Engaging AAPIs in
Ohio
The Patient Protection & Affordable
Care Act (PPACA)
and
The Ohio Health Insurance
Exchange/SHOP
Objectives
1. Describe problems in the current health care system
2. Explain ACA improvements to the current health
care system
3. Explain the Health Insurance Exchange/SHOP
Potential benefits
o Points of advocacy
o
…for AAPIs in Ohio, and
4. Address the impact of Issue 3 on the ACA and
Exchange/SHOP in Ohio
AAPI Employment Issues
National data show that Southeast Asians and
NHPIs especially suffer from:
• Low earnings
• High poverty rates
• High unemployment rates
Specifically the Vietnamese, Cambodian,
Hmong, Lao, and NHPI ethnic groups
AAPI Employment Issues
Median Family
Income
Median Income Poverty Rate
per Person
(all families)
Unemployment
rate
White, nonHispanic
69,636
31,735
6.3
6.2
Asians, all
79,145
30,055
8.1
5.9
Vietnamese
59,129
22,263
12.1
6.6
Cambodian
49,226
16,913
13.9
9.6
Hmong
49,918
11,030
24.7
11.5
Native Hawaiian
/ Pacific Islander
60,515
20,286
12.9
9.9
Source: Kim, Marlene. 2011. “Asian Americans and Pacific
Islanders: Employment Issues in the United States.” AAPI Nexus
9(1-2)
Poverty rates all above 10%
And in 2011, AAPIs as a whole had the highest long-term
unemployment rate of any ethnic group: over half were
unemployed for over 6 months.
The State of AAPI Business
National data show that AAPI-owned
businesses:
• Are clustered in low-paying industries (retail,
restaurants, personal services)
• Employ fewer workers on average than whiteowned businesses.
• Report much lower average receipts than
white-owned businesses
The State of AAPI Business
Firms with Employees
% Employer Firms
Average
Sales/Receipts
Average Number of
Employees
White, non-Hispanic
21.5%
$2,082,036
11.5
Latino
11%
$1,124,848
7.7
Black / AfricanAmerican
5.5%
$911,594
8.5
Asian
25.6%
$1,141,280
Native Hawaiian /
Pacific Islander
11%
Native American
10%
60%
55%
7.1
$1,264,828
9.1
$1,161,951
7.8
Source: Tran, Diem Linda and OiYan A. Poon. 2011. “The State of
Asian American Businesses.” AAPI Nexus 9(1-2)
Most AAPI businesses see lower revenue and have a small
number of employees
Objectives
1. Describe problems in the current health care system
2. Explain ACA improvements to the current health
care system
3. Explain the Health Insurance Exchange/SHOP
Potential benefits
o Points of advocacy
o
…for AAPIs in Ohio, and
4. Address the impact of Issue 3 on the ACA and
Exchange/SHOP in Ohio
Problems in Health Care Today
for AAPIs
Vulnerable AAPIs ‘slip through the cracks’ of the
health care system due to:
Lack of insurance
Underinsurance
Health disparities
Health Care Problems for AAPIs
Many AAPIs Cannot Afford Insurance
Employer-sponsored insurance
 Over half of all unemployed AAPIs remained so for over 6 months in
2011, an increase from 2010.
Expensive small group and individual plans
 High poverty rates among Southeast Asians and NHPIs.
• Many low-income AAPI individuals cannot afford private health
insurance
 Asian-owned businesses clustered in low-earning industries.
• Low-end AAPI firms cannot afford to purchase insurance for
employees
No Medicaid
• No coverage for most adults: only children and their parents,
pregnant women, and people with disabilities
• Legal permanent residents are ineligible for Medicaid in Ohio.
Health Care Problems for AAPIs
Many AAPIs Are Denied Insurance
Pre-existing conditions
• Insurers can still deny coverage to people who come to
them with a medical condition
• AAPIs in greatest need of health insurance are denied it
'Dropping‘
 Asian Indians, Filipinas, and NHPIs, have high risk and
rates of developing Type II diabetes.
• Before the PPACA was passed, insurers could 'drop' an
enrollee who became sick
• AAPIs in greatest need of health insurance ended up
losing it
Many AAPIs Are Underinsured
Inadequate small group & individual plans
 Asian-owned firms tend to be smaller in size and revenue.
