Introduction
In an effort to participate in the healthcare discussions that are dominating our national attention, we've invited Jeffrey Caballero, executive director of the Association of Asian Pacific Community Health Organizations (AAPCHO), to answer a few of our questions.
AAPCHO is a national association of community health organizations that serve Asian and Pacific Islanders (API) across the United States, and its Pacific Island territories and freely associated states. AAPCHO performs multiple tasks for it member organizations including training and education, and serving as the advocate and voice for its membership.
Jeffrey Caballero has led AAPCHO as Executive Director since 1993. In this capacity, Mr. Caballero advocates for programs and policies that increase access to high-quality, comprehensive community health care services that are culturally and linguistically appropriate.
Mr. Caballero participates on numerous national committees that address issues affecting APIs, such as tuberculosis, hepatitis B, diabetes, and cancer. His work experience encompasses a variety of fields, from grassroots organizing, health education, to bone marrow transplant and primary health care. Mr. Caballero has played leading roles in the development of several national plans to reduce health disparities, including Eliminating Hepatitis B in Asian Pacific Islander Communities, Utilization of Health Information Technology to Eliminate Health Disparities, and Development of Patient Centered Medical Homes.
Recently, Mr. Caballero was a featured speaker on the topic of health care reform at the 2009 California Hepatitis Alliance Meeting and at the Asian American Healthcare Conference in Maryland. He also spoke at the US Department of Health and Human Services Office of Minority Health's 2009 World Hepatitis Day in Washington, DC.
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Rather than tackling the complex and thorny issues on how to go about changing our healthcare system, we wanted to get a sense of the current state of API American health, the healthcare system as it pertains API Americans, and why we should care about healthcare reform.
Note that for the purpose of this interview, we will use the nomenclature that AAPCHO and the Office of Management and Budget (OMB) has adopted for describing Asian and Pacific Islander Americans - that being Asian Americans & Native Hawaiians and other Pacific Islanders (AA & NHOPI).
Interview
One of the interesting things that I've learned is that the percentages of uninsured has been relatively level at around 16.7ince 1989, but that since the population is increasing, the actual number of people that are uninsured also increased during this period of time. Do AA & NHOPIs have higher, same, or less percentages of uninsured? Are there any projections that show increasing divergence from the general public?
The percentage of uninsured people in the U.S. is even slightly lower right now than the double-decade average you noted-about 14%, or 1 in 7 Americans in general are uninsured. Compare this to the 1 in 6 Asian Americans and 1 in 4 in Native Hawaiians & Pacific Islanders who are currently uninsured, and you can clearly see the stark disparities in coverage across our communities.
There are several reasons for these higher uninsured rates, all complex and in some ways interconnected. Many Asian Americans own or work in small business that cannot afford to purchase health insurance, for example. Others might live in poverty and thus cannot afford available options to purchase health insurance. For members of either group I mentioned, one's immigration status is an added burden to access, as one must wait to become eligible for Medicaid/Medicare to access affordable care.
Without proper inclusion of some basic amendments that AAPCHO and our national partners have helped shape with our communities in mind, the proposed version of the Senate Finance Committee Health Reform Bill would increase the number of uninsured AA & NHOPI because so many more would not be eligible for subsidies to purchase insurance or Medicaid.
What is the state of our health - are we higher, same, or less healthy than the general public? Another interesting thing I've learned in my research is that the leading cause of death for AA & NHOPIs is cancer and not heart disease like the general populace. Are there other glaring differences such as this? Do AA & NHOPIs have special healthcare needs?
We have health conditions such as hepatitis B, tuberculosis, thalassemia (which is an inherited blood disorders that cause the body to make fewer healthy red blood cells and less hemoglobin than normal. Complications include heart and liver disease, infections, osteoporosis, and other problems.) These conditions and a slew of others are significantly more prevalent in our community than others, yet unfortunately are traditionally under-funded so people are not getting the resources they need to get educated, get screened and get treatment.
Do we have deficiencies in AA & NHOPI healthcare givers? Do cultural and language differences require us to have more AA & NHOPI workers?
Culturally and linguistically appropriate health care is such a critical piece of building, protecting and sustaining a community's health, which is why our member health centers across the country play such significant roles in their neighborhoods and beyond. Community health centers-especially those that serve predominantly non-English speaking populations-are by definition informed by and responsive to their specific community's needs.
