“My time is coming. It’s already time for me to die. I can’t wait. … So yeah I plan to kill myself during spring break, which by the way, starts in two days.” — Wynne Lee wrote in a March 29, 2012 journal post
Wynne Lee’s mind was at war with itself – one voice telling her to kill herself and another telling her to live. She had just turned 14.
She tried to push the thoughts away by playing video games and listening to music. Nothing worked. Then she started cutting herself. She’d pull out a razor, make a small incision on her ankle or forearm and watch the blood seep out. “Cutting was a sharp, instant relief,” she said
When it comes to mental health treatment, Asian Americans often get short shrift. Researchers say they are both less well-studied and less likely to seek treatment.
At first, Wynne thought she felt sad because she was having a hard 8th grade year. She and her boyfriend broke up. Girls were spreading rumors about her. A few childhood friends abandoned her. But months passed and the feelings of helplessness and loneliness wouldn’t go away.
“I was really happy as a kid and now I was feeling like this,” she said. “It was really unfamiliar and scary.”
Wynne Lee didn’t know where her despair was coming from. The words “depression” and “suicide” were not in her vocabulary. She knew, however, that she was failing — she was defying expectations of who she was supposed to be. Continue reading
By Eyob Mazengia, PhD, RS, Food Protection Program
Public Health – Seattle & King County
When I started as a food inspector, I was assigned to the International District. And I liked it. It was almost like walking into a new culture, a new era.
What fascinated me was that as a public health worker, I had permission to walk into people’s personal spaces. I liked the smells, the sounds of their languages, their wall hangings and the way things looked.
It was a privilege, really, to be allowed into their personal spaces. Going on food inspections in the I.D., it was like walking into 3-4 different countries every day, without traveling outside the neighborhood.
Over the years, I established good relationships with the restaurant establishments. They were no longer just restaurant operators—they were mothers, fathers, grown kids. They’re not just businesses—there’s a family behind every door, people who had often gone through difficult times to be here.
And as I got to know them, I could recognize the sacrifices they made to give their children better opportunities in the U.S., and what they left behind. Even those born and raised here, you could recognize the sacrifices they were making. Continue reading
International Community Health Services (ICHS) been cited by the federal government as a “National Quality Leader” for exceeding national clinical benchmarks for chronic disease management, preventive care, and perinatal/prenatal services.
The Seattle-based health center also was recognized for achieving some of the best overall clinical outcomes nationally for health centers and for showing significant improvement in clinical quality measures between 2012 and 2013.
ICHS is a non-profit community health center that specializes in providing affordable health care services to Seattle and King County’s Asian, Native Hawaiian, Pacific Islander, and other underserved communities.
It operates medical and dental centers in Seattle’s International District and Holly Park neighborhoods, as well as in the cities of Bellevue and Shoreline; a school-based health center at the Seattle World School, and a primary care clinic at ACRS, a social and mental health services agency in Seattle.
In recognition of its accomplishment and to fund further quality improvement, ICHS will receive $84,169 in Affordable Care Act funding by the U.S. Department of Health and Human Services.
Efforts to enroll Asian Americans in the health law’s marketplace plans have generally been touted as a success, but because coverage details are provided primarily in English or Spanish, those who depend on their native languages have encountered roadblocks as they try to use this new insurance.
The issue of language access gained attention last summer when the Obama administration notified thousands of people that their health insurance subsidies were at risk unless they updated their citizenship documentation because information on their initial applications could not be verified.
Advocates said many of those in jeopardy did not speak English well and did not understand the paperwork they received.
If people who face English language challenges don’t understand their coverage, maneuvering the health care system could prove unwieldy.
Asian Americans, with limited English who enrolled in plans with the help of bilingual navigators and in-person assisters, are now trying to understand a slew of documents – things like explanations of benefits packages or notifications about paperwork deadlines – that often are not translated. Continue reading
By Milly Dawson
Health Behavior News Service
Nationality at birth appears to play a significant role in whether or not adults in the United States are routinely vaccinated for preventable diseases, a new study in the American Journal of Preventive Medicine finds, reflecting a risky medical lapse for more than one in ten people nationwide.
