Southeast Asian American Elders and the Affordable Care Act
Historically Southeast Asian Americans have faced significant barriers to accessing affordable health insurance and culturally and linguistically appropriate health care. These barriers have contributed to health disparities:
• Southeast Asian American communities experience high uninsurance rates; 26.7% of Hmong Americans live in poverty and 18.3% of Vietnamese Americans lack health coverage.
• Cervical cancer incidence rates are among the highest in the U.S. for Laotian, Vietnamese and Cambodian American women. Factors for this disparity have been attributed to low Pap smear rates, lack of preventive care prior to immigration and a lack of sensitivity by providers.
• Asian American adults aged 65 years and older were 30% less likely to have ever received the pneumonia shot compared to white adults of the same age group.
• One of the greatest health disparities between Southeast Asians and the general population is liver cancer, 80 percent of which is caused by chronic hepatitis B virus infection. Liver cancer rates for Vietnamese men are 13 times higher than rates for White men.
The Affordable Care Act (ACA) has provided many benefits to the Southeast Asian American (SEAA) community, and in particular, its elder population. The positive impacts have continued with the start of Open Enrollment in the Health Insurance Marketplace. The ACA’s benefits include:
• Medicare Reform – Preventive Care: Preventive care, which includes regular check-ups and screenings, is now free to elders and does not require “out-of-pocket” co-payments. This change will help decrease many preventable diseases that are prevalent in SEAAs, such as cardiovascular disease, diabetes and hypertension.
• Medicare Reform – Prescription Medication: The ACA closes the coverage gap in Medicare Part D by lowering out-of-pocket expenses by at least 50% thus reducing the need to choose between medications and other household expenses.
• Medicaid Expansion: The ACA expands Medicaid to increase eligibility and include adults under 65 without children who are currently not eligible for the program. For the states that participate, individuals that make less than 133% of the federal poverty level will now qualify for Medicaid coverage. This expansion will provide access to health insurance for many lower-middle class SEAA elders who are currently ineligible for Medicaid and cannot afford private insurance. California, the state with the largest population of Cambodian, Hmong, Laotian and Vietnamese Americans is one of the 25 states moving forward with Medicaid expansion. Unfortunately, recent immigrants are not eligible for Medicaid within their first five years of residence and undocumented immigrants are prohibited from receiving Medicaid.
• Mental Health: Many SEAA elders suffer from mental health concerns as a result of the trauma experienced during their refugee experiences. The ACA requires health insurance policies to cover mental health services (without increasing premiums) and prevents discrimination based on pre-existing conditions
• Community-Based, Culturally and Linguistically Appropriate Care: Over 90% of SEAAs over 65 live in “family households” as opposed to institutional alternatives, such as nursing homes and assisted living facilities. SEAA elders utilize community-based health services to age in the comfort of their home and community. The ACA significantly improves the quality of care for elders in their community. The ACA invests in Community Health Centers (CHCs) allowing them to double the number of patients served from 19 million to nearly 40 million in 2015. CHCs are located in medically underserved communities and are a resource to underserved populations. For SEAA elders who had to deal with long waiting periods in crowded community clinics, this investment in CHCs will significantly improve quality and access to health care. The ACA also includes provisions that create grants for the development of a culturally competent workforce and the promotion of community health workers.
• Health Insurance Exchanges: This past October 1, Health Insurance Marketplaces opened in every state to give consumers a simplified and regulated marketplace to purchase health insurance. Every health insurance plan offered on the exchange is required to include essential health benefits and cover pre-existing conditions. Some of these benefits of importance to SEAA elders are preventive and wellness services and chronic disease management, prescription drug coverage and mental health services. The Exchanges are accessible to anyone who is not already covered by private or public insurance and offer tax credits for those with lower incomes to help pay premiums. The Exchanges are required to be linguistically accessible for limited-English proficient consumers and to provide assistance to help consumers choose a plan that best fits them.
Check out the Health Policy Resource Hub on SEARAC’s website. Our policy briefs, reports, factsheets, and other resources will help you better understand the Affordable Care Act and other health care related policies. The fact sheets explore the ACA’s benefits for various situations including:
• Currently Uninsured or Having Difficulty Buying Your Own Insurance – Also available in Hmong and Vietnamese.