Hispanic Democratic lawmakers say Latinos, who are overrepresented in the ranks of the uninsured, stand to gain from the recent passage by the U.S. House of Representatives of a historic health care reform bill. The reform bill was approved on a 219–212 vote.
"There are a lot of people in our community who are uninsured because they are working poor, and this bill addresses these folks," says Rep. John Salazar, a Democrat from Colorado.
On Tuesday, March 23, President Obama signed the bill—approved by the Senate on Christmas Eve—into law.
The Senate is now debating a package of fixes and hopes to vote for it soon. Known as the reconciliation bill, it was also approved by the House on Sunday and it would strengthen the Senate bill. The reconciliation bill's expansion of help for Hispanics helped win the support of Latino lawmakers for reform.
In the end, Hispanic House Democrats—more than 20 lawmakers—voted to overhaul the nation's health system. The House's three Hispanics Republican members, however, voted no on the measure, which Florida Rep. Lincoln Diaz-Balar called "dishonest" and "irresponsible." His brother, Rep. Mario Diaz-Balart, R-Fla.,said he is concerned savings from Medicare—mostly from payments to insurers for high-cost Medicare advantage plans—would threaten the program's solvency.
"If that's not a reason to vote against it, I don't know what is," he says.
House Speaker Nancy Pelosi, D-Calif., said the reform bill would extend Medicare solvency for more than a decade. .
Before the vote on Sunday, March 21, the Senate bill had prompted some handwringing among Hispanic Democrats in the House because it is less generous to Hispanics than a health reform bill the House approved last year. It bars undocumented immigrants from purchasing insurance in new exchanges that aim to make coverage more affordable. It also maintains a five-year waiting period for legal residents who are otherwise eligible for Medicare or Medicaid, the government's health care program for the poor.
Rep. Raul Grijalva, D-Ariz., called the five-year waiting period "obscene." He said Hispanic Democrats met several times to discuss how they would vote.
"We decided we didn't want to be part of a group that killed health care," Grijalva says. "We felt other significant gains overrode our concerns."
Rep. Luis Gutierrez, D-Ill., also took a high-profile stance against the bill before the epic vote for reform. But he said an assurance from the White House that it understood the difficulties undocumented workers face in obtaining medical coverage and a promise to re-energize efforts on a comprehensive immigration bill secured his support. Gutierrez is one of the main House sponsors of a comprehensive immigration bill that would legalize the status of many undocumented immigrants.
Rep. Nydia Velázquez, D-N.Y., said the new legislation would cover 8.8 million uninsured Hispanics. She also said the end of the denial of coverage to those with preexisting health problems and new tax credits to help small businesses buy insurance for their workers will help Latinos.
"Taken together, these reforms constitute a critical step toward enhancing both access and quality of health care for Latinos," she says.
Janet Murguia, president and CEO of the National Council of La Raza, said the final bill "is far from perfect" because of its treatment of undocumented immigrants and legal residents. But she said NCLR endorsed the bill because the good outweighed the bad. In a press release, she said Latinos will be helped by expanding the number of uninsured, giving more money to community health centers, and providing new funding for programs that aim to combat health disparities in the Hispanic community.
Murguia also said several provisions for Puerto Rico that were negotiated at the last minute helped win NCLR's support. Those included an agreement to offer Puerto Rico residents access to state insurance exchanges and $2 billion for Medicaid spending in Puerto Rico and the other U.S. territories.
Help for Puerto Rico was included in the reconciliation bill that's being debated by the Senate. To set up their own insurance exchanges under the new legislation, Puerto Rico and the other U.S. territories must vote on a plan by October 2013. Those plans must be approved by the U.S. Department of Health and Human Services.
Unlike state exchanges that have no limits, federal subsidies to help Puerto Ricans buy insurance would be capped at $925 million for the five years from 2014 through 2019. Because of the subsidy cap, Puerto Rican Delegate Pedro Pierluisi said he is seeking flexibility from the White House and Congress to set up the island's insurance exchange.
The reconciliation bill would also gradually close the "doughnut hole" in Medicare's prescription drug coverage.