Foreign-born adult U.S. residents, who make up about 13 percent of the population, receive vaccinations at significantly lower rates than U.S.-born adults.
Foreign-born adult U.S. residents make up about 13 percent of the population.
The study’s lead author, Peng-Jun Lu, MD, PhD, a researcher at the Center for Disease Control and Prevention, noted the rise in the foreign-born population in the United States, which stood at only five percent in 1970.
“As their numbers continue to rise, it will become increasingly important to consider this group in our efforts to increase vaccination and eliminate coverage disparities,” he said. Continue reading
By Shefali Luthra
KHN / September 24
Language and cultural issues, along with immigration concerns, could still pose major barriers to enrolling Asian-Americans, Native Hawaiians and Pacific Islanders in health insurance plans this fall, according to a report released Wednesday by Action for Health Justice, an advocacy coalition that aims to educate these populations about the health law.
If those issues are not addressed by this year’s open enrollment – which begins Nov. 15 – they will likely continue to be a roadblock to expanding coverage, according to the report. Continue reading
As soon as Deb Emerson, a former high school teacher from Oroville, Calif., bought a health plan in January through the state’s insurance exchange, she felt overwhelmed.
She couldn’t figure out what was covered and what wasn’t.
Why weren’t her anti-depressant medications included?
Why did she have to pay $60 to see a doctor?
The insurance jargon – deductible, co-pay, premium, co-insurance – was like a foreign language. What did it mean?
“I have an education and I am not understanding this,” said Emerson, 50. “ I wonder about people who don’t have an education — how baffling this must be for them.” Continue reading
From the US Centers for Disease Control and Prevention
- Hepatitis A: Outbreaks in the US do occur.
- Hepatitis B: Asian Americans and Pacific Islanders have higher rates.
- Hepatitis C: New treatments can cure the disease.
Viral hepatitis is a major global health threat and affects over 4.4 million Americans. In observance of May as Hepatitis Awareness Month, here are brief overviews of each of the three most common types of viral hepatitis in the United States: Hepatitis A, Hepatitis B and Hepatitis C.
Hepatitis A: Outbreaks in the US can and do occur
By Stephanie Stephens
Health Behavior News
While past research has shown that, as a whole, Asian Americans and Native Hawaiian/Pacific Islanders living in the U.S. smoke at a lower rate than the national average, a new study in American Journal of Health Behaviorfinds significant differences in tobacco use when analyzed by specific Asian or Pacific Islander ethnicity.
Dramatic social, demographic and behavioral differences exist between Asian American (AA) and Native Hawaiian/Pacific Islander (NHPI) groups, said lead study author Arnab Mukherjea, Dr.P.H., M.P.H., who was a postdoctoral scholar at the Center for Tobacco Control Research & Education at the University of California, San Francisco at the time of the study. Continue reading
By Michael Ollove
Stateline Staff Writer
African-Americans are more likely to suffer heart disease and diabetes than whites. The cancer death rate for men is a good deal higher than it is for women.
American Indians and Alaska Natives are more likely to smoke tobacco than Hispanics, blacks or whites.
And Native Hawaiian adults are less likely to exercise than other ethnic groups.
These differences are called “health disparities,” and in the last two decades, the federal government and the states have focused on eliminating them. Continue reading
By Anna Gorman
FEB 18, 2014
In a push to cover immigrants excluded from the nation’s health reform law, a California state senator has proposed legislation that would offer health insurance for all Californians, including those living here illegally. Continue reading
By Sarah Varney
KHN Staff Writer
Feb 6, 2014 — Chinatown here is a city within a city. Built by immigrants in the latter half of the 19th century, Chinatown was a refuge from the era’s vicious prejudice. But the crowded blocks of Chinatown were also somewhat of a prison.
Chinese residents feared leaving the area after dark, and they were barred from local schools and the city’s hospitals — even during an outbreak of bubonic plague in San Francisco. Continue reading
Find enrollment assistance, with help in many languages
By Keith Seinfeld
Public Health – Seattle & King County
Buying insurance online with Washington Healthplanfinder is getting faster every week.
But many people still need in-person help, so King County and its network of assisters are hosting two enrollment events this weekend with room to handle large numbers of people.