 High unemployment and poverty rates among Southeast Asians and
NHPIs.
• Low-income AAPIs individuals and businesses can only
afford cheaper private health plans: minimal benefits, high
deductibles, and other unfavorable terms
• AAPIs with pre-existing conditions may only qualify for
such health plans
 High risk and rates of Type II diabetes among Asian Indians, Filipinas,
and NHPIs.
Many AAPIs Suffer from Health Disparities
Inadequate multilingual support
• Example: Ohio Medicaid website has only Somali support
• Limited English-proficient AAPIs cannot make informed
decisions about their health plans
Inadequate data collection
• Federal agencies currently collect health data on minority
populations in overly broad racial categories ('Asian',
'Hispanic')
• Health care providers remain ignorant of AAPI health needs
 E.g. Type II diabetes, domestic violence, and mental illness
among AAPIs
 ASIA was recently denied funding to start an HIV screening
program “specifically because APIs are not considered to be at
risk for HIV”.
Objectives
1. Describe problems in the current health care system
2. Explain ACA improvements to the current health
care system
3. Explain the Health Insurance Exchange/SHOP
Potential benefits
o Points of advocacy
o
…for AAPIs in Ohio, and
4. Address the impact of Issue 3 on the ACA and
Exchange/SHOP in Ohio
The ACA Can Improve Health Care for
AAPIs
The ACA contains provisions to make health care
more affordable
more accessible
and more fair to consumers
Implemented correctly, these provisions can combat
Lack of insurance
Underinsurance
Health disparities
How the ACA Improves Health Care
for AAPIs
The ACA is being implemented in two
phases:
Today
Phase 1
2014
Phase 2
How the ACA Improves Health Care for AAPIs
RIGHT NOW!
In effect today
No more pre-existing condition denial for children
In effect today
Insurance coverage for dependents up to age 26
In effect today
Seniors on Medicare receive drug rebate checks
How the ACA Improves Health Care for AAPIs
RIGHT NOW!
 Asian Indians, Filipinas, and NHPIs have high risk and
rates of developing Type II diabetes
In effect today
No more ‘dropping’
In effect today
FREE preventive health care for adults
• The ACA requires new health plans to make all adult
preventive services FREE
• Examples: diabetes screening, some vaccines, Pap
smears, prostate cancer screening
How the ACA Improves Health Care for AAPIs
RIGHT NOW!
In effect today
Most AAPI businesses qualify for tax credits to
provide insurance
• Tax credit: up to 35% of employer’s insurance cost
• For employers with 25 or fewer full-time employees and
average annual wages of less than $50,000
 Remember: Asian and NHPI firms employ an average of
7 and 9 employees, respectively.
Today
2014
Phase 1 How the ACA Will Improve AAPI Health Care
March 2012
Improved data collection to reduce health
disparities
Additional racial and ethnic categories for reporting on
Asian, Hispanic/Latino, and Pacific Islander populations
(March 23, 2012)
2014
Phase 2 How the ACA Will Improve AAPI Health Care
January 1, 2014
[The individual mandate]
All citizens and legal residents must enroll in a
health plan or pay a tax penalty
EXEMPTIONS
• Undocumented immigrants
• Financial hardship
• Lowest cost plan > 8% individual
income
• Incomes below tax filing threshold
• Religions objections
• Without coverage less than 3
months
 High poverty rates & low
earnings for Southeast
Asians and NHPIs
Economically vulnerable
AAPIs will be exempt.
2014
Phase 2 How the ACA Will Improve AAPI Health Care
January 1, 2014
[The employer mandate]
• Employers with over 50 full-time workers must
offer health insurance to their employees or pay a
tax penalty.
Asian and NHPI firms employ an average of 7 and 9
employees, respectively
• Most AAPI-owned businesses will be exempt
from the penalty but eligible for tax credits to
provide employee insurance.
