Thursday, 15 August 2013
ICUH2014: ICUH 2014 Speaker Profiles: Professor Ian Jacobs
ICUH2014: ICUH 2014 Speaker Profiles: Professor Ian Jacobs: www.icuh2014.com is proud to announce Professor Ian Jacobs, The University of Manchester’s Vice President and Dean of the Faculty of Medi...
Get proper documentation; it helps ease path to health care access in USA
Holes in the Safety Net — Legal Immigrants' Access to Health Insurance
Comments open through August 21, 2013- Article
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- While Congress debates whether publicly supported health care should be available to undocumented immigrants who may be placed on a path to citizenship under immigration reform, the health care needs of already legal immigrants continues to be overlooked. More than 12 million immigrants are lawfully present in the United States. They serve in the military, pay taxes, and contribute to the economy. Yet like undocumented immigrants, whose health care vulnerabilities are outlined in the Perspective article by Sommers, legal immigrants face substantial barriers to obtaining insurance coverage (see graph
Health Insurance, According to Citizenship Status, 2009.). As a result, some — such as Antonio Torres, an uninsured Arizona farmworker who was in a coma after a car accident — have been forcefully transferred to their native country when their treating hospitals were unable to find facilities willing to provide them with long-term care.1Legal immigrants form a highly heterogeneous group that includes legal permanent residents (“green card holders”), refugees, asylum seekers, and many others. Because of the heterogeneity of the class and the complexity of immigration categories, information on the proportion insured is scarce. Augmenting data from the 2008 Current Population Survey, the Pew Hispanic Center reports that 24% of legal immigrants were uninsured in 2008, as compared with 59% of unauthorized immigrants and 14% of native citizens.2 In a 2005 article that was based on data from the Los Angeles Family and Neighborhood Survey, Goldman et al. reported that 32% of permanent legal residents remained uninsured for an entire 2-year period, as compared with 65% of undocumented immigrants and 18% of citizens.3Although legal immigrants, like other immigrants, spend less on health care and appear to be healthier than citizens, that appearance may be attributable in part to undiagnosed illnesses and lack of access to a regular source of care.4There are many reasons why legal immigrants have low rates of health insurance. They are more likely to work in sectors of the economy, such as agriculture, that tend not to provide health insurance. Linguistic and cultural barriers also limit their access, as do laws barring them from public insurance programs.There is no evidence that immigrants are excessive users of public benefits. Nevertheless, responding to the charge that immigration burdens taxpayers, Congress in 1996 enacted the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA), which barred most legal immigrants from Medicaid and other federal health programs for the first 5 years after they attain their lawful status. PRWORA also permanently prohibited undocumented immigrants and several other classes of noncitizens, such as persons with temporary administrative status, from receiving federal benefits.Since 1996, Congress has permitted federal funds to be used to insure noncitizen children and pregnant women. PRWORA also allows states to use their own money to insure immigrants who are ineligible for federal programs. Sixteen states and the District of Columbia do so.5 However, state-funded programs for immigrants (who cannot vote) are often the first programs cut when state budgets are tight.Although Congress has broad authority over immigration and can discriminate against legal immigrants, legal aliens are a protected class for purposes of the Equal Protection Clause of the U.S. Constitution. As a result, courts reviewing challenges to laws that are discriminatory against legal immigrants apply strict judicial scrutiny, the most stringent form of judicial review, and find the laws unconstitutional unless they are necessary to further a compelling state interest. Discriminatory state laws may also violate state constitutions.Two recent cases demonstrate how courts look at state laws eliminating legal immigrants' access to state health programs — in different ways, depending on whether those programs insure only immigrants or citizens as well. Finch v. Commonwealth Health Insurance Connector Authority(Massachusetts Supreme Judicial Court, 2012, 2011) was a class action brought under the Massachusetts