Q&a: Getting Api Small Business Owners to Enroll in Health Insurance Exchange

Editor's Note: Asian Americans own 5.7 percent of all businesses nationwide and 11 percent of small businesses. The majority of these small businesses have no paid employees, so the owners cannot take advantage of federal tax credits offered by the Exchanges or online health insurance marketplaces. Kathy Ko Chin, executive director of the Asian and Pacific Islander American Health Forum (APIAHF), a national health justice organization, talks to New America Media health editor, Viji Sundaram, about the importance of reaching out to these business owners.

NAM: What are Asian American and Pacific Islander (AAPI) organizations such as yours doing to get their communities to enroll in Covered California, the state's health insurance exchange?

APIAHF: Several organizations in California, including Asian Americans Advancing Justice – Los Angeles and the California Pan-Ethnic Health Network have been advocating for months and trying to work with Covered California to provide education and assistance about Obamacare, including how to enroll in health insurance coverage, in culturally and linguistically appropriate ways. As a national organization, APIAHF has been advocating for full implementation of health reform, focusing primarily on ensuring that the federally facilitated Exchanges are accessible for people who do not speak English, or don't speak the language very well, and for immigrants who will face additional enrollment barriers.

Many AAPI community-based organizations and community health centers in California and other states are doing their own outreach to help get individuals enrolled in the communities they serve. They have been using a variety of ways to do outreach and education, including creating their own educational materials in various languages for individuals/clients/patients they already serve and organizing town hall meetings and focus groups. APIAHF has developed several outreach materials including fact sheets, FAQs, an ACA toolkit for communities, and an "Enrollment Style" video available at our Health Reform Resource Center. We have also partnered with the Centers for Medicare and Medicaid Services (CMS) to translate an educational tool titled, "The Health Care Law and You" into 11 different Asian and Pacific Islander languages that provides an overview of the law's benefits.

NAM: Since the majority of Asian American-owned small businesses have no paid employees, and are therefore not eligible for the small business tax credit, how would you encourage them to enroll on the individual exchange?

APIAHF: If they are not eligible for tax credits, small business owners may still qualify for no-cost health insurance through the expanded Medi-Cal program or, depending on their income, financial assistance to help afford private coverage. These small business owners can find out what plans they are eligible for and what forms of assistance are available for themselves and their families at the individual marketplace website.

NAM: A majority of API small business owners in California will not qualify for coverage through SHOP (Small Business Health Options Program). Should there be a strategy to enroll those of them who are self-employed?

APIAHF: Small business owners will now have access to more affordable health insurance coverage that was not available before through Covered California. In order to get individuals enrolled in coverage, Covered California should engage in targeted marketing strategies using trusted sources of information in the Asian American, Native Hawaiian and Pacific Islander small business community (community-based organizations, community health centers, faith-based organizations and various forms of ethnic media) to: 1) emphasize the importance of having health insurance, 2) explain the new coverage options, and 3) highlight that health insurance is more affordable now because of the Medi-Cal expansion and availability of financial assistance for low- and middle-income individuals and families through the Covered California marketplace.

NAM: Many editorials in major newspapers have criticized the Obama administration of doing a poor PR job in promoting Obamacare, which is why many states are now scrambling to do outreach, given that Open Enrollment on the Exchange and in Medicaid (Medi-Cal in Calif.) is just around the corner. Do you agree with the critics?

APIAHF: A "poor PR job" is not the reason why states are concentrating efforts on outreach. The Affordable Care Act represents a dramatic shift in how Americans can and will access health care and health insurance. These are systemic changes that will forever change the way we obtain and understand health care. Change takes time, and while millions have already benefited from Obamacare, millions more will gain health insurance for the first time in just the next few months.

NAM: When the ACA was being drafted, did APIAHF lobby the Obama administration to do away with the five-year waiting period for immigrants to qualify for public health programs?

APIAHF: We have been longtime advocates for eliminating the 5-year waiting period. We advocated against its formation in the Personal Responsibility and Work Opportunity Act (PRWORA) in 1996, and have used every available legislative opportunity to eliminate the waiting period including most recently the Senate-passed immigration reform bill. Fortunately, some states such as California and New York use state dollars to provide these immigrants with health insurance coverage. In addition, immigrants subject to the 5-year waiting period are eligible for premium assistance to purchase health insurance plans offered through the marketplaces.

NAM: On your website, you talk about mixed status families and the Exchanges, how such a status will "only add confusion and delay, and even erroneous denials of enrollment." Could you explain what you mean by that?

APIAHF: Eligibility determinations based on immigration status can be very complicated due to the patchwork of restrictive laws and regulations, even for trained eligibility staff. The most common composition of a mixed immigration status family is of an undocumented parent with U.S.-born children. While the children are eligible for safety-net programs like Medi-Cal or SNAP (formerly known as food stamps) because they are citizens, the undocumented parent is generally not eligible, yet that parent must often complete application forms on his/her child's behalf. While there are protections and guidance in place for individuals applying for benefits on another person's behalf, most immigrant applicants and many program staff are unaware of these protections, and, based on past experience with enrollment into other public programs, turn individuals away due to assumptions about what information is required for beneficiaries vs. a parent completing the application on a child's behalf. Additionally, research by the Center on Budget and Policy Priorities indicated that families with mixed immigration status did not enroll in Medicaid coverage when states used online applications—the primary method of enrollment for the health insurance marketplace—indicating that this will be a serious challenge moving forward.

NAM: What would you like to see included in the immigration reform bill now debated in Congress that would benefit the APIAHF communities in terms of health care?

APIAHF: Our vision for health equity in immigration reform is for parity in access to health care and health insurance for everyone, regardless of immigration status. Our top policy priority is for the elimination of the five-year waiting period for legal permanent residents who are hardworking, paying taxes and call America home. We also hope newly legalized immigrants (referred to as provisional immigrants in S. 744) are provided the same access and affordability options as lawfully present immigrants and citizens so that they can stay healthy and continue to contribute to their communities.