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March 2006
In this Issue:
New Resources
AHRQ: Cultural Competence California Style
The Opportunity Agenda: State of Opportunity in America
Families USA: An Action Kit for Community Leaders
Activities in the Field
Policy Updates
President’s Budget
Medicare
Medicaid
Reflections From Our Advocates
Upcoming Events
New Resources
The Agency for Healthcare Research and Quality has just released Cultural Competence California Style, which reports on the cultural competence activities of eight leading California health plans and how these activities were influenced by California's promulgation of cultural and linguistic competence standards for public insurance programs.
The Opportunity Agenda has recently released State of Opportunity in America, the first national study to measure opportunity in America across a range of indicators—including health—while looking at race, gender, income, and immigration status. The report found that Americans are facing sharply increasing barriers to opportunity despite their best efforts to achieve the American dream. The report also calls on national leaders to take specific steps to expand opportunity for all Americans.
Families USA has developed an action kit designed to provide community leaders with the information, tools, and resources necessary to engage in health advocacy and improve the health and well-being of their communities.
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Visión y Compromiso, an umbrella organization created to develop a statewide forum to exchange information related to quality of health care, well-being, and social policy, runs the Community Health Worker/Promotoras Network in California. Promotoras are community members who serve as liaisons between their communities and health, human, and social service organizations. They work to bring information back to their communities and often play several different roles, including advocate, educator, mentor, outreach worker, role model, and translator. Visión y Compromiso brings together promotoras from all over the state for training and to discuss important issues they need to be aware of when they go out into the community. For more information on Visión y Compromiso and the promotora model/community health worker model, click here for a presentation by Maria Lemus, executive director.
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The President’s Budget
Last month, President Bush released his fiscal year 2007 budget proposal. While it includes many measures purportedly designed to respond to the growing health care crisis, several of the health care proposals pose a serious threat to efforts to reduce racial and ethnic health disparities.
In general, the President's proposals seek to dismantle America's traditional health insurance model by shifting toward a privatized system in which individuals bear more of the financial burden when they become sick. For example, the President proposes to expand Health Savings Accounts (HSAs), which are tax-sheltered savings accounts tied to high-deductible insurance policies. For most people, these accounts will bring higher out-of-pocket costs and strong incentives to forego needed care. While such accounts might appeal to healthy individuals with high incomes, they will likely deepen the health care gap for racial and ethnic minorities by raising costs and providing less comprehensive care for a population that is disproportionately plagued by poor health
Another distressing provision is the President's proposal to reduce funding for the Office of Minority Health (OMH) by almost 20 percent in 2007. The OMH is critical to raising awareness about disparities and promoting research to improve the health of racial and ethnic minorities. By seeking to cut OMH funding by $10 million in 2007, the President's budget seems to indicate that improving minority health is not a priority.
For more on the President's budget, including his proposals to cut funding for Medicaid and the State Children's Health Insurance Program (SCHIP), read Families USA's budget analysis.
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Medicare
More than two months into the new prescription drug benefit, Medicare Part D continues to confuse millions of beneficiaries and their families. As of January 1, 2006, 6.2 million "dual eligibles"—low-income seniors and people with disabilities who qualify for both Medicaid and Medicare—lost their Medicaid drug coverage and were supposed to be enrolled in private prescription drug plans through Medicare. However, thousands showed up to the pharmacy in January to discover that they were unable to fill their prescriptions due to administrative complications. This is a problem of particular concern to communities of color, since almost half of all dual eligibles belong to racial and ethnic minority groups.
Fortunately, more than 30 states have stepped up since January to smooth the transition from Medicaid to Medicare by paying for emergency supplies of drugs for thousands of people who otherwise would be unable to fill the prescriptions that they are entitled to receive. This is not, however, a permanent solution, and many low-income Medicare beneficiaries now face new copayments and greater restrictions on the prescriptions they can fill.
General enrollment figures for the Part D program have also been very discouraging. Despite promises from the Administration that Part D would expand affordable drug coverage to the millions of seniors and people with disabilities who need it most, only about 4.1 million people have signed up for the drug benefit so far who did not already have prescription drug coverage.
What's more, low enrollment figures have shown that Medicare has not been effective at reaching many of the low-income individuals who stand to benefit the most from the new benefit. Racial and ethnic minorities are disproportionately represented among low-income Medicare beneficiaries: 64 percent of African American beneficiaries and 62 percent of Latino beneficiaries have incomes below 150 percent of poverty ($24,900 for a family of three in 2006), compared to 32 percent of white beneficiaries. Many of these individuals are eligible for a separate Medicare program known as the "extra help" program—a subsidy that helps low-income beneficiaries pay for premiums, deductibles, and copayments if they enroll in a Part D prescription drug plan. Unfortunately, only 1.4 million of the estimated 8 million beneficiaries eligible for “extra help” received the subsidy after the first month (updated enrollment figures for February are not yet available).
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Medicaid
In February 2006, the Budget Reconciliation Spending Cuts Act (S. 1932) was passed by Congress and signed into law by the President. Also known as the Deficit Reduction Act (DRA), this new law will fundamentally alter the Medicaid program by reducing Medicaid spending (along with spending for other entitlement programs such as student loans) by nearly $7 billion over five years. It contains both mandatory and optional provisions. Mandatory provisions include such measures as a citizenship documentation requirement and stricter regulations for asset transfer laws that affect Medicaid long-term care eligibility. Optional provisions would allow states to make changes to their Medicaid programs through state plan amendments. These changes could lead to increases in copayments, the implementation of premiums, changes to the benefit package, and the introduction of health savings account demonstrations.
A provision in the DRA that is particularly troubling to many racial and ethnic minorities—and to all those who care about fair access to necessary health care—is Section 6036, which requires states to obtain proof of citizenship for all new Medicaid applicants and from current enrollees who renew their eligibility. According to the Center on Budget and Policy Priorities (CBPP), approximately 49 million U.S.-born citizens (and 2 million naturalized citizens) who are covered by Medicaid over the course of a year would be required to submit documents proving their citizenship or they would lose their health care coverage. A telephone survey conducted by the CBPP revealed that 3.2 to 4.6 million U.S.-born citizens could be at risk of losing their Medicaid coverage because they do not have these documents readily available. Groups at greater risk of losing Medicaid coverage for this reason include older African Americans (who may have never been issued a birth certificate due to racial segregation of hospitals), individuals living in rural areas, and families whose homes are destroyed by fire or other natural disasters, such as hurricane Katrina. This new provision, which will go into effect on July 1, 2006, is sure to create insurmountable barriers for many trying to enroll in Medicaid and decrease overall access to health care for those Americans who need it the most.
To help advocates prepare for these changes, Families USA is producing a series of issue briefs designed to inform advocates about the specifics of these changes and to highlight key implementation issues and strategies. Click here to read the first two of these briefs.
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Working with the faith community can be both rewarding and smart. And the right strategy can really make your commitment worth the extra effort. Barbara Baylor, Minister for Health and Wellness at the national office for the United Church of Christ, spoke at Families USA’s Health Action 2006 conference at a plenary called “Faith and Justice: The Religious Rationale for Health Care.” During her speech, Ms. Baylor identified several tips and practical strategies for engaging and working with the faith community around health care issues, particularly drawing from her work with congregations that represent communities of color.
To read Ms. Baylor’s tips for working with the faith community, click here.
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We’d like to hear from you!
If you would like to see your organization or event highlighted in a future edition of our newsletter, please send us a brief description of your organization and its activities, as well as your contact information. We also welcome guest authors for the Reflections section of the newsletter. Please send all correspondence to: minorityhealth@familiesusa.org.
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