constitution by legal immigrants who challenged a 2009 state law excluding them from Commonwealth Care, a state-subsidized premium-support program established by the Massachusetts 2006 health care reform law. Initially, all legal residents with incomes under 300% of the federal poverty level who lacked access to other forms of health insurance were eligible for Commonwealth Care. After the 2008 financial crisis, the state excluded immigrants for whom it could not receive any federal support owing to PRWORA. The state simultaneously established a program with a more limited network of health care providers for immigrants who had been removed from Commonwealth Care, but that program was closed to noncitizens who first sought coverage after July 2009.Since Commonwealth Care insured both immigrants and citizens, the Massachusetts Supreme Judicial Court saw the immigrants' exclusion as discriminating against them in favor of citizens. In 2011, Justice Francis X. Spina, writing for a five-to-three majority, ruled that the discrimination was subject to strict scrutiny under the state constitution. He added that PRWORA left the decision about whether to insure immigrants with state funds up to the state and did not justify less-searching judicial review. The next year, a unanimous Court, in an opinion by Justice Robert Cordy, ruled that the immigrants had been terminated from Commonwealth Care for fiscal reasons, which did not constitute a compelling state interest. As a result, the exclusion of the immigrants from Commonwealth Care was unconstitutional.Bruns v. Mayhew (Federal District Court, Maine, March 14, 2013), in contrast, was a class action brought in federal district court by Hans Bruns, a legal permanent resident with adenoid cystic carcinoma, and Kadra Hassan, an asylum seeker with end-stage renal disease. Both had been insured by a program that used state funds to provide immigrants with insurance comparable to Medicaid. When Maine eliminated the program, the plaintiffs sued, claiming a violation of the federal Constitution. In March, Federal Judge John A. Woodcock, Jr. denied the plaintiffs' request for a preliminary injunction. The judge found that unlike the program in Finch, the program at issue was a separate program, limited to immigrants. As a result, its termination did not put immigrants at a disadvantage as compared with citizens. An appeal is now pending.Regardless of the appellate court's decision, once the relevant provisions of the Affordable Care Act (ACA) are implemented in 2014, legal immigrants will be eligible for tax subsidies and credits to purchase insurance through the newly established health insurance exchanges. Ironically, in states that choose not to expand their Medicaid programs — an option the Supreme Court gave states in its ACA decision last summer — legal immigrants with incomes below 100% of the federal poverty level may have greater access to insurance than will low-income citizens: the drafters of the ACA assumed that citizens with such low incomes would receive Medicaid and therefore left them, but not legal immigrants, without support for purchasing insurance on the exchanges. It remains to be seen, however, whether the insurance on the exchanges will be affordable to such low-income immigrants. Moreover, medically frail and disabled low-income legal immigrants will continue to lack access to Medicaid's coverage for long-term care. As a result, many immigrants will remain dependent on state programs that continue to be susceptible to fiscal pressures. More litigation is likely.Public policies that deny legal immigrants equal access to public insurance programs leave lawful residents and their health care providers unnecessarily vulnerable when injuries and illness strike. By encouraging immigrant-only programs, such policies also perpetuate needless complexity in the health care system. Only by offering legal immigrants the same coverage as citizens can we ensure their health security and establish a more rational health care system.Disclosure forms provided by the author are available with the full text of this article at NEJM.org.This article was published on July 24, 2013, at NEJM.org.SOURCE INFORMATION
From Northeastern University School of Law, Boston.
Friday, 2 August 2013
Listen, learn from others
RWJF News Digest: Vulnerable Populations
This frequently updated news digest on the subject of Vulnerable Populations showcases select articles from major journals, news publications and blogs. Articles within this digest highlight the integral relationship between our health and how and where we live, work, learn and play. The digest is a free service of the Robert Wood Johnson Foundation.
