Rep Luis V. Gutiérrez, one of Congress’ most outspoken advocates for immigrants, on Wednesday called for expanding the Affordable Care Act to cover all of the estimated 11 million undocumented migrants in the United States.
“The goal is to make integration and inclusion real for millions of families that are locked out under current law,” the Illinois Democrat said in a floor speech introducing his proposed legislation.
“As it stands right now, undocumented immigrants are not subject to the individual mandate and cannot buy into health insurance exchanges even if they use their own money. My legislation will change that. It says that we stand for inclusion.”
Citing last week’s papal address to Congress (the pope repeatedly urged U.S. lawmakers to follow “the Golden Rule”), Gutiérrez said: “Doing unto others as you would have them do unto you means moving forward with no restrictions on which brother and sister and neighbor we think of as ‘eligible’ or ‘deserving.’”
The Gutiérrez legislation faces long odds in the House, where proposals to overhaul immigration have been stymied by Republicans who insist the federal government must first address holes in border security.
BY RICHARD POLLOCK
Federal officials admitted for the first time Monday that the collapse of the largest and most costly of nearly two dozen Obamacare-funded health insurance co-ops may not be the program’s last failure.
The admission followed the collapse Friday of Health Republic of New York after regulators ordered the co-op “to cease writing new health insurance policies,” leaving 155,000 customers scrambling to find new coverage by the end of the year.
“If a co-op has solvency issues, and we cannot rule out that others may this year, we will work with the states so that consumers have affordable options on the marketplace,” said Department of Health and Human Services spokesman Aaron Albright. “As a startup business, we recognize not all will succeed.” Albright is a spokesman for the department’s Centers for Medicare and Medicaid Services (CMS), which administers Obamacare.
The federal government gave Health Republic $265 million in start-up money in 2012. Taxpayers also funded an additional $91 million in emergency “solvency loans” last year, for a total of $356 million. The startup funds were to be paid back after the co-ops became financially viable.
The $356 million for Health Republic went to Sarah Horowitz, a liberal New York political activist who previously launched the Freelancers Insurance Company that state officials have ranked as providing the poorest consumer service among Empire State health insurers.
Horowitz was awarded another $170 million to start Obamacare health co-ops in New Jersey and Oregon. Health Republic is the sixth of 23 Obamacare co-ops to fail since the $2.4 billion program was launched in 2011. Co-ops in Vermont, Iowa, Nebraska, Nevada and Louisiana have also been terminated.
Critics of the program said that CMS was only recognizing the reality of the disaster unfolding for the remaining co-ops.
“CMS is begrudgingly acknowledging reality,” said Grace-Marie Turner, president of the Galen Institute, a free-market health policy think tank. “They recognize that failures are going to be popping up in the near future.”
Thomas Miller, a resident scholar and health insurance expert at the American Enterprise Institute (AEI), said it’s possible up to 10 co-ops could fail this year.
Louisiana Insurance Commissioner Jim Donelon, who presided over the collapse of the Louisiana Health CO-OP, believes all of the Obamacare co-ops were doomed from the beginning.
“I think the challenge of rolling out a new health insurer at the same time as the roll out of the Affordable Care Act was a near impossible task,” Donelon said.
“It’s playing out that way in 22 of the 23 states,” he said, noting that insurance industry ratings experts found that last year all but one of the co-ops suffered large net losses.
New York insurance regulators refused to disclose financial data about Health Republic’s problems and gave no explanation for why the co-op failed.
Data collected by the independent National Association of Insurance Commissioners (NAIC), however, show that Health Republic lost $94 million in 2014, more than a third of the $241 million the co-op had in cash on hand. The total amount of losses by all co-ops was released in a report filed by the Galen Institute and AEI’s Miller.
Louisiana co-op documents obtained by TheDCNF from the Louisiana insurance department also illustrate why most co-ops are failing.
The Louisiana co-op reported it had received $60 million in federal funds, but faced $46 million in liabilities in the last two quarters of 2014. Net losses last year were $21 million. The co-op was far behind in payments to hospitals and doctors, with more than half of its accounts due being unpaid from 90 to more than 120 days.
Turner said the next co-op to go belly up could be the Kentucky Health Cooperative, which serves customers there and in West Virginia. It is the second largest co-op behind Health Republic and claimed 57,000 customers in 2014.
“Kentucky is one that we have our eye on. It’s the second biggest enrollment after NY,” Turner said.
Because the co-op was unprepared for a large enrollment, Turner said it has had to pay higher premiums to other insurers for access to their doctors, clinics and hospitals.
“Most have to rent networks from established carriers for which they have to pay a premium. And they attracted a sicker population, so they had to pay higher costs,” she said.
CMS gave the Kentucky co-op $65 million in emergency solvency funding in November 2014. The infusion of capital was to assure the co-op met state requirements for minimum cash on hand.
NAIC reported that last year the Kentucky co-op faced net losses of $127 million, with $124 million in federal cash.
Like New York, the co-op with customers in Iowa and Nebraska had high enrollment. ut because the co-op was paying $1.40 in benefits for every $1 it got in premiums, the higher enrollment only meant bigger losses.
