Academic journal article Asian American Policy Review

The No Wrong Door Policy: Keys to Implementing the Affordable Care Act for Uninsured and Underinsured Asian Americans

Academic journal article Asian American Policy Review

The No Wrong Door Policy: Keys to Implementing the Affordable Care Act for Uninsured and Underinsured Asian Americans

Article excerpt

Although the Patient Protection and Affordable Care Act (ACA) was signed into law two years ago, many provisions of the new health care reform law require state and federal action for full implementation. The most critical of these actions includes preparing for expanded coverage through existing public health programs like Medicaid and establishing the Health Benefit Exchange, a regulated, state-operated marketplace for consumers to purchase private health insurance. California has taken significant steps in implementing the ACA. For instance, it was the first state to create a decision-making body to establish an exchange. The state also established policies to help limited English proficient individuals navigate through the new health care reform law. In addition, California is a pilot state for the establishment of a "Bridge to Reform" program that will empower local counties to expand coverage for low-income individuals prior to the 2014 ACA implementation deadline.

This article will analyze the establishment of a "no wrong door" policy that has helped the Southeast Asian American (SEAA) population without insurance in California. The article will also provide policy recommendations on how California and other states may continue to move forward to improve access to care for historically medically underserved populations.

THE SOUTHEAST ASIAN AMERICAN COMMUNITY IN CALIFORNIA

Nearly one-third of the 2.26 million refugees who have arrived in the United States since 1983 have been individuals escaping war and persecution in Cambodia, Laos, and Vietnam in the aftermath of the Vietnam War and the surrounding atrocities (Office of Refugee Resettlement 2008). As a result, Southeast Asian refugees constitute the largest group of refugees in the United States (Office of Refugee Resettlement 2007). Today, California is home to the largest Southeast Asian American population in the nation, numbering more than 900,000 individuals concentrated in communities throughout the state (U.S. Census Bureau n.d.).

As one of the more recent immigrant populations to resettle in the United States, SEAAs face significant struggles that are often overlooked due to the prevalence of the model minority myth, the belief that all Asian Americans unfailingly succeed and encounter no obstacles. As refugees, many came to the United States with little or no financial capital, few marketable job skills, and limited English language proficiency. In California, the impact of these barriers has resulted in:

* Lower educational attainment, with nearly 28.3 percent of Vietnamese, 36.8 percent of Laotians, 39.3 percent of Cambodians, and 42.7 percent of Hmong Californians having less than a high school diploma

* Higher percentages of the community living below the federal poverty line (FPL), with rates of 15.2 percent for Vietnamese, 17.3 percent for Laotians, 25.3 percent for Cambodians, and 33.2 percent for Hmong (U.S. Census Bureau n.d.)

* Lower levels of language proficiency as exemplified by the fact that 41 percent of Cambodian Americans speak English less than "very well" compared to only 8.7 percent of all Americans (U.S. Census Bureau n.d.; Southeast Asia Resource Action Center 2011)

These low levels of educational attainment, high levels of poverty, and limited English proficiency constrain employment options. This leads many SEAAs into low-wage work that lacks benefits, especially health care. Consequently, nearly one in five SEAAs is uninsured (Kaiser Family Foundation 2008) and a higher percentage of SEAAs utilizes public health coverage than any other racial or ethnic group (U.S. Census Bureau n.d.).

As such, SEAAs also represent a significant proportion of individuals who are eligible for California's State Medicaid program (Medi-Cal) and the Children Health Insurance Program (Healthy Families). However, because of a lack of information, language barriers, and unfamiliarity with existing enrollment structures, there are many who are not enrolled in these public health insurance programs. …

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