2014
Phase 2 How the ACA Will Improve AAPI Health Care
January 1, 2014
Most AAPI businesses will qualify for even higher tax credits
to provide insurance
• Phase 2 tax credit: up to 50% of employer’s insurance cost for two
years
• 25 full-time employees or <$50,000 average annual wages
January 1, 2014
Expanded Medicaid coverage
• Medicaid will be expanded to all citizens under age 65 with incomes
up to 133% of the federal poverty level
 Will especially benefit naturalized citizens from AAPI groups
marked by 10%+ poverty rates
• Legal permanent residents still unlikely to be eligible in Ohio
2014
Phase 2 How the ACA Will Improve AAPI Health Care
January 1, 2014
No more refusal for pre-existing conditions
 Especially beneficial to AAPI populations at risk for Type II
diabetes, obesity, mental illness, and chronic conditions
• Health insurers will be prohibited from refusing health
coverage due to a pre-existing condition
June 2012!
Establish State insurance Exchange and SHOPs
Objectives
1. Describe problems in the current health care system
2. Explain ACA improvements to the current health
care system
3. Explain the Health Insurance Exchange/SHOP
Potential benefits
o Points of advocacy
o
…for AAPIs in Ohio, and
4. Address the impact of Issue 3 on the ACA and
Exchange/SHOP in Ohio
The Ohio Health Insurance
Exchange & SHOP
1. What are the Exchange & SHOP*?
2. Benefits of an Exchange & SHOP for AAPI
Ohioans
3. Making the Exchange & SHOP Work for
AAPIs
*Small Business Health Options Program
The Ohio Health Insurance
Exchange & SHOP
The Exchange & SHOP will be “insurance
supermarkets” for individuals and small
businesses, respectively.
They will have an easy-to-use website for
comparison shopping of multiple health
plans.
The PPACA calls on each state to pass legislation
establishing an Exchange/SHOP by June 2012.
Benefits of an Exchange &
SHOP
If designed and operated ideally, the Exchange & SHOP
would offer AAPIs greater and fairer access to health
insurance through:
Affordability
Transparency
Quality
An Essential Health Benefits package in every plan sold
in the Exchange/SHOP (Qualified Health Plan)
Consumer advocacy and guidance
Navigators from the communities they serve.
Benefits of an Exchange & SHOP
Affordability
Lower premiums, higher
discounts
Bargaining
power of
many
individuals
and small
businesses
Exchange & SHOP will also monitor premium
increases
Benefits of an Exchange & SHOP
Affordability
Tax credits to help buy insurance for middle-class consumers
[family of 4 earning up to $90,000 in 2011]
Co-pay & deductible assistance for eligible consumers.
 Although unlikely to be eligible for Medicaid, legal permanent
residents WILL QUALIY FOR TAX CREDITS to buy insurance
in the Exchange
 Would especially benefit low-income AAPI groups (Southeast
Asians & NHPIs)
Tax credits for small employers to help buy insurance
Increase from 35% to 50% of insurance costs in 2014
 Again, majority of AAPI-owned firms will qualify due to low
numbers of employees
Benefits of an Exchange & SHOP
Transparency
Easy comparison of health plans for consumers
• Easy-to-understand, standardized language
describing costs and benefits of all Qualified Health
Plans (QHPs)
• Easy-to-use website built for comparison shopping
Benefits of an Exchange & SHOP
Quality
Essential Health Benefits package: every QHP sold in the
Exchange/SHOP, regardless of price, will cover a
standard set of benefits from 10 benefit categories.
1. ambulatory patient
services
2. emergency services
3. hospitalization
4. maternity and newborn
care
5. mental health and
substance use disorder
services*
6. prescription drugs
1. rehabilitative and
habilitative services
and devices
2. laboratory services
3. preventive and
wellness services and
chronic disease
management*
4. pediatric services,
including oral and
vision care.
Benefits of an Exchange & SHOP
Consumer Advocacy & Guidance
The Exchange/SHOP will regulate participating
insurers
•
•
Prohibit unethical advertising
Monitor and review premium increases
Designated or certified “Navigators”
•
•
Non-profit, third-party organizations
Help consumers find, understand and enroll in the
Exchange health plan which best suits their needs
Objectives
1. Describe problems in the current health care system
2. Explain ACA improvements to the current health
care system
3. Explain the Health Insurance Exchange/SHOP
Potential benefits
o Points of advocacy
o
…for AAPIs in Ohio, and
4. Address the impact of Issue 3 on the ACA and
Exchange/SHOP in Ohio
Exchange & Shop
Making it Work for AAPIs
To maximally empower AAPIs, and all health care
consumers, the Exchange & SHOP should be designed
and operated along these principles:
Run by Ohio
Pro-consumer governing board
Multilingual access
Effective regulation
Exchange & SHOP: Making It Work for AAPIs
Run by Ohio
Ohio should establish and operate the Exchange/SHOP
• Avoid defaulting to a federal-level Exchange/SHOP
unlikely to meet the needs of diverse AAPI groups in
Ohio.
