On the issue of costs, Saturday morning’s session on “Bending the Cost Curve: The Social Determinants of Health” will look at how tackling social determinants of health can help lower costs and improve health, particularly when it comes to health care systems such as hospitals and other networks. Continue reading
When the Affordable Care Act passed in 2010, Tammy Worth, an award-winning freelance health and business writer in Kansas City, Mo., was interested in how undocumented immigrants would fare under the new law.
She recognized that undocumented immigrants were ineligible for both of the main provisions of the law meant to extend coverage to 32 million Americans: the Medicaid expansion and the state insurance exchanges.
To fund her work, she applied in 2011 to the Association of Health Care Journalists for an AHCJ Reporting Fellowship on Health Performance, supported by the Commonwealth Fund. At the time, the fellowship program was in its second year of supporting journalists in their work reporting on the performance of local health care systems and the U.S. health system as a whole. In December 2011, she was named one of three fellows for 2012. (Note: Applications for the 2015 program are being accepted until Oct. 1.)
In 2012 and 2013, she focused her reporting on three areas: the economics of immigration, the effect of the law on providers and the health care community, and immigrant health stories.
The result was a three-part reporting project that was produced earlier this year for the Hale Center for Journalism at KCPT, a Kansas City public television station. Read more about how she did the reporting and her advice for other journalists.
We’ve posted a tip sheet from the National Immigration Law Center on how the Affordable Care Act affects immigrants. They let us put their guide on the site with one request – that we include their website and suggest that you check their site if you write on this topic in case there are updates.
There’s no sense in repeating what you can find on the tip sheet (undocumented immigrants don’t get covered, documented ones do under the circumstances described – generally, they can go in the exchanges with subsidies if they qualify but still face a wait to get into Medicaid). But it is worth addressing the nexis between the health law and the current debate over helping immigrants become documented.
The bill will go through changes before it passes – IF it passes (a big question mark, particularly in the House). But the key message from our perspective as health reporters: Given what’s been said so far by Democrats and Republicans alike, it is highly unlikely that undocumented immigrants will get health benefits WHILE they are going through what looks to be a multi-year process of becoming documented. However, once they are documented they will be treated like the rest of the documented immigrant population.
More than 50 journalists gathered at AHCJ’s fall workshop in San Antonio to understand and better report stories on the health of immigrants in the United States.
The workshop – “Covering the Health and Medical Care of Immigrants” – kicked off Thursday with hands-on data sessions requiring overflow seating.
On Friday, journalists learned from Elizabeth Arias, Ph.D., a demographer with the National Center for Health Statistics, that at age 65, life expectancy for the U.S. Hispanic population, despite a generally lower socio-economic status, is longer than for whites, something Arias called the “Hispanic Mortality Paradox.”
Arias also pointed out that tracking Hispanic health and death rates is problematic because the National Center for Health Statistics uses Medicare data which doesn’t allow for estimates of the Hispanic population. It wasn’t until 1980 that Social Security added Hispanic, Asian and American Indian to its application. But David V. Espino, M.D., a geriatric medicine expert who recently retired from the University of Texas Health Science Center at San Antonio, said Mexican Americans more likely to be disabled as they age than whites.
Julie Appleby, an AHCJ board member and a senior correspondent with Kaiser Health News, offered an overview of how the Affordable Care Act impacts immigrants and journalists learned that undocumented immigrants won’t be able to buy insurance through the health insurance exchanges, even using their own money.
Juan H. Flores, M.U.P., executive director of the La Fe Policy Center, pointed out that states and regions will respond differently to the needs of immigrants under the Affordable Care Act, just as they always have. He described Texas’ Medicaid program for adults as one of the most restrictive in the country, saying people have to be “destitute” to qualify.
Rodolfo Urby, M.D., M.P.H., M.B.A., medical director of the Southwest Texas Network, said federally qualified health centers would play a larger role in caring for immigrants.
In a discussion about the mental health needs of immigrants, Cervando Martinez Jr., M.D., a professor of psychiatry and family medicine at the University of Texas Health Science Center at San Antonio, said that drug and alcohol abuse are uncommon in Mexico but occur among Mexican immigrants in the United States. Octavio N. Martinez Jr., M.D., M.P.H., M.B.A., F.A.P.A., executive director of the Hogg Foundation for Mental Health, said that when officials cut the services for mental health, costs are just shifted elsewhere, such as the criminal justice system. Concern over their undocumented status can add to immigrants’ anxiety. So can stigmas attached to mental health care and, in particular, antidepressants.
Surprisingly, both speakers said many people in Texas go to Mexico for less expensive medical and dental care, and that there are many plastic surgeons just south of the border.
For a panel about workplace safety and health for immigrants, Karen Lee Ziner, a staff writer at The Providence (R.I.) Journal, described injuries immigrants suffered on the job. Jora Trang, managing attorney of Worksafe, said that 30 percent of immigrant workers in construction companies are not employees and so do not have rights and benefits. They tend to be less likely to report accidents for fear of retribution.
The final panel of the workshop, about special challenges in covering immigrant health, included a discussion about whether journalists should use the terms “undocumented immigrant” or “illegal immigrant” and moved to less-reported challenges.
Kaiser Health News’ Phil Galewitz spotlights a 50-year-old federal effort to provide health care to migrant farmworkers, one which provides funds to 156 health centers (list) throughout the country. There are 13 each in Texas and Florida and 27 in California, and in 2010 the government contributed $166 million to the care of about 900,000 migrant and seasonal laborers. “Such clinics,” Galewitz writes, “have become the latest flash points in the national immigration debate.”
Health center officials across the country describe how local, state and national law enforcement authorities have staked out migrant clinics, detained staff members transporting patients to medical appointments and set up roadblocks near their facilities and health fairs as part of immigration crackdowns.
Proponents say the clinics help ensure the health of the people most responsible for the handling and production of the American food supply, while conservative groups argue that the federal government shouldn’t be providing benefits for illegal immigrants, a group that makes up about half of the 3 million-strong migrant farm labor force.