by Maysoun Freij, Jenny Rejeske, Adam Gurvitch, Amanda Ferrandino, and Linda Weiss
description
Transcript of by Maysoun Freij, Jenny Rejeske, Adam Gurvitch, Amanda Ferrandino, and Linda Weiss
“MUTUAL RESPONSIBILITY”:
A STUDY OF UNINSURED IMMIGRANT
PERSPECTIVES ON HEALTH INSURANCE IN
NEW YORK CITY by Maysoun Freij, Jenny Rejeske, Adam
Gurvitch, Amanda Ferrandino, and Linda Weiss
Participating Organizations
New York Immigration Coalition New York Academy of Medicine United Hospital Fund
Korean Community Services Shorefront YM-YWHA El Centro Del Inmigrante
Background
In New York State: 29% of uninsured under age 65 are non-
citizens 18% of UHF’s 2005 Estimate of Eligible
but Uninsured (EBU) are Non-Citizens (140,000 out of 800,000 EBUs)
Non-citizens are nearly three times more likely than citizens to be uninsured (34% versus 11% respectively).
Purpose of Study
To inform policy discussions about: How to optimize immigrant enrollment in
current health insurance programs. How to design coverage expansions that are
appropriate for immigrant populations. Offer enrollers and outreach workers
understanding of immigrant concerns about health coverage in order to promote informed decision making and overcome widespread reluctance to enroll.
Methods and Analysis
Qualitative Data Collection Six focus groups
2 Spanish 2 Russian 2 Korean
10 enroller/ health advocate interviews
Analysis Coded using NVivo software Analyzed for themes and patterns
Distribution of Participants
53 uninsured participants were screened and surveyed for participation in focus groups Participants were assigned to focus groups
based on their eligibility for public insurance. Number of Focus Group Participants by Insurance Eligibility Category
N=48
Eligibility Category Korean (n=22)
Russian (n=14)
Spanish (n=12) Total
Eligible but Uninsured 14 7 2 23 Ineligible: Over-income 8 7 0 15 Ineligible: Due to Immigration Status 0 0 10 10
Distribution of Participants continued:Enroller/ Health Advocacy Interviews
(N=10)
2 Russian 2 Korean 1 Spanish 1 Arab 1 Balkan 1 Haitian 1 South Asian 1 general population
Findings
Similarities/differences Among 3 ethnic groups: Russian/
Korean/ Spanish Between those eligible for public
insurance & those ineligible based on income or immigration status
Between immigrants and general population
Cross Ethnic Group Differences
Spanish: Mostly likely to report experiencing
discrimination when seeking health care Korean:
Most concerned that using public health insurance may affect immigration status
Only participants to report association between social stigma and public insurance
Russian: Most likely to report relying on non-
practicing medical providers from home country.
Cross Ethnic Group Similarities Avoided seeking health care because
they lacked insurance Feared cost of health care
Faced language barriers Sought health care on visits to home
country Received medicine from home country
Wanted health insurance Favored government health insurance for all Favored sharing costs of premium
Eligible vs. Ineligible for Public Insurance
Differences: Among those over income for public insurance
Koreans more likely to have purchased private insurance in past
Russians more likely to have had employer based coverage in past
Among those ineligible due to immigration status More likely to experience discrimination
Similarities between both eligible and ineligible: Concern about cost and quality of coverage
Among the Eligible but Uninsured Barriers to public insurance
enrollment included: Lack of information about eligibility
Recertification problems Documentation of income Immigrant specific Issues
Immigrant vs. General Population
Immigrant Differences: Concern about consequences to
immigration status from using public insurance and/or medical debt Public Charge and Sponsor Liability
Language and cultural barriers when navigating the health insurance system
Trusting the government
Example: Public Charge
A Korean man who was eligible for public insurance but not enrolled explained:
“I used to have Medicaid, but terminated it when someone told me that I shouldn’t
use such benefits...I even have diabetes, and need more than
$150 just to pay for my medications.”
Example: Sponsor Liability
One enroller recalled the following case:
“I know a guy who is Spanish and his wife is Yemeni. Her mother came to visit, and had an emergency case. They were scared to take her to the hospital. I told him to trust
me and to get Emergency Medicaid. He didn’t and so went online to make sure it
was true. She got Medicaid and was in the hospital for 4 days. It was kidney failure, so
it was really serious.”
Example: Language/ Cultural Barriers
A Korean health advocate explained:
“They need help. It’s as simple as that. They don’t have confidence in their
linguistic ability and – it even sounds like a cliché at this point – but navigating the
health care system in the U.S., even if you are fluent in English is such a damn hard thing to do, excuse my language.”
Example: Trusting the Government
South Asian Health Advocate explained:
“They ask me, ‘are you SURE?’ ‘Can you guarantee that won’t happen?’ And I’m like, well… I personally don’t feel very confident
[telling them it’s safe to use public benefits]. I mean, I let them know that technically it’s not going to happen… we have never heard about anyone being arrested or denied for
these things… But, I just wonder.”
Similarities with the General Population
Cost of health care without insurance Cost of purchasing insurance Impact of economic crisis Issues with documentation of income
Self attestation
Issues to Consider: Immigrant Specific Proactively address immigrants’ concerns about
the potential consequences of enrolling in public health insurance (e.g. public charge, sponsor liability). Clear and consistent messages, including from
government. Promote linguistically and culturally appropriate
communication throughout the health insurance system, including at enrollment and renewal of coverage.
Increase resources for community based health advocates who help immigrants navigate the health insurance and health care system.
Issues to Consider: Overlap with General
Population Continue to promote the availability of
public health insurance coverage. Simplify and reduce the documentation
necessary to enroll in public health insurance and maintain coverage. State should continue to allow the use of
self-attestation of income Eliminate documentation when 3rd party
match is available
Issues to Consider: Overlap with General
Population Create an affordable buy-in option for
comprehensive public health insurance. Include those left out of federal health
reform e.g. non-immigrant visa holders &
undocumented immigrants
Contacts For Further Information
Maysoun Freij, PhD, MPHSenior Researcher/ EvaluatorNew York Academy of [email protected] / 212-822-7377
Jenny Rejeske, MSHealth Advocacy Coordinator
New York Immigration [email protected] / 212-627-2227 x 223