Category Archives: Hispanic Health

International Community Health Service recognized as ‘National Quality Leader’

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International Community Health ServicesInternational 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.

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How Obamacare went south in Mississippi

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In the country’s unhealthiest state, the failure of Obamacare is a group effort.

By Sarah Varney
KHN / October 29, 2014

The lunch rush at Tom’s on Main in Yazoo City, Mississippi, had come to a close, and the waitresses, having cleared away plates of shrimp and cheese grits, seasoned turnip greens and pitchers of sweet tea, were retreating to the counter to cash out and count their tips.

It didn’t take long: The $6.95 lunchtime specials didn’t land them much, and the job certainly didn’t come with benefits like health insurance. For waitress Wylene Gary, 54, being uninsured was unnerving, but she didn’t try to buy coverage on her own until the Affordable Care Act forced her to. She didn’t want to be a lawbreaker.

Months earlier, she had gone online to the federal government’s new website, signed up and paid her first monthly premium of $129. But when her new insurance card arrived in the mail, she was flabbergasted.

“It said, $6,000 deductible and 40 percent co-pay,” Gary told me at the check-out counter, her timid drawl giving way to strident dismay. Confused, she called to speak to a representative for the insurer Magnolia Health. “’You tellin’ me if I get a hospital bill for $100,000, I gotta pay $40,000?’ And she said, ‘Yes, ma’am.’”

Never mind that the Magnolia worker was wrong — her out-of-pocket costs were legally capped at $6,350. Gary figured with a hospital bill that high, she would have to file for bankruptcy anyway. So really, she thought, what was the point?

“This ain’t worth a tooth,” she said.

She canceled her coverage.

The first year of the Affordable Care Act in Mississippi was, by almost every measure, an unmitigated disaster. In a state stricken by diabetes, heart disease, obesity and the highest infant mortality rate in the nation, President Barack Obama’s landmark health care law has barely registered, leaving the country’s poorest and perhaps most segregated state trapped in a severe and intractable health care crisis. Continue reading

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Vaccination rates lower among US adults born abroad

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Vaccine SquareBy 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.

This gap poses special risks for certain groups of people who are vulnerable to many serious and sometimes deadly diseases that vaccines can prevent.

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

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One in four Latinos remain uninsured

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By Teresa Wiltz
Stateline

In the “sala de espera,” or waiting room, at La Clinica del Pueblo, a community health center in Washington, D.C., signs in Spanish encourage patients to “Empower yourself!” and sign up for insurance coverage through the Affordable Care Act.

Adults slump in chairs, scribbling on application forms, texting friends, waiting. In a tiny office a few feet away, William Joachin, the center’s patient access manager, faces down the frustrations of trying to navigate the federal health care program for the thousands of mostly Central American immigrants who flood the clinic each year. He’s not alone.

A year after open enrollment for the ACA began, one in four Latinos living in the U.S. does not have health insurance, according to new census data, more than any other ethnic population in the country—and most states have few backups in place to help those in the coverage gap.

Latino health insurance graphic

 

Latino immigrants are the hardest hit: Foreign-born Hispanics are more than twice as likely to be uninsured than are U.S.-born Hispanics, according to census data compiled by the Pew Research Center. (Pew also funds Stateline.) Continue reading

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Federal judge blocks Texas restriction on abortion clinics

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200px-Flag-map_of_TexasBy Carrie Feibel, KUHF
AUGUST 30TH, 2014, 10:18 AM

This story is part of a partnership that includes Houston Public MediaNPR and Kaiser Health News.

In a highly anticipated ruling, a federal judge in Austin struck down part of a Texas law that would have required all abortion clinics in the state to meet the same standards as outpatient surgical centers.

The regulation, which was set to go into effect Monday, would have shuttered about a dozen abortion clinics, leaving only eight places in Texas to get a legal abortion — all in major cities.

. . . state’s regulation was unconstitutional and would have placed an undue burden on women, particularly on poor and rural women.”

The regulation, which was set to go into effect Monday, would have shuttered about a dozen abortion clinics, leaving only eight places in Texas to get a legal abortion — all in major cities.

