HJ News and Resource Roundup 10/28/13

In this week’s edition of the News and Resource Roundup, we’ll be discussing the various barriers consumers are facing when trying to enroll for coverage under the ACA, the ongoing campaign to bring back labor and delivery services to the North Bronx, transgender health access, and more!

Affordable Care Act Implementation

While many states are struggling with technical glitches on Healthcare.gov, New York’s health plan marketplace website has run quite smoothly. However, pricey premiums are posing a challenge to enrolling New Yorkers’ into coverage.

And it seems that in spite of the House GOP’s efforts, the ACA gained popularity during the government shutdown.

Immigrant Access to Health Care

Last week, Immigration and Customs Enforcement (ICE) issued clarification confirming that immigrant parents can enroll their children and other eligible family members in health insurance programs under the Affordable Care Act without triggering immigration enforcement activity. This announcement will alleviate many fears among mixed-status families who wish to enroll eligible members of their families.

The Community Service Society, in partnership with the New York Immigration Coalition, NYC Office of Immigrant Affairs, the NYS Office for New Americans, and others, has launched the NYC Immigrant Services Manual. The manual includes information and resources on where and how to access food assistance, housing, as well as health insurance and health services programs.

Hospital Closures

Governor Cuomo is considering a proposal that would consolidate Kingsbrook Jewish, University, and Brookdale hospitals in Brooklyn into one facility.

More coverage of the fight to bring back labor and delivery services to North Central Bronx Hospital from Norwood News and Reporting NYC.

Health Disparities

This article discusses the many barriers that transgender people face when accessing health care.

HIV prevention activists are pressuring the NYC Department of Health to work with LGBT and HIV/AIDS communities to release and fully fund a comprehensive plan to prevent HIV infection in NYC.

A new study documents the cost of unplanned pregnancies incurred by public programs such as Medicaid, CHIP, and the Indian Health Service.

A project by Brown.Girl.Farming blogger Natasha Bowens maps food justice initiatives around the U.S.

HJ News and Resource Roundup 10/18/13

In this week’s edition of the News and Resource Roundup, we’ll be continuing our coverage of the ACA and discussing a variety of health issues facing communities of color, including important local trends in health and health care.

Racial and Ethnic Health Disparities and Minority Health Issues

The Department of Health and Human Services has announced a new health data collection initiative on the underserved and understudied Asian & Asian Pacific Islander population. Similarly, the Asian & Pacific Islander American Health Forum has released a set of fact sheets on the incidence of cancer in this community.

A recent European study has linked air pollution and low birth weight, both of which are prevalent in many of New York City’s low-income communities of color.

A further look at the health costs of the government shutdown points out how marginalized communities suffered under the suspension of services and questions which services should be considered truly essential.

A video series documents the intersection of public health, racial profiling, and transgender rights in New York City.

The Affordable Care Act

An important piece refutes Tea Party myths about the ACA.

The ACA may expand health coverage and economic opportunity for people with disabilities.

Women’s Health and Reproductive Justice

In a recent reproductive justice victory, California Governor Jerry Brown has signed legislation to expand abortion access in California, benefiting vulnerable populations of poor women, rural women, and women of color.

Black women face disproportionately high rates of maternal health complications.

October is Breast Cancer Awareness Month, and many survivors are thinking beyond the pink ribbon. Local Health New York State officially declares housing to be a vital aspect of health care. Grassroots organizations from around the Bronx have planned the Bronx Health Platform Walk for tomorrow, October 19th. The “Health Walk” will promote a fair economy, access to fresh food and opportunities for physical activity, school health, affordable housing access, environmental sustainability, and individual wellness. More information here.

HJ News and Resource Roundup 10/11/13

Happy second week of open enrollment! In this week’s edition of HJ News and Resource Roundup, we’ll largely be discussing the rollout of the ACA health plan marketplaces and barriers that immigrants are facing when applying for coverage. In other news, the government shutdown is having an impact on the health of people of color, and the suspension of labor and delivery services in a Bronx hospital is mobilizing community members. But before you dive in, be sure to check out what these cute animals have to say about the ACA.

ACA Implementation and Immigrant Access to Health Care

Our very own Christine Chiu and Shena Elrington penned a guest piece for New York Daily News with recommendations on improving language access for limited English proficient (LEP) New Yorkers seeking to enroll in coverage in NYS’ health plan marketplace.