Status and Stress
The New York Times, Moises Velasquez-Manoff, 07/27/2013
Although professionals may bemoan their long work hours and high-pressure careers, really, there’s stress, and then there’s Stress with a capital “S.” The former can be considered a manageable if unpleasant part of life; in the right amount, it may even strengthen one’s mettle. The latter kills. What’s the difference? Scientists have settled on an oddly subjective explanation: the more helpless one feels when facing a given stressor, they argue, the more toxic that stressor’s effects. Perhaps most devastating, the stress of poverty early in life can have consequences that last into adulthood. The British epidemiologist Michael Marmot calls the phenomenon “status syndrome.” He’s studied British civil servants who work in a rigid hierarchy for decades, and found that accounting for the usual suspects — smoking, diet and access to health care — won’t completely abolish the effect. There’s a direct relationship among health, well-being and one’s place in the greater scheme. “The higher you are in the social hierarchy,” he says, “the better your health.”
The New York Times, Moises Velasquez-Manoff, 07/27/2013
Although professionals may bemoan their long work hours and high-pressure careers, really, there’s stress, and then there’s Stress with a capital “S.” The former can be considered a manageable if unpleasant part of life; in the right amount, it may even strengthen one’s mettle. The latter kills. What’s the difference? Scientists have settled on an oddly subjective explanation: the more helpless one feels when facing a given stressor, they argue, the more toxic that stressor’s effects. Perhaps most devastating, the stress of poverty early in life can have consequences that last into adulthood. The British epidemiologist Michael Marmot calls the phenomenon “status syndrome.” He’s studied British civil servants who work in a rigid hierarchy for decades, and found that accounting for the usual suspects — smoking, diet and access to health care — won’t completely abolish the effect. There’s a direct relationship among health, well-being and one’s place in the greater scheme. “The higher you are in the social hierarchy,” he says, “the better your health.”
Q: What If We Treat Violence Like An Epidemic Disease? A: We Could Put Violence Into The Past!
TEDMED, Gary Slutkin, M.D., 07/30/2013
Dr. Slutkin writes: What if we, as public health professionals, approached violence as a public health problem in a serious way? What if we, as public health professionals, approached violence as a problem that we can treat with health interventions and prevent using science based solutions? I asked myself those questions when we launched the Cure Violence model of violence reduction 15 years ago. Following more than 10 years of fighting health epidemics in Africa and Asia, I returned to the United States and began to notice parallels between the trajectory of violence plaguing U.S. cities and the trajectory of diseases plaguing the communities in which I previously worked abroad.
Editor's Note: Cure Violence is a RWJF grantee.
TEDMED, Gary Slutkin, M.D., 07/30/2013
Dr. Slutkin writes: What if we, as public health professionals, approached violence as a public health problem in a serious way? What if we, as public health professionals, approached violence as a problem that we can treat with health interventions and prevent using science based solutions? I asked myself those questions when we launched the Cure Violence model of violence reduction 15 years ago. Following more than 10 years of fighting health epidemics in Africa and Asia, I returned to the United States and began to notice parallels between the trajectory of violence plaguing U.S. cities and the trajectory of diseases plaguing the communities in which I previously worked abroad.
Editor's Note: Cure Violence is a RWJF grantee.
Kids’ Lawyer Puts Out Shingle—At The Hospital
New Haven Independent, Brianne Bowen, 07/30/2013
The child came to the hospital to see a doctor to treat muscular dystrophy. It turned out the child needed to see a lawyer too—and found one without leaving the building. That was able to happen because of a new in-house law office at Yale-New Haven Hospital dedicated solely to remedying poverty-related legal problems for pediatric patients—problems that can sometimes contribute to medical problems as well. Since the law office – called a medical legal partnership – opened in June, Yale-New Haven has sought to tackle both kinds of problems in tandem.
Editor's Note: The National Center for Medical-Legal Partnership (referred to in the article) is a RWJF grantee.
New Haven Independent, Brianne Bowen, 07/30/2013
The child came to the hospital to see a doctor to treat muscular dystrophy. It turned out the child needed to see a lawyer too—and found one without leaving the building. That was able to happen because of a new in-house law office at Yale-New Haven Hospital dedicated solely to remedying poverty-related legal problems for pediatric patients—problems that can sometimes contribute to medical problems as well. Since the law office – called a medical legal partnership – opened in June, Yale-New Haven has sought to tackle both kinds of problems in tandem.
