As I explored in this piece two years ago, the Latinx community made great gains because of the Affordable Care Act (ACA). The uninsured rate among Latinxs dropped from 43 percent in 2010 to less than 25 percent in 2016, with four million more Latinxs obtaining health insurance. The ACA also created new consumer protections, including a prohibition on discrimination in health programs and activities (including Medicaid) based on race, ethnicity, national origin, age, disability, and sex. These new guarantees also included a new host of benefits, like maternity care, preventive care, mental health services, and others. All of these components and features particularly benefitted Latinxs.
The Trump administration, however, is working to wipe out these achievements, and move radically on a direct attack towards the Latinx community. For example, the administration just announced its attempt to re-write a longstanding immigration law provision that has shielded individuals and families seeking to immigrate to the U.S. from accessing vital federal government programs, such as Medicaid. The Department of Homeland Security – in a cruel effort to confuse, intimidate, and discourage people seeking to secure legalization in the U.S. – has proposed re-making the “public charge” immigration provision to allow federal immigration officials to consider the use of Medicaid and other federally funded public programs for other vital, basic needs like shelter and food, in blocking people from immigrating or preventing them from obtaining permanent legal residency.
And while the Trump administration and its Republican enablers in Congress have, so far, failed on multiple occasions to repeal the Affordable Care and severally cut Medicaid, the administration continues to sabotage ACA protections and coverage. A tax measure that was enacted at the end of last year eliminated the penalty for those who do not have health insurance through the Affordable Care Act. Without an enforceable mandate, as predicted by the Congressional Budget Office, premiums are on the rise and less people will be enrolling in the marketplaces, among them the one million Latinxs who gained coverage. The consequences of these decisions fall upon the Latinx community specifically. According to a Commonwealth Fund survey from May, the uninsured rate for nonelderly Latinx adults is at 32 percent, compared to 25 percent in 2016. Indeed, the health insurance disparities between Latinxs and whites has increased in the last year.
The administration is also making major moves to diminish the Medicaid program. First, it is pushing for “work and community engagement” requirements for Medicaid recipients, which are insensible, unnecessary, burdensome, and harmful to low-income families and communities of color. Women of color, including Latinas, are more likely to be employed as domestic workers or in other informal job settings, where there are no timesheets, pay stubs, or other forms of documentation to show their employment status. They are also more likely to be unemployed and have longer periods of unemployment compared to whites. Hence, coverage cuts as a result of these requirements are more likely to affect them. Further, these policies prey on historical stereotypes that stigmatize people of color, including Latinxs.
Outreach efforts, which greatly helped with Latinx enrollment into health insurance programs, have been slashed. The ACA created navigator programs to provide education and enrollment to people who are likely eligible for Medicaid and the marketplaces. This year, the Center for Medicare and Medicaid Services is spending only $10 million for navigator activities during the 2019 enrollment and plan year, $36 million less than last year, and 34 percent less than the Obama administration allocated for the 2017 plan year enrollment.
This summer, the administration proposed to change Title X, the only federal program solely dedicated to providing family planning and related preventive services. Latinxs comprise 32 percent of the population served by this program and 13 percent of Title X patients are Limited English Proficient. Title X health care providers also offer services for foreign-born individuals who are less likely to have coverage. Along with others, the Latinx population will no longer have the comprehensive critical care that it has received for almost 50 years. By placing onerous requirements to providers and loosening protections on reproductive health care access and information, Latinxs will be disproportionately and severely harmed by the coming rules.
During Hispanic Heritage Month, National Health Law Program calls on Latinx communities to watch for introduction and implementation of measures intended to severely limit their access to quality health care coverage. Even with the advances achieved via the ACA, Latinxs still have the lowest health coverage rates than any other racial population in the U.S. With ongoing threats from Trump and the right-wing movement, health disparities that were previously narrowed are likely to widen again.