 Including but not limited to the Burmese, Bhutanese, Hmong,
Mon, Karen, and Nepalese refugee communities.
Exchange & SHOP: Making It Work for AAPIs
Pro-Consumer Governing Board
The board that designs and oversees the Exchange &
SHOP must include
Consumer, labor, and small business representatives
alongside industry experts.
An AAPI health expert among other minority health experts.
A strong conflict of interest clause that excludes those with
financial interests in health care.
…and
Hospitals
Physicians
Insurers
Brokers
any
individuals or
organizations
who may
profit from
enrollment in a
health plan
Exchange & SHOP: Making It Work for AAPIs
Multilingual Access
The Exchange & SHOP should be accessible to limited
English proficient communities:
Exchange website should have AAPI language support
Navigators for AAPI ethnic groups
• Based in the communities they serve
• Ethnically diverse
• Culturally and linguistically competent
Exchange & SHOP: Making It Work for AAPIs
Effective Regulation
Ensure quality health plans in the Exchange & SHOP
•
The Exchange/SHOP should be able to accept or reject health plans
for sale based on price and quality
 Advocacy example: to be sold in the Exchange, a health plan
must help reduce health disparities by offering customer service
in AAPI languages and covering prevention, treatment, and
management of common AAPI conditions
Bad example: Utah’s
Exchange must accept all
health plans
Massachusetts: allows
its Exchange to select bidding
health insurers based on quality
and value.
Objectives
1. Describe problems in the current health care system
2. Explain ACA improvements to the current health
care system
3. Explain the Health Insurance Exchange/SHOP
Potential benefits
o Points of advocacy
o
…for AAPIs in Ohio, and
4. Address the impact of Issue 3 on the ACA and
Exchange/SHOP in Ohio
What about Issue 3?
New Ohio Constitution Section 21A: No federal, state, or local law or
rule shall compel, directly or indirectly, any person, employer, or health
care provider to participate in a health care system.
This section was written to prevent the ACA's individual responsibility
requirement from applying in Ohio. However:
Participation in the Exchange & SHOP is voluntary
• Individuals and employers are not required to purchase from the
Exchange or SHOP
• Insurance companies are not required to sell plans in the Exchange
or SHOP
The Supreme Court is reviewing the constitutionality of the ACA.
Under the federal supremacy clause, federal law trumps state
law
What about Issue 3?
Pending the Supreme Court’s decision, the ACA
is the law of the land.
Issue 3 has no bearing on the establishment of
an Ohio Exchange & SHOP.
Key Takeaways
1. The Affordable Care Act extends greater consumer
protections to all Ohioans.
2. The ACA makes health insurance more affordable for
economically vulnerable AAPI groups.
3. The ACA makes health insurance more affordable for
AAPI business owners.
4. The Exchange & SHOP give all Ohioans greater
control over their health care (easy-to-use, comparison
shopping website).
5. The Exchange & SHOP can be designed to benefit
AAPI health interests.
Sources
• “Asian Americans continued to suffer the most from long-term unemployment in
2011” (Economic Policy Institute) : http://www.epi.org/publication/ib323s-asianamerican-unemployment-update/
• “Better Health Insurance Options for Ohio” (Ohio Consumers for Health Coverage”
• “Essential Health Benefits Bulletin” (Center for Consumer Information and
Insurance Oversight) Dec. 16, 2011
• “Exchanges: Top Ten Priorities for Consumer Advocates” (Community Catalyst)
• “Summary of Coverage Provisions in the Patient Protection and Affordable Care
Act” (Kaiser Family Foundation)
• “Summary of New Health Reform Law” (Kaiser Family Foundation”
• “Why We Need a Health Insurance Exchange” (Families USA)
• http://erc.msh.org/provider/informatic/AAPI_Diabetes_Incidence.pdf
• “The Health Care Law and You: What’s Changing and When”:
http://www.healthcare.gov/law/timeline/