The quickening downward spiral of the co-ops, which represented a vision of President Barack Obama and co-op activists in 2010, now is taking a toll on their once friendly relations.
The National Alliance of State Health CO-OPs, a trade association representing the Obamacare co-ops, has blamed the problems on the Obamacare law itself and programming decisions by Obama administration officials.
Following Health Republic’s collapse, Kelly Crowe, NASHCO’s CEO, released a statement saying “from practically their inception, health insurance co-ops have been hamstrung by both the structure of the program and the way in which [Obamacare] was implemented.”
Capitalization levels “were insufficient” and the program contained numerous “regulatory obstacles,” she said.
“We should cover people regardless of immigration status”
By FARIDA JHABVALA ROMERO | NPR | SEPTEMBER 24, 2015
A California county voted Tuesday to restore primary health care services to undocumented adults living in the county.
Contra Costa County, which includes the cities of Richmond, Concord and Antioch, joins 46 other California counties that have agreed to provide non-emergency care to immigrants who entered the country illegally.
“Providing health care coverage to all is not only about the human morality issue that we should address, but also from a cost-effective point of view … this is absolutely the right thing,” said Jane Garcia, CEO of La Clínica de la Raza, which serves 25,000 patients in Contra Costa, many of them low-income Latinos.
Adult immigrants who are undocumented are not able to participate state health exchanges under the Affordable Care Act, but can get emergency care in hospitals.
The program is not full scope insurance, but will provide preventive care. Health care providers and other supporters say that increasing access to preventive services will cut down visits to the emergency room and save the county money in the long run.
“It will mean better health care access for all, improved public health, lower cost to our health care system, and it’s just the right thing to do for people, especially undocumented adults who are not covered under the Affordable Care Act,” said County Supervisor John Gioia, a supporter of the measure.
The movement to increase health care access to more residents has also made strides at the state level. In June, the California legislature and Gov. Jerry Brown announced a budget deal to provide public healthcare coverage for undocumented children from low-income families as early as May 2016.
A number of California counties were already covering children regardless of immigration status, says Tanya Broder, staff attorney at the National Immigration Law Center. That paved the way for the statewide agreement.
“California is one of the few states with a large immigrant population that recognizes that it makes sense to provide health care to immigrants ineligible for federal care,” said Broder. “And the state is taking steps to provide coverage to all residents, but it’s not there yet.”
At least two recent proposals to expand health coverage to undocumented adults have been unsuccessful in the state legislature. However, Broder believes the issue will resurface next year.
Alvaro Fuentes, executive director of the Community Clinic Consortium, led efforts to revive health care services for undocumented adults in Contra Costa County.
“Now, the conversation is not whether we should cover people regardless of immigration status. It’s how do we do it,” said Broder.
Washington, Illinois, New York, Massachusetts and the District of Columbia already provide health coverage for immigrant children. But D.C. goes even further. At the state level, only D.C. allows all qualifying residents, including the undocumented, to receive public health coverage through the DC Healthcare Alliance program, according to data from the National Immigration Law Center.
In its first year, the program, Contra Costa Cares, will assign up to 3,000 people a “medical home” at a community health center. Benefits will include regular physician check-ups, immunizations, a nurse advice line and mental health services.
Rosa Arriaga, 72, joined the dozens of supporters wearing “Health4All” t-shirts who packed the supervisors’ meeting. She buys over-the-counter medication to help ease the arthritic pains she feels in her knees and along her left arm, but hopes to get regular medical treatment for her asthma and depression as well.
“I have worked, paid taxes and never asked for anything from the government. But now I feel sick, and I need to see a doctor,” said Arriaga in Spanish. She has lived in Richmond for 24 years.
“It’s not just me. A lot of other people in the county need this program,” added Arriaga, who is currently unemployed and says she has trouble paying the rent for a single room she shares with her nephew.
The Cares program is being established as a year-long pilot program. It will benefit 16 percent of the estimated undocumented population in Contra Costa, about 19,000 people. Advocates hope the program will continue and be expanded after this first year.
The Board of Supervisors agreed to allocate $500,000 to Cares. In addition, three local hospitals — including Kaiser, Sutter Health and John Muir Health — have promised an additional $500,000 in funding.
Supervisor Candace Andersen cast the lone dissenting vote, saying that she worries that funding for the program is not sustainable.
“To me when you start a pilot program, you need to see where to go next, and I don’t see the funding in place right now,” said Andersen. “I’m very troubled that we are having to take half a million dollars from our general fund.”
Before the summer, only a few counties in California provided health care services to immigrants in the country illegally. In June, a group of 35 mostly-rural counties in California opted to cover all residents regardless of immigration status, according to the advocacy group Health Access. Last week, the Monterey County Board of Supervisors gave a thumbs-up to expanding health care services.
“Contra Costa is in good company in regards to this,” said Anthony Wright, executive director of Health Access. “It’s a really important step forward.”
In California, an estimated 1 million undocumented immigrants remain uninsured, said Wright.