Likos Afkas is a native of the Federated States of Micronesia, part of a cluster of islands in the Pacific where nuclear testing by the U.S. government during the Cold War left behind high rates of cancer.
Together with neighboring Palau and the Marshall Islands, the Federated States of Micronesia has a special compact with the U.S. under which its people, heavily recruited by the U.S. military, can live and work here indefinitely — but as noncitizens, they are denied certain federal benefits.
Afkas, 48, first came to the U.S. a year ago, suffering from diabetes and heart problems, and was immediately diagnosed with kidney failure that requires three-times-a-week dialysis.
Last month, he was notified that he lacked sufficient job credits to continue receiving the Medicare coverage he’s depended on to cover some of his medical bills.
Now, like untold numbers of his countrymen and other immigrants, Afkas is taking stock of his health-care options as the clock counts down to the Oct. 1 opening day for enrolling in health coverage under the federal government’s Affordable Care Act (ACA). Coverage begins Jan. 1.
“If I go back home, I’d only be going back to die.”
Ultimately, how he and other immigrants fare under this massive health-care overhaul will depend on many factors: their income, immigration status, how long they’ve lived in this country and — in the case of people like Afkas — their country of origin.
While his household income would otherwise qualify him for Medicaid, the primary option under ACA for delivering health coverage to low-income people, Afkas’ immigration status makes him ineligible.
He worries he’ll be required to buy health insurance under the law or face a penalty — neither of which he says he can afford. However, he is likely exempt from that requirement if the cost of insurance premiums would be more than 8 percent of his household income, or if he makes so little that he doesn’t file a tax return.
Returning to Chuuk, his home state in Micronesia, is not an option, he said, because of the woefully inadequate health system there.
“If I go back home, I’d only be going back to die.”
The health-care-overhaul law, commonly known as Obamacare, targets people who lack health insurance — an estimated 1.09 million residents of Washington state.
It’s unclear what percentage of them are immigrants.
Studies have shown that in general, immigrants tend to be healthier than the rest of the population — they are younger and are subject to medical examination to obtain green cards — though many of the same studies also suggest they become less healthy over time.
“There are some people who have gotten used to being uninsured, so we need to provide a whole other level of information about why they’d even want to be insured now that it’s available to them,” said Michael McKee, health-services director of theInternational Community Health Services, whose clinics serve large numbers of immigrants.
“Part of it is also helping them understand the penalties,” he said. “That’s going to be totally new to everybody.”
As complicated as the law will be for the average American, immigrant advocates worry it will be even more daunting for those whose primary language is not English and for whom regular visits to a doctor are not a cultural tradition.
“We look at access to care and coverage as opportunities to address health disparities,” McKee said. “It’s incumbent on us to educate people on the importance of preventive care and healthy options so they can avoid some of the costly outcomes.”
Options for uninsured
Under the ACA, the majority of the state’s uninsured will be required to buy health-care coverage, or face a penalty.
They can purchase an individual insurance plan on their own or from the state-administered health-insurance marketplace, the Washington Health Benefit Exchange.
Those with the lowest income — about a third — will qualify for Medicaid, the free or near-free health-insurance program that will be expanded under Obamacare to deliver health care to the poorest Americans.
How and where immigrants fit into all this are questions many advocacy groups continue to unravel.
“I don’t think there’s any question the majority of immigrants will benefit from this,” said Jenny Rejeske, policy analyst for the National Immigration Law Center. “It’s going to require vigilance from advocates and people who want this to work. It’s not going to be perfect on day one.”
Mary Wood, section manager at Washington State Health Care Authority, said the rules related to immigrants’ eligibility for Medicaid under the health law haven’t changed: If their immigration status made them ineligible before the law took effect, they’ll remain ineligible.
U.S. citizens and legal permanent residents or green-card holders who have been in this country for five years or longer will be treated the same as U.S.-born citizens when it comes to coverage. They can apply for Medicaid under the program’s broadened guidelines if their income is low enough.
Other types of immigrants will also qualify regardless of how long they’ve been in this country: asylum seekers and refugees, special immigrants from Iraq and Afghanistan, victims of trafficking and immigrants who served in the armed services.
