Trump’s legacy looms as Colorado aims to close Hispanic insurance gap

Armando Peniche Rosales has a crooked finger that has been predicting the weather for years, and becomes increasingly sensitive when it rains or hails.

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

Benish Rosales, 35, said the toe is a small reminder of the times his relatives felt they had to “choose between your health or your future” in the United States. His mother chose her health, and returned to Mexico to seek treatment for her migraines and thyroid disease, even though that meant she had to spend a decade separated from her family. His father chose his future, and worked weeks long through symptoms that free clinics told him were hemorrhoids but were actually colon cancer.

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

He’s resting in his house, how would he like it,” said Benish Rosales. “I love mountains.”

nationally and in ColoradoThe proportion of people without health insurance has always been significantly higher among Hispanics than among the white, black, or non-Hispanic Asian population. Immigrants who lack legal status and those who have legal residency but whose families have a mix of immigration status make up a large part of that group. Colorado recently made some eligible for health coverage, but advocates working with immigrants say the state faces a challenge: to roll back the horrific effects of Trump administration policies that have scared some, even those who qualify, from signing up. For health insurance can jeopardize their ability – or the ability of a loved one – to remain in the country.

“People who might have thought about seeking health benefits, out of fear of potential repercussions, whether it was on them now or to adjust their immigration status in the future, have gone back to living in the shadows,” said Maria Albaniel Rangel, policy. and advocacy director for the Tri-County Health Network in Telluride, Colorado, a nonprofit that works to increase access to health care. “Trust is lost. It takes time to rebuild that.”

KHN worked with the Colorado News Collaborative for State progress check on tackling racial and ethnic inequality, including in health, in recent years.

The state Department of Health estimates that about 30% of Hispanic adults do not have health coverage. This contrasts with the state average of 12% of adults in Colorado who do not have insurance. Most Colorados Hispanics are citizens or legal residents, but they may encounter barriers to registration, including language and cost.

People living in the United States without a permit fall into a certain dilemma: They can’t get public benefits in most states — unless they land in the emergency room with a life-threatening condition — or buy health insurance from the ACA markets. According to KFF, about Third Uninsured Hispanic residents under the age of 65 are not eligible for ACA, Medicaid, or Children’s Health Insurance coverage because of their immigration status.

Colorado has made moves to change this for specific groups of unauthorized residents who live in low-income households. a Recently passed law It will provide Medicaid and CHIP coverage for pregnant women and children starting in 2025. Starting next year, a The law was passed in 2020 He will use state funds to help some residents who live below 138% of the federal poverty level buy health insurance in the individual market. In 2019, the state joined about 12 other countries Regular dialysis coverage For people who may have to wait until they are so sick that they land in the emergency department.

Lilia Cervantes, director of immigrant health at the University of Colorado School of Medicine and lead advocate to change dialysis, which saved the state about $10 million annually, according to data from Health Care Policy and the state’s Department of Finance. But she would like to see more people get the care they need to avoid developing a chronic condition like kidney disease in the first place.

Armando Peniche Rosales says his parents had to choose between staying in the United States without receiving proper health care or leaving the country to seek care and being separated from their family.(AAron Ontiveroz for KHN)

The data suggest that expanding the pool of people eligible for health insurance, by itself, is not enough to address coverage inequality. Nationally, following the implementation of the Affordable Care Act, coverage rates improved across racial and ethnic groups, but inequalities persisted.

said Samantha Arteja, director of the KFF Racial Equity and Health Policy Program. “Then what we saw in 2017 was that the rates of the uninsured started going up again.”

Doctors, researchers and advocates for expanding access to health services for immigrants in Colorado suspect that the recovery was linked to the Trump administration’s immigration policies, including changes to the general shipping rule. The long-standing rule determines when someone can be denied a green card or visa because they are likely to rely on or already use government benefits.

The Trump administration has expanded the types of benefits that can be used to deny someone immigration status to food stamps, non-emergency medical care, and housing benefits.

Search Published by the nonprofit Behavioral Science Group 42 . thoughts In Health Affairs in 2020, it found that announcing the Trump administration’s changes to the public official’s rule was associated with a nationwide decline in enrollment of an estimated 260,000 children compared to 2017 levels.

Colorado also saw a drop in Hispanic insurance rates. He found the Colorado Health Institute in a statewide survey That while the overall rate of uninsured in the state has stabilized since the implementation of the Affordable Care Act, uninsured rates have risen among Hispanics or Coloradine Hispanics, particularly among children. The institute estimated that about 3% of Hispanics or Hispanics age 18 or younger were uninsured in 2015, compared to about 8% in 2021. Among children who were eligible for insurance but did not enroll in it, about half were Hispanics despite being made up of about one-third of all Colorado kids, said Erin Miller, vice president of health initiatives for the Children’s Campaign of Colorado.

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

“But that doesn’t change the fact that a lot of immigrants are really, really careful about what they can share and with whom they can share,” said Liz Tansey, senior director at the Colorado Community Health Network.

Survey from the Immigrant Rights Coalition Protect Immigrant Families in 2021 from predominantly Hispanic, Asian, and Pacific Islander immigrant families I found it Nationwide, 40% have not heard of the reversal. Nearly half of respondents whose families needed assistance during the pandemic said they declined to apply due to immigration concerns.

Ricardo Gonzalez Fischer, a surgical oncologist with the Servicios de la Raza social services organization, provides registration assistance from the Health Resource Center at the Mexican Consulate in Denver. More than half of the immigrants he sees are uninsured. He said many immigrants told him that even if they had insurance, they wouldn’t use it for fear of attracting the wrong kind of attention. “They say, ‘We all have at least one or two undocumented people in our house that we don’t want them to see,'” Gonzalez Fisher said.

Insurance that unauthorized Colorado residents receive as a result of the latter state’s laws cannot count against them in public liability decisions, said Rina Hetlag, with one important exception: if children need long-term care due to, say, severe disabilities or illnesses. chronic; D., a senior policy director for the Center for Health Advancement, an advocacy group for health equity in Denver.

Maria Rodriguez, a healthcare equity and communication specialist for the Colorado Division of Insurance, is the state’s important figure in spreading the word about new benefits To help unauthorized persons purchase health insurance. It has hosted meetings with community organizations to prepare for the November 1 open registration.

In the first year of the benefit program, the state can enroll up to 10,000 unlicensed Colorados, representing only a portion of the state’s unauthorized and uninsured Hispanics.

Colorado still lagging behind Washington and California in offering cancer care coverage, which may have helped Benish’s father, Rosales. Without health insurance or tens of thousands of dollars to start treatment, he couldn’t even get care I found a hospital That would cover it using charitable money.

A photo shows two portraits of Armando Peniche Rosales' father and his family in a picture frame.
Armando Peniche Rosales’ father remained in the United States to support his family but went without proper medical care. Died of colon cancer.(AAron Ontiveroz for KHN)

The night before Peniche Rosales had an interview with USCIS – an interview that would grant him legal residence – he had to take his father to the emergency room again. His father told him to go home and rest.

“He was more concerned about meeting me than anything else,” said Benish Rosales. He got his green card while his father was still alive. “Although he was in pain, it brought him so much joy.”

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