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Health Information and Education
The Impact of Health Care Reform on Health Coverage for Asian Americans, Native Hawaiians,and Pacific Islanders
 
Overview
 
Health care reform will provide coverage to countless uninsured and underinsured Asian
Americans, Native Hawaiians, and Pacific Islanders (AAs and NHPIs). More than one in six
Asian Americans and one in five Native Hawaiians and Pacific Islanders are uninsured. An
expanded Medicaid program, new Health Insurance Exchanges, the Pre-existing Condition
Insurance Plan (also known as the High Risk Pools), the Small Business Health Options
Program Exchange, and the extension of coverage for young adults to remain on their
parent’s health plan until age 26, offers our communities new options for affordable quality care.
Most Americans get their health coverage through their employer. AAs and NHPIs are less
likely to have employer-sponsored coverage compared to non-Hispanic Whites, and are more
likely to be uninsured. Native Hawaiians and Pacific Islanders are more likely to be uninsured
and more likely to be on Medicaid than both Asians and non-Hispanic Whites.
There is wide variation in health coverage among AA and NHPI ethnic subgroups, which
correlates with type of employment. Employer coverage rates range from as low as 49
percent among Koreans, almost two-thirds of whom work in small businesses, to a high of 77
percent among Asian Indians.
Reliance on Medicaid and other public coverage ranges from 4 percent among Asian Indians
to 19 percent among Southeast Asians, and uninsured rates range from 12 percent among
Asian Indians to 31 percent among Koreans.
 
Medicaid Expansion
 
Beginning in 2014, Medicaid will be expanded to cover eligible children and families with
incomes at or below 133 percent of the Federal Poverty Level, including childless adults.
Currently, nearly one in 10 Asian Americans and one in four Native Hawaiians and Pacific
Islanders are enrolled in Medicaid. Nearly half of the current uninsured population, or 21
million people, would be eligible for coverage under this expansion. It is difficult to estimate
how many AAs and NHPIs would be newly eligible for Medicaid, but the expansion is
expected to provide the largest increase in the number of people with health insurance than
any other coverage expansion measure in the law. In California alone, it is estimated that
over 140,000 Asian Americans, Native Hawaiians, and Pacific Islanders would be eligible for
coverage under an expanded Medi-Cal program (the state’s Medicaid program).
 
Health Insurance Exch anges
 
Each state will create its own Health Insurance Exchange (HIE), or the federal government will
operate one for them. The HIE will serve as a one-stop marketplace for purchasing insurance
coverage, with all plans containing an “Essential Benefits Package,” which sets the minimum
benefits to be provided. Starting in 2014, individuals and families with incomes between
133 and 400 percent of the Federal Poverty Level will be eligible for subsidies to buy health
insurance in the Exchange. Nearly one in five families who are currently uninsured will be
eligible for subsidies in the Exchange.
 
 
Pre-Existing Condition Insurance Pl an
 
Health care reform established the Pre-existing Condition Insurance Plan (also known
as theHigh-Risk Pools). Prior to health care reform, insurance companies could deny
health coverage to individuals with pre-existing conditions. Now, insurance companies
are prohibited from this type of discrimination, allowing individuals living with chronic
conditions to access the life-saving testing and treatment services that have been
inaccessible to them in the past.
Currently, eligible individuals with chronic diseases can apply for coverage under the “Preexisting
Condition Insurance Plan.” Today, nearly one in five adults with a chronic condition
lacks health insurance coverage. Among Asian Americans, three in 10 are living with
asthma, diabetes or hypertension. AAs and NHPIs are also disproportionately affected by
certain chronic diseases. About 1.3-1.5 million people in the U.S. are chronically infected
with Hepatitis B, the leading cause of liver cancer, with AAs and NHPIs accounting for over 50
percent of the chronic Hepatitis B cases. An estimated 9.4 percent of Asian Americans have
diabetes, with Japanese, Chinese, Filipinos, and Koreans exhibiting higher prevalence rates
than the non-Hispanic White population. In addition, while AAs and NHPIs have lower cancer
rates than non-Hispanic Whites, they experience higher rates of certain kinds of cancer
including lung, breast, cervical, liver and stomach.
It is unknown how many AAs and NHPIs have been denied coverage because of a preexisting
condition, but the Pre-Existing Condition Plan will provide an affordable, quality
coverage option to those who are living with Hepatitis B, diabetes, cancer, heart disease or
other chronic conditions.
 
Small Business Health Options Program Exchange
Many small businesses struggle to provide health coverage for their employees. More than
three-quarters of small business employees in businesses with less than 100 workers are
currently uninsured. Starting in 2014, small businesses with up to 100 employees will be
able to buy health coverage through a state-based Small Business Health Options Program
(SHOP) Exchange. The SHOP Exchange will offer better health coverage options at a lower
price for small businesses than what is currently available. Nearly 18 million small business
employees could gain coverage through the SHOP Exchange.
Health care reform also establishes tax credits to help small businesses pay for health
coverage for their employees. An estimated 4 million small businesses are eligible for
these credits.
Both the SHOP Exchange and small business tax credits will provide relief for the more than
1.5 million Asian American, Native Hawaiian, or Pacific Islander-owned businesses in the U.S.
0an Francisco, CA 94108
Young Adult Coverage
 
Under health care reform, parents can elect to keep their young adult children on their
health plans until age 26. Before health care reform, adult children could be kicked off their
parent’s health plan at age 19 (older if the child was a full-time student). Currently, nearly
one in four Asian American and three in ten Native Hawaiian and Pacific Islander young
adults (18-24 year olds) are uninsured. More than 300,000 AA and NHPI young adults could
gain insurance under this reform.
 
For more information about the health care reform law, please visit our Health Care Reform
Resource Center at www.apiahf.org/hcr