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by Diane Velasco, AARP VIVA, September 2009
Diane Martinez, who is 57 and self-employed, is too young for Medicare and can’t afford health insurance. So she goes without basic checkups and preventive care.
Candace Diaz, after she retired at age 61, faced skyrocketing insurance costs for herself and her husband, forcing her to return to work.
Clara Galvez, 72, suffered a broken wrist but, without a home health aide, still cared for her 95-year-old mother.
While families across the United States struggle with health care issues, Hispanic families face additional hurdles. One third of Latinos are uninsured, the highest rate of any ethnic or racial group. Even when they do have insurance, language barriers and cultural issues make them less likely to access preventive care, according to the National Council of La Raza. And significant health care disparities exist: more than a quarter of Hispanic adults have never had their cholesterol checked, for instance; two thirds over 50 have never had a colonoscopy; and more than half of Hispanic women over age 40 hadn’t had a mammogram in the previous year, according to a 2008 study by the Agency for Health Research and Quality for the U.S. Department of Health and Human Services.
Three key proposed reforms now under consideration in Congress could begin to address some of these obstacles. One would guarantee access to affordable coverage for those ages 50–64 by allowing them to buy into Medicare early. The second would close or reduce the “doughnut hole” coverage gap in Medicare Part D, helping Hispanics and others afford necessary medications. And the third would expand funding and eligibility for home care, which could help lower hospital readmissions.
Falling Through the Cracks
With an income that dipped dramatically, along with the economy, Diane Martinez, a self-employed bookkeeper in El Paso, Texas, can’t afford private insurance, isn’t old enough for Medicare, but isn’t poor enough to qualify for other public programs. Unable to pay for basic checkups, she was unprepared when crisis struck.
“I was going through tax season and noticing I was having issues seeing the computer,” she says. “I was terrified because diabetes runs in our family. I went to an eye doctor and found I had cataracts in both eyes.” By Texas standards, she was legally blind in one eye, but the other had not deteriorated enough to meet state standards for legal blindness.
She was told the surgery could cost up to $25,000. County and state programs rejected her plea for assistance, but help came from an unexpected source: the Knights Templar Eye Foundation, a nonprofit that assists those who need surgery to prevent loss of sight but can’t pay or receive adequate assistance from government agencies or elsewhere. The foundation, along with her ophthalmologist, stepped in to negotiate on her behalf to lower the price and make the surgery possible. Without their assistance, Martinez would be blind today.
But that one-time assistance didn’t solve her long-term need for health insurance. Martinez still can’t afford bone scans, mammograms, or pap smears—she hasn’t had any in more than five years—much less regular eye exams. Without checkups, other untreated health conditions have started to affect her daily life, and she faces a daunting future as she continues to age.
Brad Plebani, deputy director of the Center for Medicare Advocacy, says lack of insurance compounds health problems for 50–64 year olds. “It’s documented, and attributable in part to not having insurance, that Latinos tend not to have a primary care provider in greater numbers than non-Hispanics,” Plebani says. “Consequently, many Latinos end up getting emergency care for acute condtions that may have been preventable. By the time they actually access an emergency room, they are usually sicker than they would have been with a primary care physician.”
Closing the “Doughnut Hole”
Under Medicare Part D, which covers prescription drugs, enrollees generally are responsible for copayments on their medications. But the program has a coverage gap, or doughnut hole, that requires individuals to pay 100 percent of drug costs after their first $2,700 of out-of-pocket expenses. Once they reach $6,152, “catastrophic coverage” kicks in and pays 100 percent of costs.
“People get into the doughnut hole and don’t know what to do about it,” Plebani says. “Some stop taking medications because they can’t afford them, [and end up] with potentially bad health consequences.”
In June, the White House reached an agreement with pharmaceutical companies to discount brand-name medicines by 50 percent for those in the doughnut hole, saving patients an estimated $80 billion over a decade. But the deal is contingent upon broader health care reform passing in Congress.
U.S. Sen. Jeff Bingaman, a Democrat from New Mexico and a member of the Senate Finance Committee that has jurisdiction over Medicare, proposed another fix in his Helping Fill the Medicare Rx Gap Act of 2009. The bill would allow low-income seniors to count assistance from other federal programs and drug makers’ patient assistance programs toward expenses incurred while in the coverage gap.
Cost of Coverage Skyrockets
In the absence of a legislative fix for Medicare Part D, many are left with no other options when they fall in the doughnut hole.
Before Candace Diaz took early retirement early, at 61, she received medical and prescription coverage through her employer. After she retired, she was notified that her insurance premiums would jump from $90 to $850 a month. Even a basic plan for her and her husband would cost $535 a month. “There was no way I could afford that,” she says.
Now 63, Diaz, who lives in Buffalo, New York, is back at work part-time, this time for the federal government as an IRS contact for taxpayers. For $150 a month in premiums, she's covered under a federal insurance plan. Her husband, who became disabled after she started the new job, gets medications through Medicare Part D. Still, Diaz worries about what will happen when she officially retires—again—and may be forced to rely on Medicare alone.
One option, says Peter Ashkenaz, deputy director of media affairs for the Centers for Medicare & Medicaid Services, is to apply for Social Security’s low-income subsidy program that covers Medicare Part D premiums. “Though applicants apply for the program through Social Security, Medicare pays for Part D coverage,” he explains.
Nowhere to Turn for Home Care
Expanding eligibility and funding for home health care helps cover not only the costs of in-home assistance, it also helps avoid costly readmissions to hospitals. But Hispanics face cultural as well as financial hurdles in accessing home care.
“[Hispanics feel] the family should take care of people,” Plebani says. “Having strangers come into the home means in some way you are shirking responsibility to a sick family member.” But lack of awareness is also at fault.
Clara Galvez, of Albuquerque, New Mexico, says no one at the hospital told her about home care options when she broke her wrist and required two surgeries last winter. Galvez takes care of her 95-year-old mother, Leoncia Perez, who does not speak English. “I thought I probably was not able to get help anyhow,” she says. “I have insurance that covered my wrist, but I guess I never thought about getting help for myself and my mother while I recovered. I’m not so poor that I cannot afford care, but it’s hard to know where to get help. I really don’t know what to do.”
U.S. Sen. Robert Menendez, a Democrat from New Jersey and also a member of the Senate Finance Committee, has proposed increasing levels of support to community-based service providers. “Many Hispanic families face high barriers to health care as a result of lack of insurance or language and cultural differences, or simply the high cost of treatment,” Menendez says. “We need to do a better job of collecting data, increasing language access, and accessing comprehensive, affordable care.”
Meanwhile, the Centers for Medicare & Medicaid Services offer materials in Spanish to Hispanic families. “There is an ongoing campaign to reach caregivers, including family members, through both churches and community groups,” Ashkenaz says.
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