Judge Lee Yeakel ruled late Friday afternoon that the state’s regulation was unconstitutional and would have placed an undue burden on women, particularly on poor and rural women living in west Texas and the Rio Grande Valley. Continue reading

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Say what? Many patients struggle to learn the foreign language of health insurance

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Jessie Yuan, physician at the Eisner Pediatric & Family Health Center in Los Angeles, treats diabetic patient Oscar Gonzales. Gonzalez was unaware he had been switched to Medi-Cal until Yuan informed him about the change (Photo by Anna Gorman/KHN).

This KHN story also ran in .

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

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How states are tackling ‘health disparities’

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Question Q&ABy 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

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Why hospitals are failing civilians who get PTSD

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Gunby Lois Beckett
ProPublica, March 4, 2014

More than 20 percent of civilians with traumatic injuries may develop PTSD. Trauma surgeons explain why many hospitals aren’t doing anything about it.

Undiagnosed post-traumatic stress disorder is having a major impact on injured civilians, particularly those with violent injuries, as Propublica detailed last month.

One national study of patients with traumatic injuries found that more than 20 percent of them developed PTSD.

But many hospitals still have no systematic approach to identifying patients with PTSD or helping them get treatment.

We surveyed 21 top-level trauma centers in cities with high rates of violence. The results show that trauma surgeons across the country see PTSD as a serious problem.  Continue reading

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California bill would extend coverage to undocumented residents

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Flag_of_CaliforniaBy Anna Gorman
KHN
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

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The PTSD crisis that’s being ignored: Americans wounded in their own neighborhoods

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GunBy Lois Beckett
ProPublica, Feb. 3, 2014

Chicago’s Cook County Hospital has one of the busiest trauma centers in the nation, treating about 2,000 patients a year for gunshots, stabbings and other violent injuries.

So when researchers started screening patients there for post-traumatic stress disorder in 2011, they assumed they would find cases.

They just didn’t know how many: Fully 43 percent of the patients they examined – and more than half of gunshot-wound victims – had signs of PTSD.  Continue reading

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Prevención del VIH/SIDA en la comunidad Latina/Hispana

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Distrito de salud de Snohomish:

Durante el mes de octubre, Distrito de salud de Snohomish reconoce Nacional Latina sobre el SIDA, una campaña destinada a involucrar a la comunidad Hispana/Latina en promover la sensibilización sobre el VIH a través de pruebas, prevención y educación.

El tema de este ano es “Comprométete a Hablar.”

En el estado de Washington, el 12% de todas las personas que actualmente viven con el VIH/SIDA son latinos, pero los latinos sólo representa aproximadamente el 9,4 % del total de la población. Las tasas de nuevas infecciones entre hombres latinos fueron más del doble que el de los hombres blancos. La tasa de infección por el VIH entre las mujeres de origen Latino fue casi cuatro veces mayor que la de las mujeres blancas.

Para abordar esta disparidad y aumentar la conciencia, personal del distrito de salud de Snohomish estará ofreciendo pruebas gratis para los miembros de las comunidades latinas y generales que califican basan en sus factores de riesgo en lugares comunitarios:

  • Tuesday, Oct. 22, from 1 – 5 p.m. at Monroe Sea Mar Behavioral Clinic, 14090 Fryeland Blvd. SE, Ste. #347
  • Tuesday, Oct. 22, from 4 – 6 p.m. at Everett Sea Mar Behavioral Clinic, 5007 Claremont Way
  • Wednesday, Oct. 23, from 9 – 11 a.m. at Everett Sea Mar Behavioral Clinic, 5007 Claremont Way
  • Wednesday, Oct. 23, from 4 – 5 p.m. at Everett Sea Mar Behavioral Clinic, 5007 Claremont Way
  • Thursday, Oct. 24, from 4 – 8 p.m. at Everett Sea Mar Medical Clinic, 1920 100th Street SE, Bldng. B
  • Friday, Oct. 25, from 12 – 4 p.m. at Monroe Sea Mar Medical Clinic, 17707 West Main Street
  • Thursday, Oct. 31, from 1 – 4 p.m. at Marysville Sea Mar Medical Clinic, 9710 State Avenue