Language barriers are already emerging as a huge challenge to successful outreach and enrollment in immigrant communities. In Los Angeles, a community-based nonprofit is conducting public education and outreach in several languages.

Concerns around privacy have also surfaced as undocumented parents seek to enroll their documented children into coverage under the ACA. Many navigator entities are grappling with how to help mixed status families navigate the new systems. This blog post from Georgetown’s Center for Children and Families talks about the many fears that immigrant families face and how they might be overcome.

And while some immigrants will be eligible to gain coverage under the ACA, the undocumented are still left in the shadow of the uninsured.

More on the Affordable Care Act

The New York State Health Foundation has a new data tool that maps potential health coverage gains in NYS under the  ACA. The tool also breaks data down by race, ethnicity, and language.

An article in the New York Times discusses the millions of poor people of color that will not benefit from the ACA because they live in states that refuse to opt into the Medicaid Expansion.

The Sellers Dorsey Foundation, Centers for American Progress, and Federal Agencies Project have launched Out2Enroll, a public campaign to educate the LGBT community about their options under the ACA.

The Health Justice and Disability Justice teams at NYLPI recently submitted comments to the Office of Civil Rights at Health and Human Services on nondiscrimination (Section 1557) under the ACA.  Read more here.

Hospital Closures

Here is some recent coverage of work we’ve supported around reopening labor and delivery services at North Central Bronx Hospital.

Health Disparities

A Texas medical school wants to build a curriculum that directly addresses racial and ethnic health disparities and documents histories of medical discrimination.

A recent study was published showing the role of insurance type on the quality of care received as well as other health outcomes.

Government Shutdown and Health Justice

The government shutdown is taking its toll on the public’s health. Our own Lindsey Hennawi analyzes the impact of the shutdown on the health of low income people of color.

Nondiscrimination and the Affordable Care Act

By Sascha Murillo, Community Organizer – Health Justice

and Mindy Friedman, Staff Attorney – Disability Justice

Last week, states around the country and the federal government debuted their health insurance marketplaces, setting the media aflutter as reports came in of glitches and system overloads.  The marketplaces are the centerpiece of the Affordable Care Act (ACA) and will allow millions of uninsured and underinsured individuals and families to shop for an affordable health plan. In New York, over 1 million NYS residents are expected to gain coverage through the marketplace, over half of whom are people of color. And while much attention was given to computer system errors, other challenges such as language barriers have also surfaced, bringing to light many access issues that different populations will face when trying to apply for coverage.

Little known to many, the ACA contains a crucial provision that aims to ensure equitable access. Section 1557 is a civil rights provision that prohibits health programs receiving ACA funding from discriminating on the ground of race, color, national origin, sex, age, or disability. Amidst the launch of the marketplaces last week, advocates around the country submitted comments to the Health and Human Services’ Office of Civil Rights (OCR) in response to a Request for Information (RFI) that was issued in August. Comments will inform proposed regulations that advocates hope will be issued later this year.

NYLPI’s Health Justice and Disability Justice programs teamed up to submit comments covering a wide range of topics, including best practices for translation thresholds, the experiences of and impacts of discrimination on people of color, people who speak a primary language other than English, and people with disabilities, as well as recommendations for compliance, oversight, and enforcement.  Here we provide some key recommendations from the comments submitted.

Language Access

NYLPI has documented many cases of individuals who were unable to access quality health care services due to language barriers. Such experiences have led NYLPI to champion policies that improve access for LEP populations in NYS. Section 1557 provides an opportunity to ensure equitable access for individuals who are limited English proficient (LEP). In New York State, 36% of individuals who are eligible for coverage through the marketplaces are limited English proficient (LEP). To adequately serve this population, marketplaces, navigators and in-person assisters, and Qualified Health Plans (QHPs) should provide linguistically appropriate services. This includes translating all vital documents and websites in the top languages in the state or service area. Oral interpretation must be provided by trained and culturally competent interpreters.

Disability Access

As of 2008, over 20% of adults 18 and older in New York State have a disability.  NYLPI has long heard complaints from individuals with all types of disabilities about the pervasive inaccessibility of health care in New York City.  Inaccessibility is the result of architectural and communication barriers, inaccessible equipment, and provider bias.  As documented in a report NYLPI released with Independence Care System last fall, these barriers exist in facilities of all sizes, including hospitals, community clinics, and doctors’ offices, and they result in inferior health care and disparate outcomes for patients as well as unnecessary costs to providers.  It is vital that Section 1557 cover the wide range of healthcare providers, programs, and organizations that engage with individuals at various points in their overall pursuit of health care services.  Additionally, many deaf individuals have limited English proficiency and should therefore be considered part of the LEP population.

