By Sergio Eduardo Muñoz and Jennifer Ng’andu,NCLR Health Policy Project
If you thought the president’s signature was the last step for a piece of legislation, think again. In many ways, the step that follows, federal rulemaking, can be just as important. In fact, it is one of the most essential ways to promote sound policies that address the needs and concerns of Latinos. Think of it this way: new bills and laws are often just an outline of what policies should do; the rules are what actually put the rubber to the road.
This past fall, health advocates waded through a flurry of proposed regulations on the building blocks of the reformed health care system under the Affordable Care Act (ACA)—regulations that have the potential to greatly improve Hispanic access to health coverage. As part of this rulemaking process, NCLR submitted comments to federal agencies about how to ensure equal access to care for Latino workers and children. Hopefully these recommendations will be taken to heart—health inequity can have devastating consequences.
Three of the comments addressed standards for the establishment, functioning, and approval of the new private health insurance marketplaces, or Exchanges. If fairly designed, these marketplaces have the potential to offer quality affordable coverage to populations that were previously vulnerable to the price-gouging and discrimination of private plans. Among the least likely to receive insurance options through their employers, despite their significant presence in the labor market, Latinos have much to gain from the Exchanges. Middle- and low-income Hispanic participants may also qualify for premium tax credits in the Exchanges, which help families afford the costs of insurance. For those low-income Hispanic immigrants who cannot afford the Exchanges even with the credits, NCLR submitted comments on the Basic Health Program (BHP), an optional ACA public health insurance program which, like the Exchanges, can be accessed by immigrants without a five-year waiting period.
Finally, NCLR commented on the historic Medicaid expansion, which will now open up the successful public health insurance program to almost all individuals at or under 133% of the Federal Poverty Level (FPL). Thirteen million Latinos, the majority of whom are children, already receive crucial coverage and care through Medicaid, and the program’s importance will only grow. In all six of our submitted comments, NCLR urged relevant agencies to acknowledge the serious health inequities affecting the Hispanic community—including disparate access to coverage and care—and to carefully draft final rules that effectively enact the ACA’s fairness measures. For example:
- NCLR requested that the proposed rules outline clear standards on nondiscrimination protections, because we know that discrimination in health care settings has contributed to widening gaps in health care access and quality.
- Insufficient requirements for language services and cultural competency are also a big problem throughout the proposed rules. A key indicator for effective Latino access to health coverage has traditionally been the ability of programs to accommodate limited-English-proficient communities, in addition to those with low health literacy or those who may not be able to read at any grade level.
- Another crucial access problem for Hispanics is the increase in immigrant restrictions for health programs. Specifically, health care reform took an unprecedented step back in immigrant health by prohibiting the participation of undocumented taxpayers in the Exchanges—even if they are seeking to buy private health insurance at full cost without any government assistance. Not only does this exclusion defeat the purpose of a law meant to increase health coverage, it also makes enrollment for everyone else that much more difficult. NCLR weighed in to ensure that this new exclusion does not needlessly affect eligibility processes, especially in a “no wrong door” system where no eligible family should be blocked from enrollment.
- Finally, because Hispanics suffer significant poverty rates and generally have a lower median income, NCLR expressed the need to improve ACA affordability measures. Along with many of our public interest allies, NCLR advocated for the revision of the proposed tax credit rule that absurdly pegged the definition of an affordable offer of employer sponsored insurance (ESI) to the cost of an individual plan, not family coverage.
Both states and advocates are anxiously awaiting the finalization of these rules in order to have these important parts of health care reform up and running by 2014. Their final shape will have a dramatic effect on Latino health, and NCLR will continue its fight to ensure health equity for all.
Federal rulemaking may appear to be an insiders’ game, but it sets the stage for all of us.