Los Centros para el Control de enfermedades y prevención dice que el impacto del VIH en los Hispanos/Latinos no está directamente relacionado a la raza o grupo étnico, sino a los retos que enfrentan por algunas comunidades, incluyendo menos conocimiento del estado serológico, la pobreza, acceso a la atención medica, estigma, aculturación de la migración (el proceso de adopción de los rasgos culturales o los patrones sociales de otro grupo) y la homofobia. Aprenda más sobre la campaña de sensibilización nacional del sitio web AIDSinfo, http://aidsinfo.nih.gov/education-materials/hiv-aids-awareness-days/169/national-latino- aids-awareness-day.

El distrito de salud ofrece gratis y confidencial del VIH pruebas y Consejería para individuos de alto riesgo durante todo el año, en nuestra clínica 3020 Rucker Avenue, con resultados en 30 minutos. Individuos con riesgo también pueden ser probados para la Hepatitis A, B, C y sífilis. Para una cita, llame al 425-339-5298.

Según la Washington State Department of Health, 730 personas en el Condado de Snohomish se supone que se viven con el VIH/SIDA.

Para obtener más información sobre la prevención del VIH/SIDA y las pruebas, llame al distrito de salud al 425-339-5298, o visite www.snohd.org.

Establecido en 1959, el Snohomish Distrito de Salud trabaja para un más seguro y más sano Condado Snohomish a través de la prevención de enfermedades, la promoción de la salud y la protección de las amenazas ambientales. Encontrar más información sobre el Distrito de Salud en http://www.snohd.org.

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Snohomish County campaign seeks to raise HIV/AIDS awareness in Latino/Hispanic community.

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nlaad-logoDuring the month of October, Snohomish Health District will present a National Latino AIDS Awareness campaign aimed at engaging the Hispanic/Latino community in promoting HIV awareness through testing, prevention and education.

This year’s theme is “Commit to Speak”/“Comprométete a Hablar.”

In Washington state, 12% of all individuals currently living with HIV/AIDS are Latino – but Latinos only compromise approximately 9.4% of the total population.

The rates of new infections among Latino men were more than double that of white men. The rate of HIV infection among Latino women was nearly four times that of white women.

To address this disparity and increase awareness, staff from the Snohomish Health District will be offering free testing at community locations to members of the Latino and general communities who qualify based on their risk factors:

  • Tuesday, Oct. 22, from 4 – 6 p.m. at Everett Sea Mar Behavioral Clinic, 5007 Claremont Way
  • Tuesday, Oct. 22, from 1 – 5 p.m. at Monroe Sea Mar Behavioral Clinic, 14090 Fryeland Blvd. SE, Ste. #347
  • Wednesday, Oct. 23, from 4 – 5 p.m. at Everett Sea Mar Behavioral Clinic, 5007 Claremont Way
  • Wednesday, Oct. 23 from 9-11 a.m. at Everett Sea Mar Behavioral Clinic, 5007 Claremont Way
  • Thursday, Oct. 24, from 4 – 8 p.m. at Everett Sea Mar Medical Clinic, 1920 100th Street SE, Bldng. B
  • Friday, Oct. 25, from 12 – 4 p.m. at Monroe Sea Mar Medical Clinic, 17707 West Main Street
  • Thursday, Oct. 31, from 1 – 4 p.m. at Marysville Sea Mar Medical Clinic, 9710 State Avenue

The Centers for Disease Control and Prevention states the impact of HIV on Hispanics/Latinos is not directly related to race or ethnicity, but rather to challenges faced by some communities, including less awareness of HIV status, poverty, access to care, stigma, migration acculturation (the process of adopting the cultural traits or social patterns of another group) and homophobia.

Learn more about the national awareness campaign from the AIDSinfo website, http://aidsinfo.nih.gov/education-materials/hiv-aids-awareness-days/169/national-latino-aids-awareness-day.

