%)-23.8 (-8.9%) Source: Health Affairs. 2012; 31:

Impact of HCA on preventive services  Requirement (of most insurance plans) to cover prevention and wellness benefits without cost sharing  Examples of specific services:  Well child visits  BP and cholesterol screening  Pap smears and mammograms  Influenza immunization  HIV screening for individuals at high risk

Other impact of ACA on Latinos  Improved chronic disease management through focus on quality/quality metrics  Increased funding for community health centers  Diversifying health care workforce (e.g., tripling number of clinicians in National Health Service Corps (Latino physicians are 21% of NHSC)  Increased focus on health disparities (e.g., PCORI; National Center on Minority Health and Health Disparities raised to NIH Institute level) Source: ASPE Research Brief, HHS, 2012

Eventual penalty for not complying with coverage requirement  The greater of:  $695/year, up to maximum of 3x that ($2085) per family  2.5% of family income  Exemptions from penalty  Undocumented immigrants  Lowest available premium exceeds 8% of family income  Income is below the tax filing threshold

Important implications  Continued efforts to get state expansion of Medicaid are critical, especially in states with large numbers of uninsured Hispanics  Targeted outreach and enrollment assistance is also critical, so that currently uninsured but eligible Hispanics are enrolled for coverage  Challenges: application process, language barriers, confusion about eligibility, fear about immigration enforcement Source: Kaiser Family Foundation