Compliance and Enforcement

OCR’s existing complaint process has achieved significant victories in the area of accessible health care. With respect to national origin and race, however, much of the discrimination that occurs in the healthcare context constitutes disparate impact discrimination for which there is no private right of action. Under Section 1557, OCR should include comprehensive enforcement mechanisms, including a private right of action for both individuals and organizations seeking to bring claims based on intentional discrimination as well as disparate impact.  Further, in order to ensure that enforcement does not depend solely on complaints, OCR should coordinate with the Joint Commission, an independent, not-for-profit organization that accredits and certifies health care organizations, to monitor health facilities for compliance on a yearly basis.  Finally, OCR should work with stakeholders to develop trainings and guidance documents for patients and providers.

Read our full comments here.

Be Our Guest: Access to the health care marketplace should be expanded to those with limited English proficiency

Check out the guest piece written for the New York Daily News by HJ team members Christine and Shena on how to improve language access in New York State’s new health plan marketplace. You can read the piece here.

Health Justice and the Government Shutdown

by Lindsey Hennawi, Program Assistant

The United States Congress regularly votes to pass appropriations bills to fund federal operations. Lately, however, the Republican-controlled House of Representatives and Democratic-controlled Senate have been unable to agree on these bills, so they instead pass a series of temporary “continuing resolutions” to keep the government funded. The last of these resolutions expired on September 30^th. Since Congress was unable to pass another, a government shutdown process has begun, and will continue until a budget is agreed upon.

The appropriations bills keep failing due to Republican provisions to defund or delay implementation of the Affordable Care Act, which went into effect on October 1^st. This has been the major sticking point between the Senate and the House and thus the main reason for the shutdown.

What does a shutdown entail, exactly? Furloughed from their jobs, more than two million federal employees will have their paychecks delayed; many may never get backpay once they do go back to work. Not all government function will cease, but many of the agencies impacted are ones most crucial to protecting marginalized people. The Social Security Administration has halted acceptance of new applications for disability pay. If the shutdown lasts for more than a week, funding will run out for the Women, Infants and Children (WIC) program, which provides health and nutrition resources to nine million new and expectant moms. If it exceeds two weeks, millions of vets will be cut off from benefits. By the end of the month, funding for food stamp aid for 47 million Americans will be drained as well. Head Start programs will close, starting with 20 this week, leaving thousands of parents without affordable options for pre-K or childcare for their children. New clinical trials, vaccination programs, and certain food safety procedures are all on hold. And so on.

This scenario is basically the conservative utopic vision of government. The state security apparatus—military, law enforcement, prisons, the NSA—is still intact (considered “essential,” they remain open), whereas social welfare programs face de facto suspension. So, programs that incarcerate and oppress poor communities of color: unaffected. Programs that feed and care for them: shut down.

How could this happen? In short, the House is really set on gutting the ACA, while the Senate wants to protect it. The driving force behind the shutdown, an extremist conservative faction, insists that the rest of Congress must be willing to compromise. But many feel those conservatives had their chance to challenge the ACA—and boy, did they try—and now must accept it as law.

So let’s be clear about exactly what’s going on here, then. Far right-wing conservatives are essentially holding the government hostage to prevent the implementation of a Supreme Court-upheld law that would provide comprehensive health care to millions of people who traditionally could not afford it: poor folks, people of color, immigrants, LGBTQ folks, people with disabilities, and youth, to name just a few groups who have received expanded protections and access to care under the ACA. But the chances of actually successfully overturning the ACA are slim to none, because, well, that’s not how laws work.

In other words: they’re strangling the democratic process, risking the lives and livelihoods of millions of working and struggling people in so doing, to deny working and struggling people access to affordable, comprehensive health care—you know, the kind of care those extremists, as mainly rich white men, have been able to access their whole lives.  And even though they have virtually no chance of succeeding in this endeavor, they’re doing it anyway, because that’s how little they value the rest of us.

This is what makes calls for compromise so insidious. Any middle-ground under these circumstances means letting a bunch of over-privileged elites throw the legal equivalent of a temper tantrum in order to perpetuate endemic health disparities, a dwindling safety net, discriminatory barriers to care, and social and economic inequality that disproportionately harm poor people of color.

And that’s not compromise; it’s capitulation.