The ACA at 5 Years: Medicaid Expansion and Immigrant Inclusion

Date and Time:
Saturday, October 31, 2:15PM-3:15PM

Facilitator: Rita Valenti, Healthcare-NOW! Georgia

Presenters: Ken Kenegos, Heathcare for All Texas; Rachel DeGolia, UHCAN; Betzebel Estudillo, California Immigrant Policy Center.

Description: After five years, the Affordable Care Act is clearly the law of the land. Yet 19 states continue to refuse to accept federal funds to expand Medicaid coverage to their own low-wage workers, Republican governors have demanded the erosion and privatization of Medicaid as a condition for expansion and immigrants continue to be excluded from nearly all of the benefits of the ACA. This workshop will take stock of the movements working to expand the benefits of the ACA to everyone in America and explore the organizing potential of linking those movements with the fight to finish the job and make healthcare a right for all.

Notes from Conference Participants:

How many states represented?

Rita V — excited about this workshop – how many folks from the south? South west? How many folks here from somewhere Medicaid has not been expanded. There is a long history in the struggle for HC that preceded SP – emphasis that HC is a right. Look at page 4 in the book – be thinking about some of those questions – panelists are amazing – not going to be speaking for very long – want a lot of dialogue and some of the strategic questions – what has happened with the ACA – strategy – we need to be together and be together with who else? 32 million who are still uninsured.

Look at the southernization of the country – not a good thing in the sense of right to work and Medicaid waivers – not one in south except for AK has expanded Medicaid

Betsey E. – Health policy coordinator – focus on HC for immigrants – expand HC to all Californians – stems from own experiences as former undocumented immigrant

Rachel – exec director of UCHAN – universal HCAction Network and one of the founders in 1992 – engaged in fighting Ohio state efforts – focus on Medicaid expansion.

On the far right

Ken K from Texas – RN – with 40 years of experience – past president of HC for All TX – focusses in on effects of budget deficits. The work that is going in on in TX is mind blowing especially considering the political framework there.

Rachel Degolia – General to specific, We celebrates Medicare and Medicaid’s 50th bday this summer – that was one big step toward UHC – one of the good things the ACA did was expand Medicaid – supposed to happen in every state but SC made it optional – 31 including District of Columbia have expanded – 19 have not – everywhere the fight to expand Medicaid – that’s a fight that all health care activist should be in – to not let the opponents of HC to roll that back and keep that from happening. In Ohio – we weren’t one of the first states – the coalition that convinced our repub gov that it would help his campaign – probably the broadest coalition in our history. Other states are asking for waivers to do it differently – in negative ways – privatize Medicaid – not just states that haven’t expanded – in Ohio – our legs are trying to roll it back – undermine the whole concept – remember what Claudia Fegan said - -it changed the conversation, worts and all , yes people actually should have access to health ins. Here’s’ what being proposed in other states – charging premiums – New Hampshire – trying to push people into market place – Ohio – setting up a health saving account – complicated system. Wellness programs – become very punitive – premium cut by 50 percent – waiting periods for coverage – caps – locked out if can’t pay premiums. Arizona it’s a year – work requirements – remember these waiver requests are to the fed govt. – HHS – sometimes they negotiate – didn’t get PENN do that, but people keep pushing. Not just the states that haven’t expanded yet. UHCAN – came into being in 1992 to work for HC justice – in the last year or so – intersectionality – connecting with other movements – we know we can’t win HC justice without that – racial justice, criminal justice – HC is right there in the mix - -need to be connecting with them – we are building relationships – organizing is all about relationships. 50th ann. Of Medicare, Medicaid, Voting Rights Act – didn’t have massive movement – had Civil Rights Movement – we don’t know what the break through issue will be. Monthly calls – always have different speakers – always have folks from other SJ fights talking about what they’re doing – you know Tuerig – in NY there was this fabulous – group called the Hedge Clippers. Got together – incensed at this finance sector – medical sector now most profitable – great demonstration targeting the CEO – example of making connections around intersectionality. Helped raise the public conc….. Moral Mondays is another one that came out – came out around Voting Rights – White Coats for Black Lives – another great example of intersectionality – making it core to their medical education. Protecting Medicaid and expanding it – fabulous common ground.

Rita V – encourage to sign up or get in touch with Rachel about these calls.