The Health District offers free and confidential HIV testing and counseling for high-risk individuals year-round, in our Everett clinic location, with test results in 30 minutes. Individuals with risk can also be tested for hepatitis A,B, C, and syphilis. For information about HIV/AIDS prevention and testing, call the Health District at 425.339.5298, or visit www.snohd.org.

According to the Washington State Department of Health, 730 people in Snohomish County are assumed to be living with HIV/AIDS.

Information from the US Centers for Disease Control and Prevention:

 Centros para el Control y la Prevención de Enfermedades

Datos breves

  • El VIH afecta de manera desproporcionada a los latinos.
  • En el 2009, los latinos representaron el 20% de las infecciones nuevas con el VIH en los Estados Unidos, aun cuando solamente constituían alrededor del 16% de la población total de los EE. UU.
  • HSH están particularmente afectados con el VIH.

El VIH es un problema de salud pública en la comunidad latina1. En el 2009, los latinos representaron el 20% (9,400) de las infecciones nuevas por VIH en los Estados Unidos, aun cuando solamente formaban alrededor del 16% de la población total de los EE. UU. La tasa de infecciones por el VIH en los latinos en el 2009 fue casi el triple que la de los hombres de raza blanca (26.4 comparado con 9.1 por cada 100,000 habitantes).

Las cifras

Infecciones nuevas por VIH

  • En el 2009, los hombres latinos representaron el 79% (7,400) de las infecciones nuevas en toda la población latina y la tasa de infecciones nuevas entre los hombres latinos fue dos veces y media más alta que la de los hombres de la raza blanca (39.9/100,000 comparado con 15.9/100,000).
  • En el 2009, los hombres latinos que tuvieron relaciones sexuales con hombres (HSH)3 representaron el 81% (6,000) de las infecciones nuevas por VIH entre los hombres latinos. Y a su vez representaron el 20% de todos los HSH. Entre los HSH latinos, el 45% de las infecciones nuevas por VIH correspondió a hombres menores de 30 años de edad.
  • Aunque las mujeres latinas representaron el 21% (2,000) de las infecciones nuevas en los latinos durante el 2009, su tasa de infección por el VIH fue más del cuádruple que en las mujeres blancas (11,8/100,000 comparado con 2,6/100,000).

Estimados sobre infecciones nuevas por el VIH en los Estados Unidos para las subpoblaciones más afectadas, 2009

Esta gráfica no incluye las subpoblaciones que representan el 2% o menos de la epidemia general en los EE. UU.

Diagnósticos y muertes por VIH y SIDA

  • En algún momento de su vida, 1 de cada 36 hombres latinos recibirá un diagnóstico de VIH, al igual que 1 de cada 106 mujeres latinas
  • En el 2009, los latinos representaron el 19% de los 42,959 diagnósticos nuevos de infecciones por VIH en los 40 estados y las 5 jurisdicciones dependientes de los EE. UU. que cuentan con sistema de notificación de infección por VIH de forma confidencial basada en el nombre.
  • En el 2009, se estima que 7,442 latinos recibieron un diagnóstico de sida en los EE. UU. y las 5 jurisdicciones dependientes. Esta cifra ha disminuido desde el 2006.
  • Para finales del 2008, se calcula que 111,438 latinos habían fallecido en los Estados Unidos y las jurisdicciones dependientes con diagnostico de SIDA. En el 2007, el VIH fue la cuarta causa principal de muerte en latinos de 35 a 44 años de edad y la sexta en los latinos de 25 a 34 años en los EE. UU.

Desafíos para la prevención

Varios factores contribuyen a la epidemia del VIH en las comunidades latinas.

