Health Care Reform

1. Health Care Reform Including migrants and other vulnerable populations - Al Hernandez Santana, LCHC

2. Presenter Disclosures Al Hernandez Santana No relationships to disclose. (1) The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months:

4. Recognize complexities of federal immigration law and allowable state options to cover immigrants. Identify three reasons for providing coverage. List 3 programs or clinic facilities that service migrant and seasonal workers. Articulate previously failed efforts to cover undocumented children or adults in public health insurance programs. Assess the political landscape that may bear on future efforts to include migrant populations as part of comprehensive reform. Learning Objectives

5. California has high number of immigrants and uninsured • California has the largest population of immigrants of any state, about 10 million. • The 2008-09 budget approved many cuts to health programs immigrants rely on. • Counties with highest rates of uninsurance have corresponding low rates of employment-based coverage.

6. Immigrants in U.S. Labor Force • Recent Mexican immigrant men have a 94% labor participation rate. • Mexican immigrant women labor force rates are lower. • Low-wage industries rely heavily on Mexican immigrant men. • Jobs filled by Mexican immigrants are the least likely to offer health insurance.

7. Percent of non-fatal occupational injuries and illnesses among Latinos resulting in days away from work, by type of injury (U.S. 1998-2000)Source: UCLA, UC Berkeley Schools of Public Health, Health Initiative of the Americas

8. Legal Status of Immigrant Population, 2002Source: Urban Institute estimates, Mar. ‘02 Current Population Survey 34.5 Million U.S. Total

9. Immigrants ‘R’ UsSource: Public Policy Institute of California, and others • One in four Californians is an immigrant, a higher proportion than any other state. • Most CA immigrants are from Latin America (56%) or Asia (34%). • About one in eleven workers in California is an undocumented immigrant. • Illegal immigrants often live in families with legal U.S. residents. • Growth has slowed in California, and second generation U.S.-born children are outpacing immigrants as the major source of Latino growth. • Two-thirds of California adults favor some form of legalization.

10. Health Insured Latinos by Annual Income, 2002Source: The Pew Hispanic Center/Kaiser Family Foundation

11. Immigration Law and Welfare Reform (PROWRA) • Federal legislation restricts many immigrants, particularly recent immigrants, from qualifying for or enrolling in Medicaid and SCHIP. • The passage of PROWRA in 1996 imposed restrictions on immigrants’ eligibility for public programs in federal welfare reform. • The 2006 citizenship verification requirement for Medicaid eligibility all reflect a widespread belief that public benefit programs are a magnet for undocumented immigrants. (UCLA Health Research Brief, Jul.07)

12. A mishmash of programs, services and health facilities • Family PACT program • Emergency Medi-Cal and pregnancy services • Child Health and Disability Prevention program • Vaccine for Children program • Medically Indigent program varies by county: MISP & CMSP • Emergency Rooms • Public hospitals, burn units, trauma centers • Expanded Access to Primary Care: 330-FQHCs, Look-Alikes, Free Clinics, Rural Health Clinics

13. Why provide insurance coverage?