1. Addressing Racism and Discrimination to Improve Health Outcomes in Immigrants and Communities of Color Betzabel Estudillo Health Policy Coordinator California Immigrant Policy Center

2. Founded in 1996, CIPC is a non-partisan, non- profit statewide organization that seeks to inform public debate and policy decisions on issues affecting the state’s immigrants and their families in order to improve the quality of life for all Californians. CIPC engages in policy advocacy, and also provides technical assistance, training and education on immigrant issues.

3. A Historic Look at Healthcare for People of Color Hippocrates – Race and Biological Differences Racism and Discrimination in Health Care in US Experimentation and Treatment of Slaves Post-Slavery to the Modern Era: Lack of Healthcare for New Citizens and Poor Whites Experimentation on Communities of Color Impact on Immigration Policy

4. Racism and Discrimination in US Healthcare System Health status related to where you live Barriers to hospitals and access to quality of care Racial disparities in medical treatment Lack of data and standardized collection methods Lack of economic access to healthcare

5. How do disparities impact people? The Case of Two Baltimore Neighborhoods – Little Italy and Canton Kids born in Little Italy are more than 10 times as likely to die before their first birthday as those born in Canton In Baltimore's Little Italy neighborhood, about two out of every 100 children die before their first birthday — which puts infant mortality in Little Italy roughly on par with Nicaragua and Uzbekistan

8. California Life Expectancy

9. The Promise of The Affordable Care Act Increased healthcare for communities of color in California POC 60% of CA population, but 75% of the uninsured post-ACA Of the Nearly 1.5 elderly adults to be newly eligible for Medi-Cal, 2 out of 3 are POC Standardizing Health Benefits Banning Pre-existing condition exclusion Source: CPEHN

10. The Failings of the Affordable Care Act Not universal healthcare Specifically excludes undocumented immigrants Access to providers continues to be problematic Reduction in funding to community clinics and safety next structures Continuation of health disparities

11. Why health equity matters? Income is a better predictor of poor health Nationally and CA institutional racism in the form of housing segregation employment discrimination unequal wages and other discriminatory practices Has created persistent inequalities that lead to poorer health outcomes and limit opportunities for communities of color

12. How do we address health disparities? Medicaid and Medicare for All Expanding health insurance coverage- health4all at the state and federal level Increase State/Federal Funding to Safety-Net Providers (Clinics/DSH) Improving the capacity and number of providers in underserved communities Data on race, ethnicity, and language access is important! Address racism, white privilege, white supremacy

13. Health4All: Breaking Down Barriers to Healthcare for All California Residents

14. California Takes Steps to Integrate Immigrants Driver’s Licenses – AB 60 (Alejo), 2013 TRUST Act – AB 4 (Ammiano), 2013 Professional Licenses SB 1159 (Lara), 2014 and State Bar Dream Act AB 1024 (Gonzalez, 2013) Protections for Workers – Anti-Retaliation, E-Verify Full Scope Medicaid for All Low-Income Lawfully Present Immigrants Expand full-scope Medicaid to undocumented children

15. HEALTH4ALL IN CALIFORNIA

16. Why is Health4All important? Though the state provides health care services through programs with limited scope or duration, and some counties provide coverage regardless of immigration status, it is not enough. o Health Care system works better when everyone participates o Emergency room treatment is expensive o Everyone deserves comprehensive and adequate care o Healthy Parents, Thriving Families o Undocumented immigrants are a major economic engine for California, and contribute to the state’s revenue o Health is a Human Right

17. Undocumented Californians and Health Access The Affordable Care Act (ACA) has expanded health coverage to millions of Californians Remaining Uninsured UC Berkeley Labor Center study- After the full implementation of the ACA, there will be 2.7-3.4 million Californians who will remain uninsured About 1.4-1.5 million will be undocumented Californians Access“Band Aid” Care Patchwork of County coverage for the undocumented. Some counties offer coverage, other counties don’t offer any coverage, and some offer limited scope or duration coverage. Emergency and charity care

19. SB 4 (Lara)  First introduced By Senator Ricardo Lara in 2014 as SB 1005  Re-introduced in December 2014 by Senator Ricardo Lara  The proposal will ensures that undocumented children in our communities has access to quality and affordable healthcare  Coalition Building: Diverse coalition of immigrant rights groups, health and consumer advocates, labor, and many others  Signed by Governor Brown on October 9, 2015!

20. Pro-Immigrant Investments in 2015-2016 Budget  The 2015-2016 state budget included exciting and historic package of investments that will help lift up our immigrant communities.  In regards to immigrant health, this year’s budget lays the foundation for improving access to health for immigrant communities by:  Investing an initial $40 million and an ongoing commitment to expand access to Medi-Cal for undocumented children, regardless of immigration status.

21. Next Steps on Health4All  SB 10  Seeks to allow undocumented adults to receive comprehensive Medi- Cal, if funding is made available.  Allow all Californians, regardless of immigration status, to purchase coverage through Covered California with their own money by requiring the state to apply for a federal Section 1332 waiver (a formal request to the federal government).Section 1332 waiver  County safety-net advocacy for undocumented residents  Continue to uplift immigrant voices and engage community in health4all efforts

22. What can you do to help advance policies that benefit immigrants and other communities of color?

23. Fight for Health4all! Support Efforts to Fight: Racial Profiling, Excesive Use of Force, and Unjust Detention and Deportation Support State Funding to CBO’s that offer Immigration Services to Assist those Eligible for Deferrred Action Support Efforts to Invest Resources in the Safety Net

24. How do we move forward and ensure positive health outcomes for all? Break down the System Founded on White Supremacy Check your privilege – (White, English Speaker, Educational Attainment, Income, Profession) Call out friends that need to see these issues through a more progressive lens Value the Health and Safety of All

25. Betzabel Estudillo California Immigrant Policy Center bestudillo@caimmigrant.org