  • Los factores de la conducta de riesgo relacionados con la infección por VIH varían de acuerdo al país de origen.Los datos indican que los porcentajes más altos de infecciones con el VIH diagnosticadas en hombres latinos se atribuyen a contacto sexual con otros hombres, independientemente del país de origen, pero los hombres nacidos en Puerto Rico tienen un porcentaje considerablemente más alto de infecciones por el VIH atribuidas al uso de drogas inyectables (UDI) que los hombres latinos nacidos en otros países.
  • Los hombres y mujeres latinas tienen más probabilidad de adquirir la infección por VIH como resultado del contacto sexual con hombres. Las mujeres latinas podrían no estar conscientes de los factores de riesgo de su pareja masculina.
  • El uso de drogas inyectables continúa siendo un factor de riesgo entre los latinos, especialmente para los que viven en Puerto Rico. Además, los usuarios ocasionales y crónicos de alcohol o estupefacientes tienen más probabilidad de practicar conductas sexuales de alto riesgo, como son las relaciones sexuales sin protección debido a que están bajo la influencia de las drogas o el alcohol.
  • Tener ciertas infecciones de transmisión sexual (ITS)puede aumentar, en forma significativa, la posibilidad de que una persona contraiga la infección por el VIH. Una persona que tiene la infección por el VIH y ciertas ITS tiene más posibilidad de infectar a otros con el VIH. Las tasas de ITS permanecen altas entre los latinos.
  • Los factores culturales pueden afectar el riesgo de infección por el VIH. Es posible que latinos eviten hacerse pruebas del VIH y buscar consejería o tratamiento para la infección por temor a la discriminación o la estigmatización o debido a su estatus migratorio. Los roles tradicionales de los hombres y las mujeres y el estigma contra la homosexualidad pueden dificultar la prevención.
  • Una mayor aculturación adoptando la cultura estadounidense tiene efectos tanto negativos (adopción de conductas que aumentan el riesgo de adquirir la infección del VIH) como positivos (comunicación con las parejas sobre las relaciones sexuales más seguras o de menor riesgo) en las conductas relacionadas con la salud de los hombres y mujeres latinos.
  • Los factores socioeconómicos, como la pobreza, los patrones migratorios, el bajo nivel de estudios académicos, la falta de seguro médico, el acceso limitado a la atención médica, o las barreras del lenguaje, contribuyen a las tasas de infección por VIH en los latinos. Estos factores pueden limitar la concientización de los latinos sobre los riesgos de infectarse con el VIH y las oportunidades para participar en consejería, pruebas de detección y tratamiento.
  • Debido al miedo a ser descubiertos y deportados, los inmigrantes indocumentados pueden ser menos propensos a recibir servicios de prevención del VIH, a hacerse pruebas de detección o a recibir atención médica y tratamiento adecuados si es que son diagnosticados positivos o que viven con el VIH.
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Jigsaw puzzle with one piece to add

How will immigrants fare under Obamacare? It’s complicated.

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By Lornett Turnbull, The Seattle Times
This story was produced in partnership with 

Jigsaw puzzle with one piece to add

Photo: Willi Heidelbach

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.”

For him, the prospects aren’t promising.

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.”

Lacking insurance

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.

Unlawful residents

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.

Particular status

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.

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Abortion laws force closure of women’s health clinics serving the poor

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Photo: Brian Stansberry / Creative Commons

By Jake Grovum, Staff Writer
Stateline

New state restrictions on clinics that provide abortions could leave millions of women—many of them poor and uninsured—without easy access to cancer screenings and other basic health care services.

In recent years, abortion opponents have tried to limit abortions by barring them after a certain number of weeks and by requiring women who want to end their pregnancies to have ultrasounds. Those strategies target abortion directly.

Now abortion opponents in some states are pushing for new standards for clinics, such as requiring doctors to have admitting privileges at a nearby hospital, that may be difficult or impossible for them to meet.

Abortion rights supporters fear the new rules could force many clinics to close—a result that would make it more difficult for women to get a broad array of health care services, not just abortions.

“Every time a clinic closes, the women who would be using those clinics, it’s not as if those women stop existing,” said Kimberly Inez McGuire of the National Latina Institute for Reproductive Health, an advocacy group. “It will affect whether women can get cancer screenings, whether women can get to a provider to get their blood pressure checked.”

“Clinics that serve women who may not have insurance are literally a lifeline,” McGuire said.

