Trump’s legacy has grown as he seeks to close the Colorado Hispanic insurance gap

Armando Peniche Rosales has a curved toe that has been predicting the weather for years, becoming sensitive to rain or cold.

“It never healed properly,” said Peniche Rosales, who broke his left toe a few years ago as a high school football player in Denver and left home without seeing a doctor. At the time, he was living in the United States without permission. From the age of 9, when he moved to Denver, until he was 20, he had no health insurance.

The toe is a small reminder of the time his relatives felt they had to “choose between your health or your future” in the United States, said Peniche Rosales, now 35. Both his parents faced this decision. Her mother chose her health, returned to Mexico for treatment of migraine and thyroid disease, although that meant she would have to spend a decade separated from her family. Her father chose her future, working long hours through the symptoms that the free clinic told her she had hemorrhoids but actually had colon cancer.

Rosales’s father in Peniche is now buried in a Denver cemetery with a view of the Rocky Mountains.

“He’s resting in his house the way he wanted to,” said Rosieles in Penicel. “He loved the mountains.”

Nationally and in Colorado, the proportion of people without health insurance is significantly higher among Hispanics than among non-Hispanic whites, blacks, or Asians. Immigrants who do not have legal status and who have legal residence but who have a mixture of immigration conditions in their family make up a large part of that group. Colorado recently made some of them eligible for health coverage, but lawyers working with immigrants say the state faces a challenge: undoing the cool effects of the Trump administration’s policy that some people fear, even those who are eligible, sign up for health insurance. Their abilities – or those of their family members – may be endangered to stay in the country.

“Those who may have considered seeking health care, fearing a possible backlash, be it now or adjusting to future immigration status, have returned to the shadows,” said policymaker Maria Albenil-Rangel, and the Colorado-based Tri-County Health Network Non-profit organizations that work to increase access to healthcare. “Faith is lost. It takes time to rebuild. “

KHN has worked with the Colorado News Collaborative in recent years to examine the state’s progress in tackling racial and ethnic discrimination, including health.

The state health department estimates that about 30% of Hispanic adults have no health coverage. This contrasts with the state average of 12% of Colorado adults who do not have insurance. Most Hispanic Coloradans are citizens or legal residents, but they may face barriers to enrollment, including language and cost.

People living in the United States without authorization are subject to certain restrictions: they may not receive public benefits in most states – unless they land in an emergency room with a life-threatening condition – or purchase health insurance in Affordable Care Act marketplaces. According to the KFF, one-third of uninsured Hispanic residents under the age of 65 are not eligible for ACA coverage, Medicaid, or Children’s Health Insurance programs because of their immigration status.

Colorado has taken steps to change this for certain groups of unauthorized residents living in low-income families. A recently passed law will provide Medicaid and chip coverage to pregnant individuals and children from 2025 onwards. From next year, a law passed in 2020 will use state funds to help some residents living below 138% of the federal poverty level buy health insurance. Individual market. And in 2019 the state joins about a dozen others who cover regular dialysis who would otherwise have to wait until they get so sick that they will land in the emergency department.

Dr. Lilia Cervantes, director of immigrant health at the University of Colorado School of Medicine and chief counsel for dialysis change, said: About $ 10 million a year, according to the state’s Department of Healthcare Policy and Finance. But he wants to see more people take care of them so they can avoid developing chronic conditions, such as kidney disease.

One photo shows Armando Peniche standing next to a couch at Rosales' house
Armando Peniche Rosales says his parents had to choose between leaving the country to stay in the United States or receiving care without proper health care and being separated from their families.(Aaron Antiverose for KHN)

The data carries the view that, automatically, expanding the pool of people eligible for health insurance is not enough to eliminate inequality in coverage. Nationally, since the Affordable Care Act came into force, coverage rates among ethnic and racial groups have improved, but inequality remains.

