Major Legislative Milestones in US Immigration History - New York ...

More documents

Recommendations

Info

It would strategically utilize existing capacity in the health care system.Concerns This option would require matching individuals with medical providersdirectly, which could involve additional administrative complexity andresources. FQHCs and rural and migrant health centers provide preventive and primarycare services, but may not provide vision or dental care, and generallydo not provide emergency or acute care. However, in many areas of theUnited States these clinics are the only available source of care to uninsuredindividuals. Some form of wrap-around coverage might be necessaryto reimburse providers for catastrophic health care expenses; the federalgovernment’s “emergency Medicaid” program currently serves this function. Patients’ advocates distrust proposals that appear to channel individualsinto the public health care system, fearing a two-tiered system. However,the reality for most uninsured US residents is that private health care isunaffordable and inaccessible. This population ultimately ends up receivingcare from public providers, if it receives care at all. Assignment to a “medicalhome” would not preclude the participation of private providers orlimit participants’ freedom to seek care. It would lack portability — an individual who relocated would need to befinancially screened again and establish a relationship with a new provider. The health care safety net in many areas of the country is over-burdenedand could ill afford to take on large additional numbers of uninsuredpatients. 24Option Three: Pre-Paid Medical CareOption Three would be the same as Option Two, with the addition of an annualassessment — for instance $500 to $1,000 — paid into a pool by employersand workers. The pool could allocate this money to the local FQHC or othercomparable safety net health care provider. As above, participants would makecontact with their “medical home” — an outpatient clinic — and receive a24 The reimbursement rates that hospitals and clinics receive from Medicaid and Medicare for providingmany outpatient services have lagged behind medical inflation for decades, resulting in fundamental structuraldeficiencies.176S ecuring the Future: US Immigrant Integration Policy
medical exam and needed care. Payment would occur either by redeeming acoupon or through a pre-paid clinic card provided to participants in an immigrationreform program.The medical fees would be determined on a sliding-scale basis, as is currentlythe case for any other low- or moderate-income patient, and the providerwould draw down from the pre-paid assessment. If a participant required morecare during the period than the pre-paid assessment covered, he or she couldthen pay the provider’s prevailing sliding-scale charges out of pocket, like anyoneelse. If, at the end of the year, the participant had not utilized care in theamount of the pre-paid assessment, the remainder could revert to the safety netprovider or be rolled over into a future period.Pre-paid medical care would not constitute insurance coverage; instead itwould establish a financial relationship directly between the patient and thehealth provider. Under this option, the individual would be asked to pay asliding-scale rate to the health provider for any medical care used in excessof the pre-paid amount. This option would allow decisions about what medicalcare was needed to be made by health care providers, rather than bymanaged care administrators, whose profit motives and duties to shareholderscan be at odds with the fundamental aim of providing appropriate medicalcare to patients.In addition to the advantages and concerns set out under Option Two, “SafetyNet Medical Home,” this option would require making direct transfers ofemployee and employer assessments to medical providers, which would involveadditional administrative complexity.Option Four: Newly Created Insurance ProgramWith government assistance, small businesses and other employers that do notcurrently provide employee health benefits could join together to form newlycreated health insurance programs for pooled employees. Participants in animmigration reform program could be encouraged or required to enroll, andgroup-rated premiums would be paid by assessments or contributions fromemployees and employers. These new insurance products could also be openedup to other uninsured US residents, including workers who are classified byemployers as temporary, contingent, or part-time employees, who do not receiveprevailing benefits, and who cannot afford to pay out-of-pocket for healthcare.New York State offers small employers, sole proprietors, and uninsured workingindividuals the opportunity to purchase health insurance coverage throughA ppendix II 177
Page 1 and 2: APPENDIX IMajor Legislative Milesto
Page 3 and 4: APPENDIX IIAccess to Health Careaft
Page 5 and 6: under immigration reform will need
Page 7 and 8: younger than 19. 9 The program allo
Page 9 and 10: Health providers could adapt their
Page 11: ical home” would ensure that unin
Page 15 and 16: no payment system in place and many
Page 17 and 18: gency room care. 34 Linguistic isol
Page 19 and 20: een new initiatives in several Euro
Page 21 and 22: 2001 were estimated to be limited E
Page 23 and 24: About the Editor andContributorsMic
Page 25 and 26: the United States, legal and illega
Page 27: The Contributions of High-Skilled I

Major Legislative Milestones in US Immigration History - New York ...

Create successful ePaper yourself

Delete template?

Save as template?