Trump’s legacy weighs heavily as Colorado seeks to fill the health insurance gap

Armando Peniche Rosales’s toes are crooked, which predicts the weather year after year and becomes sensitive to rain or cold.

“It never healed properly,” said Peniche Rosales, who broke his left toe a few years ago as a Denver high school soccer player and left home without seeing a doctor.

At the time, he was living in the United States without documents. 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 when his family felt that in their country they had to “choose between their health or their future,” said Peniche Rosales, now 35. Both parents faced that decision.

Her mother chose her own health, returned to Mexico for treatment of migraine and thyroid disease, even if it meant spending a decade away from her family. Her father chose her future, working for weeks with symptoms that the free clinic told her he had hemorrhoids but actually had colon cancer.

Rosales’s father in Peniche is now buried in a Denver cemetery overlooking Rocky Mountain.

“He’s resting at home, just like he wanted,” said Rosieles in Penichel. “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 residency but whose families have mixed immigration status, make up a large part of that group.

Colorado recently qualified some of them for health coverage. But advocates working with immigrants say the state faces a challenge: reversing the crippling effects of the Trump administration’s policy, which has raised concerns in some – even among those eligible – that signing up for health insurance could jeopardize their ability, or Their family members, to stay in the country.

Maria Albanil-Ranzel, policy and publicity manager for the Tri-County Health Network, said “for fear of repercussions, either now or in the future immigration system, those who may have been thinking of seeking health care have returned to live in the shadows.” Which works to increase access to healthcare “It simply came to our notice then. It takes time to rebuild. “

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

The state health department estimates that about 30% of Hispanic adults do not have health coverage. This is in contrast to the statewide average of 12% of Colorado adults who are uninsured. Most Hispanic citizens or legal residents of Colorado, however, may face barriers to enrollment, including language and cost.

People living in undocumented countries are subject to certain restrictions: in most states, they cannot access public benefits যদি unless they end up in an emergency room with a life-threatening condition এবং and they cannot buy health insurance at all under the Affordable Care Act (ACA). Market established by.

Armando Peniche Rosales said her parents had to choose between staying in the country or leaving for better care without proper medical care, but separated from the family.(Aaron Antiverose for KHN)

According to the KFF, approximately one-third of Hispanic residents under the age of 65 are not eligible for ACA, Medicaid or Children’s Health Insurance Program (CHIP) coverage because of their immigration status.

Colorado has taken steps to change this for a specific group of unregistered residents living in low-income families.

A recently passed law will provide Medicaid and chip coverage to pregnant women and children from 2025 onwards.

From next year, a law passed in 2020 will use state funds to help some residents living below the federal poverty level (ব্যক্ত 13,590 a year for one person or $ 27,750 a year for a family of four in 2022) to buy insurance. Individual market.

And in 2019, Colorado joins a dozen states that cover regular dialysis for people who might otherwise have to wait to go to their emergency room until they get sick.

“We no longer have 130 patients coming through ER who need urgent dialysis,” said Dr. Lilia Cervantes, director of immigrant health at the University of Colorado School of Medicine and a leading advocate for this change in dialysis services. The state has saved about 10 10 million a year, according to the state Department of Healthcare Finance and Policy.

But Cervantes wants more people to get the care they need to prevent the development of chronic conditions, such as kidney disease.

The data confirms that expanding the pool of people eligible for health insurance alone is not enough to eliminate inequality in coverage. Nationally, since the implementation of the Affordable Care Act, coverage rates have improved across all ethnic and racial groups, but inequality persists.

“Hispanics benefited the most from coverage at the time, which helped reduce some inequality, but they were still significantly more likely to be uninsured than whites. [no hispanos]Says Samantha Artiga, director of the KFF’s Ethnic Equity and Health Policy Program. “And then what we saw in 2017 was that the uninsured rate started rising again.”

Doctors, researchers and advocates for expanding access to healthcare for immigrants in Colorado suspect the increase was related to the Trump administration’s immigration policy, which includes changes to public charge rules. This long-standing rule determines when someone can be denied a green card or visa because it is considered that they are probably relying on government benefits or are already using them.

Armando Peniche Rosales’s father decided to stay in the country to help his family, but he did not receive the health care he needed. He died of colon cancer.(Aaron Antiverose for KHN)

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

A study by Ideas42, a nonprofit behavioral science think tank published in the Journal of Health in 2020, found that the Trump administration’s announcement of a change in public charge rules was associated with a national decline in Medicaid enrollment, about 260,000 fewer children, compared to the 2017 level.

Colorado has seen a decline in insurance rates among Hispanics. A statewide study by the Colorado Institute of Health found that since the ACA came into force, the state’s overall insurance rate has remained stable, with an increase in insurance rates among Hispanics / Latinos in Colorado, especially among children.

The institute estimates that about 3% of Colorado Hispanics or Latins aged 18 and under were uninsured in 2015, compared to about 8% in 2021. About one-third of all Colorado children are Erin Miller, vice president of health initiatives for the Colorado Children’s Campaign.

In 2021, the Biden administration reversed the public charge changes that the Trump administration implemented in 2019, and a new public charge rule is expected to be finalized later this year.

“But that doesn’t change the fact that many immigrants are really wary of what they can share and with whom,” said Liz Tansy, senior manager of the Colorado Community Health Network.

A survey conducted in 2021 by immigrant families, mostly Hispanic and Asian American and Pacific islanders, conducted by the Immigrant Rights Coalition found that, nationally, 40% had not heard of the withdrawal. Nearly half of those surveyed 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 services organization Servicios de la Raja, provides enrollment support from the Health Resource Center at the Mexican Consulate in Denver. He sees more than half of the immigrants as uninsured. He said many of them told him that even if they had insurance, they would not use it for fear of being misled. “We all have at least one or two unregistered people in our house and we don’t want them to see us,” Gonzalez-Fischer said.

As a result of recent state law, insurance accessed by unregistered Coloradans cannot be included in determining the public charges against them, with one significant exception: if children need long-term care, for example, for serious disability or chronic illness, Denver-based Health Equity Advocacy, Raina Hetlage, senior policy manager at For Health Progress, explained.

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 registered individuals buy health insurance. He has arranged a meeting with community entities to prepare for the November 1 open enrollment date.

In the first year of the grant program, the state could enroll about 10,000 unregistered Coloradans, representing only a fraction of the state’s unregistered and uninsured Hispanics.

Colorado still follows Washington and California in providing cancer care coverage, which could help Rosieles’ father in Penichel. Without health insurance or a few thousand dollars to start treatment, he was unable to care until he found a hospital that would cover him with charitable funds.

The night before Peniche Rosales was for an interview with the United States 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.

“I was more concerned about my interview than anything else,” said Peniche Rosales, who received her green card while her father was alive. “Even though she was in pain, it gave her a lot of joy.”

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