“Hispanics gained the most coverage during that time, which helped somewhat narrow the gap, but they were still significantly more likely to be uninsured than whites,” said Samantha Artiga, director of the Ethnic Equity and Health Policy Program at KFF. “And then what we saw in 2017 was that uninsured rates started to rise again.”

Doctors, researchers and advocates for expanding immigrants’ access to health in Colorado suspect the rebound was related to the Trump administration’s immigration policy, which included changes to the public charge rules. Long-term rules determine when someone may be denied a green card or visa because they are likely to be relying on government benefits or are already using them.

The Trump administration has expanded the benefits of food stamps, non-emergency Medicaid, and housing subsidies that could be used to deny someone immigration status.

A study published by the nonprofit Behavioral Sciences Group Ideas42 in the journal Health in 2020 found that the Trump administration’s announcement of a change in public charge rules was associated with a nationwide decline in Medicaid enrollment of an estimated 260,000 children compared to 2017 levels.

Colorado has seen a decline in Hispanic insurance rates. A statewide study by the Colorado Health Institute found that although the state’s overall insurance rate has remained stable since the Affordable Care Act came into force, the insurance rate among Hispanic or Latino Coloradans has increased, especially among children. The institute estimates that in 2015 about 3% of Hispanic or Latino Coloradoans 18 and younger were uninsured, compared to about 8% in 2021. Colorado Children’s Third, says Erin Miller, vice president of health initiatives for the Colorado Children’s Campaign.

The Biden administration has reversed the Trump administration’s 2019 public charge changes in 2021 and is expected to finalize a new public charge rule later this year.

Liz Tansy, a senior manager at the Colorado Community Health Network, said: “But that doesn’t change the fact that many immigrants are really careful about what they can share and with whom.

Most Hispanic and Asian American and Pacific immigrant families polled in 2021 by the Immigrant Rights Coalition Protecting Immigrant Families found that nationally 40% did not hear the opposite. Nearly half of respondents whose families needed help during the epidemic said they refused to apply because of immigration concerns.

Dr. Ricardo Gonzalez-Fischer, a surgical oncologist who works with the social service organization Servicios de la Raja, provides enrollment assistance from a health resource center at the Mexican Consulate in Denver. He sees more than half of the immigrants as uninsured. He said many immigrants tell him that even if they had insurance, they would not use it for fear of getting the wrong kind of attention. “We all have at least one or two unregistered people in our homes and we don’t want them to see us,” Gonzalez-Fischer said.

As a result of recent state law, insurance that unauthorized Coloradans access cannot be counted against them in determining public charges, with one important exception: if children need long-term care, for example, serious disability or chronic illness, says Raina Hetlage, one of the Center for Health Progress. Senior Policy Manager, Denver-based Health Equity Advocacy Group.

Maria Rodriguez, a healthcare equity and outreach specialist at the Colorado Division of Insurance, is the state’s point person to talk about new subsidies to help unauthorized people purchase health insurance. He has arranged meetings with community organizations to prepare for the November 1 open-enrollment date.

In the first year of the subsidy program, the state could enroll about 10,000 unlicensed Coloradans, representing a portion of the state’s unlicensed and uninsured Hispanics.

Colorado still lags behind Washington and California in providing cancer care coverage, which could help Peniche Rosales’ father. Without health insurance or a few thousand dollars to start treatment, he could not take care of it until he found a hospital that would cover it using charitable funds.

A photo shows two pictures of Armando Peniche Rosales' father and family in a photo frame
Armando Peniche Rosales’s father left for the United States to support his family but left without proper medical care. He died of colon cancer.(Aaron Antiverose for KHN)

The night before Peniche Rosales had an interview with the US Citizenship and Immigration Services – an interview that would allow him to stay legally – he had to take his father back to the emergency room. Her father told her to go home and rest.

“She was more concerned about my interview than anything else,” said Rosieles in Penichel. He received his green card while his father was alive. “Even though she was in pain, it brought her a lot of joy.”

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