Editor's Note: The National Center for Medical-Legal Partnership (referred to in the article) is a RWJF grantee.
Can Ex-Offenders Stop The Spread Of Gun Violence?
WYPR.org (Baltimore), Mary Rose Madden, 07/29/2013
James Timpson of Safe Streets has been working on the issue of gun violence for years. Contrary to what some may assume, he says, it isn’t all gang related, but could be “a simple argument over a can of soda or you owe me a dollar.” But what to do about it? Timpson looks at gun violence through a different lens. Rather than focusing on illegal guns or getting the police involved, he’s part of a team, Safe Streets, that focuses on the abnormal behavior behind picking up a gun to solve a dispute. Gary Slutkin, the founder and executive director of Cure Violence – the Chicago model for Safe Streets and other programs like it, says the health department is the logical place for the program.
Editor’s Note: Cure Violence is a RWJF grantee.
WYPR.org (Baltimore), Mary Rose Madden, 07/29/2013
James Timpson of Safe Streets has been working on the issue of gun violence for years. Contrary to what some may assume, he says, it isn’t all gang related, but could be “a simple argument over a can of soda or you owe me a dollar.” But what to do about it? Timpson looks at gun violence through a different lens. Rather than focusing on illegal guns or getting the police involved, he’s part of a team, Safe Streets, that focuses on the abnormal behavior behind picking up a gun to solve a dispute. Gary Slutkin, the founder and executive director of Cure Violence – the Chicago model for Safe Streets and other programs like it, says the health department is the logical place for the program.
Editor’s Note: Cure Violence is a RWJF grantee.
Childhood Economic Status Affects Substance Use Among Young Adults
HealthCanal.com, 07/30/2013
Children who grow up in poverty are more likely than wealthier children to smoke cigarettes, but they are less likely to binge drink and are no more prone to use marijuana, according to researchers at Duke Medicine. The researchers also found that economic strains in early life – including family worries about paying bills or needing to sell possessions for cash – independently erode a child’s self-control, regardless of strong parenting in adolescence. Lack of self-control often leads to substance use. The findings, appearing July 30, 2013, in the Journal of Pediatric Psychology, debunk common assumptions about who abuses substances, and provide a basis for better approaches to prevent young people from falling into drug and alcohol addiction.
HealthCanal.com, 07/30/2013
Children who grow up in poverty are more likely than wealthier children to smoke cigarettes, but they are less likely to binge drink and are no more prone to use marijuana, according to researchers at Duke Medicine. The researchers also found that economic strains in early life – including family worries about paying bills or needing to sell possessions for cash – independently erode a child’s self-control, regardless of strong parenting in adolescence. Lack of self-control often leads to substance use. The findings, appearing July 30, 2013, in the Journal of Pediatric Psychology, debunk common assumptions about who abuses substances, and provide a basis for better approaches to prevent young people from falling into drug and alcohol addiction.
RWJF Invests $1.2M In BCT Partners And Frontline Solutions To Improve The Health And Success Of Young Men Of Color
Barber Shop Magazine, Dallas Xavier Evans, 07/24/2013
BCT Partners and Frontline Solutions announced today that they have been awarded $1.2 million to provide advisory services and national technical assistance on behalf of the Robert Wood Johnson Foundation’s $9.5 million Forward Promise initiative. Forward Promise aims to vastly expand the potential for boys and young men of color to grow up healthy, obtain a good education, and find meaningful employment.
Barber Shop Magazine, Dallas Xavier Evans, 07/24/2013
BCT Partners and Frontline Solutions announced today that they have been awarded $1.2 million to provide advisory services and national technical assistance on behalf of the Robert Wood Johnson Foundation’s $9.5 million Forward Promise initiative. Forward Promise aims to vastly expand the potential for boys and young men of color to grow up healthy, obtain a good education, and find meaningful employment.