Fifteen states now require clinic doctors to have hospital admitting privileges, according to the Guttmacher Institute, which supports abortion rights.

In addition, 26 states require abortion-providing clinics to meet surgical facility standards, which stipulate everything from the size of certain rooms, the types of light switches used and the width of hallways.

Supporters say such requirements are common-sense public health measures. They cite high-profile examples of poor oversight and gruesome malpractice cases, most notably the Kermit Gosnell case in Philadelphia.

“What is so wrong about having high health standards in place?” asked Alabama Rep. Mary Sue McClurkin, who sponsored legislation which includes clinic regulations and requirements for doctors that has been blocked by a federal judge. “If they would just do what was in the best interest of the patient, it would not be a problem.”

Opponents of such laws say they might close a vital health care entryway for women. In many states, the clinics offer services ranging from sexually transmitted disease testing and treatment to mammograms, Pap tests and cancer screenings.

They also offer family planning counseling and birth control services—in many cases at reduced fees for the uninsured.

In 2011 and 2012, the Guttmacher Institute conducted a survey of women receiving services at family planning centers located in communities in which there were other health care options.

About four in 10 women said they used a clinic as their exclusive health care provider in the past year. Among other reasons, the women said they preferred going to a clinic because staff there knew more about women’s health and it was easier to talk to them about sex.

The connection between the clinics, public health care programs and women’s health was further underscored by a Kaiser Family Foundation study.

The report noted that in many states, there are few providers willing to accept Medicaid or other subsidized insurance programs. In those places, the clinics are a vital, and sometimes the only, option for low-income people.

For example, in 2011 Texas blocked Planned Parenthood-affiliated health centers from receiving funds from the state’s Medicaid Women’s Health Program.

Prior to the funding cut-off, those centers were caring for nearly 50,000 patients. The program served 63 percent fewer women the year after the cuts, state data showed.

The American Congress of Obstetricians and Gynecologists has also argued that clinic closings could damage women’s health. The group blasted Texas’ new abortion law and measures under consideration in North Carolina.

Those who back the laws argue the regulations would make the clinics safer.

So far, courts haven’t bought that argument, seeing laws that could shutter clinics as potentially unconstitutionally restrictive of abortion.

Courts already have blocked physician requirements in Mississippi and Alabama. Last week, Wisconsin’s law was temporarily blocked by a federal judge and advocates are preparing to fight Texas’ law as well.

“The courts have seen right through the arguments that this is somehow supposed to protect women’s health,” said Julie Rikelman of the Center for Reproductive Rights, which is involved in the legal fights.  “These laws really hurt women’s health, not help them.”

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Stateline is a nonpartisan, nonprofit news service of the Pew Center on the States that provides daily reporting and analysis on trends in state policy.

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Connecting Latino communities to health care

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Spanish-language interpreter Samuel Alcocer, right, helps a patient communicate with diabetic nurse educator Michele Kimber at NorthPoint Health and Wellness Center in Minneapolis (Photo by Jennifer Simonson/MPR News).

Spanish-language interpreter Samuel Alcocer, right, helps a patient communicate with diabetic nurse educator Michele Kimber at NorthPoint Health and Wellness Center in Minneapolis (Photo by Jennifer Simonson/MPR News).

By Elizabeth Stawicki, Minnesota Public Radio

When Samuel Alcocer arrived at the reception desk of a North Minneapolis clinic with a swollen cheek in 1996, he was desperate for relief.

Spanish-language interpreter Samuel Alcocer, right, helps a patient communicate with diabetic nurse educator Michele Kimber at NorthPoint Health and Wellness Center in Minneapolis (Photo by Jennifer Simonson/MPR News).

One of his wisdom teeth had erupted into a throbbing, painful ache.

At the time, Alcocer, a native of Santa Cruz in the Mexican state of Guanajuato, spoke no English. No one at the clinic spoke Spanish. So he and the receptionist resorted to gestures, to little avail.