They will be among an estimated 250,000 people who state officials estimate will become newly eligible under the expanded Medicaid limits for those with incomes up to 138 percent of the federal poverty level — or $15,856 for a single person.
Meanwhile, other legal immigrants — those with higher incomes or those here for fewer than five years, people temporarily in this country, such as students and work-visa holders, as well as people like Afkas — won’t qualify for Medicaid.
They may, however, purchase insurance from the exchange, using the Washington Healthplanfinder.
Those among them with incomes between 139 and 400 percent of the federal poverty level — $45,960 for a single person — will qualify for subsidies and tax credits to help cover insurance premiums.
And all low-income children, regardless of their immigration status, will be covered under any number of federal and state health care programs.
For adults in the country unlawfully, the government has little to offer.
While most undocumented immigrants work in jobs that do not provide health insurance, it is estimated that 25 percent of them do have coverage.
Still, undocumented immigrants account for about 14 percent of Washington state’s uninsured. And those with no coverage — an estimated 127,530 — will continue to go without.
Undocumented adult immigrants are unable to participate in Medicaid or Medicare and that won’t change. They are also ineligible to purchase from the health exchange. But unlike most other groups, they won’t face a penalty for not having insurance.
There is coverage available for low-income women during pregnancy regardless of their immigration status, and like everyone else, undocumented immigrants continue to qualify for emergency care under federal law.
And those whose incomes would otherwise entitle them to Medicaid but for their immigration status can qualify for emergency Medicaid for emergent conditions, such as heart attacks.
And then there are people like Afkas, whose status most Americans do not know.
Micronesia, Palau and the Marshall Islands are former United Nations trust territories, which the U.S. Navy administered between 1947 and 1951.
Today, they are sovereign nations, each with a Compact of Free Association with the United States under which their people can work and live in this country indefinitely, though they are neither U.S. citizens or nationals.
In 1996, when Congress reformed welfare, it barred most legal immigrants from Medicaid and other federal health programs for the first five years of residency. It also indefinitely barred those from the compact states from receiving Medicaid.
Many use their immigration privilege to seek treatment — mostly state-funded — for the cancer and other health problems plaguing their countries, usually in Hawaii, but increasingly in places like Washington state, said Xavier Maipi, who runs a nonprofit agency to advocate for residents from compact countries.
An estimated 2,000 — mostly Marshallese and Micronesians — live here.
Afkas lived on the island state of Chuuk in Micronesia before he came to the Seattle area a year ago, his health failing.
Already suffering heart problems and diabetes, he was diagnosed with kidney failure at Seattle’s Harborview Medical Center, whose reputation as a source for indigent care he and others say has become well known in the islands.
The medical bill for his monthlong stay totaled $100,000, which Medicare covered.
But in July, Afkas was notified he lacked sufficient job credits to continue receiving $700 in monthly Supplemental Security income and Medicare.
He’ll continue to receive weekly dialysis through a state program geared to those whose immigration status disqualifies them for Medicaid but will have to go uncovered for everything else.
Afkas’ wife earns a small amount to provide home health care for him from another part of the same program that covers his dialysis. “Right now, I don’t know what I’m going to do,” he said.
Like many people, he doesn’t know much about the Affordable Care Act and hasn’t given it much thought. Paying for health insurance — any amount — isn’t in the household budget.
“Many of these folks are simply trying to survive,” Maipi said. “For health care, they go to the emergency room — and usually that’s when they’re at death’s door.”
‘A lot of questions’
Immigrant advocates know they face a daunting task preparing clients and constituents for the coming change.
While information about the exchange will be available in eight different languages, thewebsite the public will use to sign up for care will be available only in English and Spanish.
“Many of our clients are refugees and immigrants and 60 percent of them have limited English proficiency,” McKee said.
Health clinics like his and other federally funded health centers that now serve anyone who walks through their doors will continue to do so — regardless of their insurance status or ability to pay.
“This is the largest sea change in public policy since Social Security,” McKee said.
“Everyone wants to get it right. And at the end of the day, there will be a lot of questions and the hope is that we can, with this first run, enroll as many people who will benefit.”
Seattle Times reporter Carol M. Ostrom contributed to this report.
This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.