Wow Of The Week: Could Rethinking Traditional Nursing Home Model Improve Senior Health?
MedCity News, Stephanie Baum, 07/27/2013
In an effort to move away from the traditional model of a nursing home, a nonprofit organization has developed an alternative — smaller scale housing for elderly residents. They’re referred to as Green Houses. The idea is that small homes of roughly 10 residents can improve social interaction and the quality of life and health of its residents. And that could reduce healthcare costs.
Editor’s Note: The Green House Project is a RWJF grantee.
MedCity News, Stephanie Baum, 07/27/2013
In an effort to move away from the traditional model of a nursing home, a nonprofit organization has developed an alternative — smaller scale housing for elderly residents. They’re referred to as Green Houses. The idea is that small homes of roughly 10 residents can improve social interaction and the quality of life and health of its residents. And that could reduce healthcare costs.
Editor’s Note: The Green House Project is a RWJF grantee.
Solving the Hiring Disconnect: Focus on Skills
We first met Alexandra when she graduated from high school in Santa Fe, New Mexico, in 2012. Raised by a single mother who speaks little English, Alexandra was determined to fulfill her dream of becoming a doctor. In her senior year, she participated in a program sponsored by CHRISTUS St. Vincent's Hospital and New Options Project partnerInnovate+Educate that helps young adults in New Mexico to enter the healthcare sector. The program required Alexandra to take a skills-based assessment, or a test that measures her work-ready skills. As a result of taking the assessment, she was able to get a job working for St. Vincent’s as a medical assistant while she attends community college.
Next fall, she will enroll at the University of New Mexico and become the first person in her family to attend a four-year college.
Had the hospital not valued Alexandra’s skills—and had Alexandra not been able to prove that she had them—it’s likely that she would have been overlooked as a qualified job candidate.
Fortunately, there is growing excitement for skills-based hiring. It is increasingly seen as a more reliable alternative to traditional hiring practices that focus on a candidate’s degree, resume and experience to predict his or her potential to succeed on the job. More than a welcome expansion of the applicant pool, this new approach addresses a widespread disconnect in the hiring landscape: Despite the high unemployment rate, many employers still struggle to fill open positions—more than 3 million jobs across the U.S. go unfulfilled. Employers simply can’t find enough candidates with the necessary skills for the job. Many others find the employees they’ve hired are unable to do the work for the position.
That’s why the New Options Project and our partner Innovate+Educate are working to change the way employers think about talent. In particular, we view out-of-school, job-seeking young adults who are typically overlooked by traditional hiring methods as economic assets, not social liabilities. Some of the leading voices in educationand business—including Bill Gates, the Aspen Institute, The National Skills Coalition and the White House— agree with this view, and have implemented similar programs bolstering skill-building and skills-based hiring.
The results speak for themselves. Research by Innovate+Educate shows that employers who have incorporated skills-based hiring into their practices have seen a 25-75% reduction in turnover, 50-70% reduction in time to hire, 70% reduction in cost-to-hire and a 50% reduction in time to train. In short, skills-based hiring is five times more predictive of success on the job than hiring by degree alone. A win-win for youth and employers!
Ultimately, our hope is that this method will help to level the playing field and give everyone a shot at having a fulfilling career regardless of past education or work experience.
Innovate+Educate’s strategy has been to work directly with communities and regions to develop a skills-based credentialing system for youth and employers, which allows for greater transparency for both the employer and the candidate. Innovate+Educate also trains HR staff to advertise job openings by skill score and match applicants’ submitted scores to available positions. And for applicants who don’t score as high as they’d like, Innovate+Educate works with local partners to offer Skill Up Centers. In the coming weeks, the City of Albuquerque will formally launch Talent Albuquerque, its partnership with Innovate+Educate, to implement skills-based hiring, including free skills assessments for job-seekers.
Have you had experience with skills training programs or skills-based hiring? Tell us about it over Twitter@NewOptions4Work.
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