“[I was] pointing hands to my face,” said Alcocer, who remembers the day vividly. “And the lady at the front desk [was] just moving her arms, like ‘What do you want me to do?'”

Seventeen years later, Alcocer helps to make sure others don’t have a similar experience, working as a Spanish interpreter at the same clinic in Minneapolis, now called NorthPoint Health and Wellness Center.

While Latinos comprise only about five percent of Minnesotans, they are a big part of the state’s uninsured population. One in eight Minnesota Latinos lacks health insurance.

That makes Latino communities a likely focus for efforts prompted by the federal health law to reduce the number of people lacking health coverage. NorthPoint, which is a federally qualified health center, received a $151,000 grant this week to hire workers who will help people sign up for insurance coverage in the state’s new exchange, MNsure.

For Acolcer, interpreting for Spanish-speaking patients and English-speaking health care workers has been a calling.

“To me,” he said, “it was like, ‘Why cannot I go over there and open the doors that [were once] shut in my face?'”

Alcocer’s tenure as a NorthPoint interpreter began 10 years ago as temporary project with funding for six months. On his first day, he was given an office, a desk, a computer, and a phone and was told he’d get a call if needed. But instead of sitting in his office and waiting, Alcocer did what he wished someone else had been doing when he arrived there the first time.

“I went and sat in the lobby waiting for anybody to show up and say, ‘Welcome. Thank you for coming. How can I help you?'” said Alcocer.

In the first month, 25 Spanish-speaking patients arrived. Their family members and friends followed in subsequent weeks. By the sixth month, Alcocer was translating for 700 patients. Today, NorthPoint sees close to 1,000 Spanish-speaking patients each month. Alcocer attributes that growth to word-of-mouth, not advertising or marketing.

The funding for his position was extended, and after eight months, Alcocer needed help, so the staff expanded. There are now eight full-time and five part-time Spanish-speaking interpreters at NorthPoint, as well as interpreters who speak Hmong, Laotian and Thai.

Alcocer said that kind of one-to-one interaction is what many people will need to understand the new federal health care law’s requirements and benefits. Radio, TV or newspaper ads in English, he said, won’t be enough.

Eva Sanchez of Portico Healthnet agrees. Sanchez, a native of Morelos, Mexico, has been working in Minneapolis helping Spanish-speaking families navigate the health insurance landscape for more than five years. She has an office in the Andersen United Community School located in the heart of one of Minneapolis’ most vibrant Latino communities.

Sanchez said health insurance itself can be a foreign concept for Latino immigrants, particularly if they grew up in a small town as she did. People may have no experience filling out health insurance forms because there was no health insurance. Patients pay the doctor at the visit.

“If it’s already difficult for people from here,” Sanchez said. “Imagine how hard it will be for other people.”

Other immigrant advocates say the new federal health care law has a mixed message for immigrants that makes it harder to convince some Latinos to enroll in health plans.

The law includes a mosaic of restrictions on immigrants. Even people who are legally entitled to be in the United States are subject to a five-year waiting period before they’re eligible to enroll in Medicaid. In addition, the law bars anyone who entered the country without authorization from receiving the health care law’s benefits.

People who work with immigrants say the law’s mingling of health and immigration policy can stoke fears about being deported.

“There’s no question that the politics that has mixed immigration policy with what I think should be public health policy has made the job much harder,” said Daniel Zingale, senior vice president of the Los Angeles-based private health care foundation, The California Endowment.

California, which has more uninsured residents than many states have people, started trying to navigate those crosscurrents before most states. Latinos make up 59 percent of its uninsured.

The California Endowment has partnered with Spanish-language media giants such as the Telemundo and Univision networks to explain the new law. According to two polls, Latino support for the federal health care law in California rose from 46 percent in April 2010 to 70 percent in Jan. 2013.

Officials with MNsure, Minnesota’s new health insurance marketplace, say they will be advertising in ethnic newspapers, translating their educational materials into Spanish, Hmong, and Somali and sending staff members to events in diverse communities to explain insurance.This story is part of a reporting partnership that includes MPR NewsNPR and Kaiser Health News.

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