Betsy E – CA – California Immigrant Policy Center – start off with a little bit about my story. I’m fairly new to the health advocacy world – came out of immigrant rights movement – leg for undocumented to pay in state tuition – organizing around the Dream movement – doing that for more than a decade – a veteran dreamer – immigrant youth issues – path to legalization/ education – part of sit-ins that happened. Young people in trenched – sit ins and hunger actions – great opportunity to work together – passionate about access to HC regardless of immigration – my parents were smart – said a 9 or a 10 – that was my experience growing up – my mother diagnosed at 37 with Parkinson’s disease – continued to go through very difficult period – luckily able to get green card – that’s why I’m so passionate about HC access – 2 years ago – HC for All campaign – started around ACA expansion –UC Berkeley Labor center study – even after full implementation – still 2 to 3 uninsured – 1.2 million undocumented – others young, unaware, rather bear penalty. Band-Aid care for undocumented – patchwork of care depending on what county you live in. In LA undoc. Included – but if you are in Orange county etc – good luck they have chosen not to expand – did decide to expand Medicaid in 2014. ACA was taken out of DACA – a few months later DACA would be excluded from ACA – decided in our state not to do that and expanded to them also – What type of care did they receive – go to hospitals – community clinics – charity care — ??? in San Diego are – organizing from the ground up – realized that this needed to be grassroots – those affects would be the driving force – had van that drove across state setting up town halls etc – Met Roberto – didn’t have care – was losing vision – and didn’t know why – had late stage diabetes and was thus losing his site – the Lions Club in San Diego pooled money and he was able to save 10 percent of vision , but no follow up – magnifying glasses. These are the types of stories we hear constantly – excluding undocumented immigrants – this is life and death – people have no time to wait – they are literally dying – legislative effort centered around grassroots effort – bringing immigrant rights orgs into health care justice movement — Single payer – very successful – never seen a more diverse group of people. SB 4 – bill introduced in CA – went through series of amendments – initially that all undoc would have access to medical and /or state exchange – bill was amended – but were able to get health care for all children / undocuments – one of 26 that provided care to all children regardless of their status – this is historic – shows where CA has been and is headed – always like to be the leader – happy to see inclusion of children – work is not over – need to make sure that parents of children have it – next year working on HC for all adults. Need a lot more supporters – Gov. has said the Health for all children is what he can do – working on expanding partnerships – affects everyone not just immigrants – we all suffer – we all feel the consequences – it’s a human right. Beginning our adult campaign next year – lots of ways to get involved. You can join ….. Want to be sure that we elevate the immigrant voice.
RV – it’s really a strong statement for the breaking down of SILOS – have to join in the fight, don’t just need to ask them to come over here.

Ken Kenegos – TX – (highest rate on uninsurance in the country) – TX the state that makes you all feel good right – or as we say – thank god for Mississippi – highest rate of uninsured – about 24 percent – over 26 million people – at least 5 million in the state are uninsured – Myth – it’s all undocuments – but if you take undoc. Out it’s still 19.8 percent! That’s racist and patently untrue. The focus in TX is very much on Medicaid expansion – in states where there is not Medicaid expansion – that’s what the ACA is about – many groups are focused on getting that – the money is sitting there. The TX state leg meets for 4 months every 2 years – would give us a little more time to hammer then – met in 2013 the first time that was an issue – rep. sen – Dr. Z proposed the TX plan – which would go along with a lot of the ugly things we see being put in the Medicaid expansion – consensus was that it would have passed if it got to the store – I’m the gov. of TX – that means my next step is Pres – had Rick Perry kill it – 2015 it didn’t even come up – current gov. thinks that he’s gonna run for pres. – killed it. They are very dug in – what it takes to get Medicaid in TX these days – if you are a single parent with 2 children – less than 7, 360 a year – if you make any more that that you are too rich for Medicaid. The surprising thing is that – The TX medical center in Houston – Huge – commissioned a study about real attitudes of Texans – to be presented at a conference – people at the conf. were flabbergasted – found that 81 percent favored a national UHC plan – out of that 42 percent believed that plan would have to be a SP type of plan – not that Texans have no heart – it’s just that we don’t have a democratic govt. at all – I’m talking small d. Is the US going to be moving toward TX – forces want to do that – or is TX gonna move the other way. – want to talk about what we’ve been doing lately. In Houston area – Harris Health – We became aware that Harris health was about to change requirements – came about because Medicaid money didn’t come in – hospitals are hurting for funds – people most hurt will be undocumented – has treated undocumented in a charity type system – HC for ALL TX – single payer org – develop relationship with org in Houston – Living hope wheel chair organization – nucleus of HC is Human right coalition. One thing that was cut from undocumented – people with spinal cord injuries – county used to supply them – 10 years ago they cut them off – 5 guys got together – now 50 with their families around them, They along with other groups in undocumented struggle – faith groups – we formed this health care is a human right coalition – giving us the opportunity to fight some of the small battles that will allow us to build for the future – one of the things that happens in SP movement – we balk at idea of incrementalism – I don’t consider myself an incrementalism – I want SP – but the process of building that power that we need is incremental and these small victories do that. We all agree that Medicaid expansion needs to happen – it needs to be done. If you come into country on visitor’s visa you are excluded from public assistance – now they are changing that policy and they will include more people – I think that these small victories are very imp. Our group is growing – point of unity is HC is HR – how do you get that – people are receptive to talking about SP – but only if SP advocates show up at the other issues. We have to be there for all of these other issues – we’ve got to be there – can’t expect them to come to us – have to go to them and form that unity. What really is gonna – one of the problems that SP groups have – when ACA came down – we shrunk way down – people started going out there and working very hard for ACA – saw a way to fill some of that need – those of us who kept with SP – if we don’t keep our eyes on the prize we will never get there – both functions are important – have to bring those people back in – the worts are showing of ACA – I think that we’ve got to be there in all those fights.