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For some, this means staffing trained "patient navigators" that speak a patient's language to help make sure that the person fills out the right forms, sees the right specialist, and understands the care they've received. For other centers, it might mean a heavy investment in creating culturally tailored signage and health education materials, as well as frequent outreaches into the surrounding areas. We need to support the continuation of these enabling services and systems that for decades have helped millions of people and their families reach and use tools for better health.
Having said this, a critical component in health reform we have not yet secured is the provision to reimburse medical providers for language access services such as the use of interpreters. Because there are so many (more than 40%) Asian Americans who are limited English proficient, without language interpreters they do not truly receive the quality health care services they deserve.
What's the state of healthcare in US Pacific Island territories like Guam, the Northern Mariana Islands, and Samoa? Are their healthcare needs even more critical?
For people from the Pacific territories, the battle for equitable access to health care is occurring on two major fronts: Pacific Islanders living in the Pacific and Pacific Islanders living in the United States. Pacific Islanders living in the United States have a legal and lawful right to travel to/from the United States because of the agreement with the U.S. Unfortunately, they are not considered U.S. citizens, nor are they viewed as immigrants, so they are not eligible for Medicaid or any other public benefits if they live in poverty. Quite simply, they are stuck in an unfair, lose-lose situation. Therefore, as we are advocating in the current health reform debate, Pacific Islanders should be able to participate in the proposed Insurance Exchange, as well as receive subsidies if they are living in near-poverty, and Medicaid if they are in poverty.
On the other front, concerning Pacific Islanders living in the Pacific territories, the health reform battle centers on eliminating the cap set on Medicaid awarded by the United States. With the current Medicaid cap, the territories have limited funds regardless of the community's present need, so those living in poverty may not have access to this public service when they require it. Consider that medical providers in the Territories often have to refer complicated medical cases for management either in Guam or Hawaii. Transportation costs, as well as health care costs for medical cases from other Pacific territories and agreements with the U.S. are difficult to anticipate and/or budget; still, they are unquestionably necessary and thus a significant portion of a capped resource is immediately spent.
A report included on your website states that one of the problems is that AA & NHOPIs are a diverse group that need more research into the individual group's needs. Can you expand on this? Will healthcare reform address the needs for more research and targeted healthcare needs?
Thank you for bringing this up, Leonard, because it's absolutely essential that we improve our collective knowledge of AA & NHOPI health challenges to ultimately develop better future health policies; indeed, the dearth of knowledge already impacts health policy today, oftentimes at our community's loss. We know, for example, that Vietnamese women have the highest mortality rates related to cervical cancer compared with women of any other racial/ethnic groups. If health reform does not have access provisions to reduce barriers to screening, prevention, and access to a regular primary care home, Vietnamese women would continue to suffer disproportionately compared to others.
What are some of the other failings of our current healthcare system in helping AA & NHOPIs?
A few major concerns for what's still lacking come immediately to mind. First, we do not have enough community health centers for all those in need in California or nationally. Community health centers provide a critical service as a vital part of the national safety net, because they provide a primary care home to those in our communities that are at greatest risks of not receiving care: the poor, the uninsured, those linguistically or culturally isolated/alienated. Our membership alone serves about 400,000 patients who are primarily AA & NHOPI and either underinsured or uninsured altogether.
Also, we need to be aware that even if we are successful in reforming our health care system and ensuring everyone gets access to health insurance, the country will still be facing it's long-time primary care provider shortage. Even with health insurance, many people may still not have timely or appropriate access to health care services because there are simply not enough primary care professionals to meet the demand for care. Many argue that this is because primary care providers are not paid as well as other health care specialists and thus there's little incentive for med students to make that their focus. A fundamental shift in how we value our primary care physicians, nurses, assistants and health educators must happen for this to situation to truly change.
What do you foresee for AA & NHOPIs if we don't get healthcare reform?
AA & NHOPIs, like many other Americans, will see more and more of our salaries going towards buying health insurance at exorbitant rates, instead of savings for our children or our home-in other words, we'll be forced to pay more now to stay healthy and invest less in our futures. More people will go without insurance altogether and not seek health care services unless their health status condition can no longer avoid it; this would mean that diseases which are preventable or curable will not be diagnosed in time as well as more people would be using the emergency rooms-in short, more families would be suffering and we all would see more of our taxes paying for emergency room care. Already, $18 billion is wasted each year on avoidable visits to ERs that could have been treated or prevented via visits to a primary care provider or community clinic.
Thank you very much for answering our questions Jeff. We wish you success on your efforts.
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