RV – I’ve been excited – so many times it’s been policy debate – political maturity – how we do this – who do we unite with.

?? – Charley from Oregon – Some people are looking at McDermott bill as looking at was to help states move toward – defines residents as only legal residents – the bill itself is just defining – what is the minimum the state has to do – now states don’t have to cover immigrants – is it important to change that?

Howard – Chicago – The two edged sword since ACA – people gotten Medicaid, ins, close to 85 of recipients – those with insurance – double digit increases – organizing strategies for those people.

UCHAN – already happening, but accelerate

Tom Wilson – IL – local struggles in Chicago – trauma center in south side – mental health clinic shut down – supported disability groups against Medicaid cuts. In communities of color. How important is it to like up with these struggles and how do that.

RV – I think a lot of what we’ve been talking about is actually building a SM – not necessarily mobilizing around a piece of legislation – because that is limiting. Without it – it’s much more difficult.

Betsey – lesson learned in CA – Medical expansion – what happened – undocumented carved out of expansion – how do you throw a comm under the bus – as you are fighting – it has to be everyone.

A… LA – what expansion program? What are some of the examples of expanded programs? Are we talking about expanding services or to people.

Presentation Notes from Ken Kenegos, "The ACA in Texas":

As in most states where the state government has refused to expand Medicaid, that expansion is the main focus for many healthcare advocates. Texas continues to have the largest number, approximately 5,000,000 and percentage, 24%, of uninsured people of any state in the country. If you remove the undocumented population from the equation and still have 19.8% uninsured.

Our legislature meets only every two years for a four-month session. In 2013. A bill was introduced by a Republican physician for a “Texas Solution” which imposed significant co-pays and increased privatization on Medicaid. Many believe there actually was a majority of the legislature willing to pass it, but political pressure from Gov. Perry because of his intention to run for president, kept the bill from getting a vote. In 2015, no bill was even discussed. Our current governor, Greg Abbott is as entrenched in opposition to Medicaid expansion as was Perry. He too may have aspirations to become president, as most Texas governors do. In Texas, a single parent with two children cannot qualify for Medicaid if they make over $3720 a year. Those on the said facts and the political situation we face.
But Texas is not a democracy. Its politics are dominated by the Republican Party. But when a poll was taken in January of this year regarding attitudes of real people on healthcare, 81% responded that they believe there should be a national universal healthcare system. A plurality, 42%, specifically voiced support for a single-payer system.

The question we all face is whether the country will become increasingly like Texas politically or whether we will democratize Texas and the rest of the country along with it? People are organizing to do the latter. In Harris County, home to Houston, a Health Care is a Human Right coalition has formed in response to proposed changes of eligibility for care in the county facilities as the budget of the hospital district is squeezed tighter due to lack of funding. One of the motive forces behind the coalition is the immigrant rights movement because we have seen that belt-tightening in health care is having its most detrimental effects on the immigrant community, particularly the undocumented, which are those with the least options for care. Others in the coalition include faith leaders, union leaders, the local Council on American Islamic Relations (CAIR-TX) and single-payer advocates.

As single-payer advocates, we pride ourselves on not being incrementalists, but, we are learning that the building of power is an incremental process. Small victories are essential to keep people engaged and optimistic that we can be successful. In Harris County. We have had a small victory changing the County’s interpretation of federal law, to allow those in the country who have over stayed a visitor’s visa to have access to County health care, which they previously did not. Another way the coalition can build power is by uniting with local activist organizations around other issues where budgets are squeezed out of resources as underfunded healthcare effects local governments’ ability to fund other important needs. All the while the coalition can serve as an important place where others can become educated about single-payer as single-payer activists become educated about other important issues in our community. Small victories strengthen organization and make bigger victories possible by creating the loyalty among people who see them as actually serving their needs.

Health care as a human right, by logical extension leads to the question of single-payer. Although health care is not everyone’s first issue as it is for single-payer advocates, it is close to everyone’s second issue and therefore can serve as a glue to create a broader movement for Justice.

Slideshows, Photos, and Video:

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