Kaiser Health News
Do Republican Spending Cuts Threaten Federal HIV Funding? For Some Programs, Yes.
Grace Abels, PolitiFact
Tue, 14 Nov 2023 10:00:00 +0000
Republicans in Congress are “trying to wipe out federal funding to end the HIV epidemic.”
President Joe Biden on Oct. 14, 2023, in remarks at the 2023 Human Rights Campaign National Dinner.
Are Republicans threatening to stop spending federal money to end one of the world's most pressing public health epidemics? That's what President Joe Biden said during a dinner hosted by an LGBTQ+ advocacy group.
“In the United States Congress, extreme MAGA Republicans are trying to undo virtually every bit of progress we've made,” Biden said Oct. 14 at the Human Rights Campaign event. “They're trying to wipe out federal funding to end the HIV epidemic.”
Programs to treat HIV and fight its spread have enjoyed bipartisan funding support in recent years, experts said, so Biden's portrayal signals a significant departure.
When we asked the White House what Biden was referring to, it pointed us to reports of budget recommendations from House Republicans that call for large cuts to the Ending the HIV Epidemic initiative, a Trump administration-era program designed to reduce new HIV infections in the U.S., as well as other programs.
The Senate Appropriations Committee passed a separate spending plan. The recommendations will be subject to negotiation as the House and Senate face a Nov. 17 deadline to pass another spending bill.
We found that although Republicans are recommending significant cuts to HIV prevention efforts across a number of public health agencies, the proposal keeps core funding intact. Meanwhile, political differences are eroding bipartisan support for global HIV-prevention funding.
Despite great strides in prevention and treatment since HIV was first reported in the U.S. in the 1980s, HIV remains at epidemic levels in the U.S. today, with approximately 1.2 million people living with HIV and around 30,000 to 35,000 new infections each year. Experts said cases are rising in the South and in rural areas, and new infection statistics show it is disproportionately affecting Black and Hispanic populations.
What Are the Proposed Cuts?
The AIDS Budget and Appropriations Coalition, a group of more than 100 public health advocacy organizations that track changes in HIV-related federal spending, said a majority of the proposed cuts to domestic HIV funding stem from House Republicans' effort to eliminate the Ending the HIV Epidemic initiative.
The program started in 2019 with the goal of reducing new HIV infections in the U.S. by 75% by 2025 and 90% by 2030. The program so far worked regionally, targeting areas that have the highest rates of HIV cases for funding.
In 2023, about $573 million was allocated for the program across various agencies, according to KFF's funding tracker.
- $220 million to the Centers for Disease Control and Prevention.
- $165 million to the Ryan White HIV/AIDS program. (It was named for a 13-year-old diagnosed with HIV in 1984 and is overseen by the Health Resources and Services Administration.)
- $5 million to the Indian Health Service.
- $26 million to the National Institutes of Health for research.
- $157.3 million to community health centers, which have treated around 200,000 HIV patients annually.
The program lags its goals as it approaches the 2025 benchmark. “It's well designed, well planned, it has targets that makes sense,” said Jeffrey Sturchio, a lead researcher on a Center for Strategic and International Studies report.
Sturchio said the problem is not a fault of design, but funding, adding, “Congress has never fully funded the initiative.”
Sturchio pointed to a range of local and state “bureaucratic hurdles.” Jurisdictions that have pulled together sufficient resources have seen “tremendous progress,” he said, and overall indicators seem to be moving in the right direction.
But covid-19 reduced HIV testing and may have diverted public health efforts, CDC administrators said. KFF Health News reported in April that stakeholders saw progress but worried that it won't be enough to make the 2030 deadline.
Democrats appear to share this concern. The spending bill proposed by the Democratic-controlled Senate Appropriations Committee maintained or slightly increased funding levels to all HIV-related programs. The committee requested more data about the program, describing its “lack of quantifiable data showing outcomes.”
The House has not yet passed the bill out of committee. We know of some proposed cuts from the bill, which the Republican-led House Appropriations Subcommittee released in July.
It outlines a $1.6 billion cut to the CDC, including a $220 million reduction in “HIV/AIDS, viral hepatitis, sexually transmitted diseases, and tuberculosis prevention” and a $238.5 million cut from the Ryan White HIV/AIDS program. The Ryan White program provides medical care and support services to low-income HIV patients and serves more than half of those diagnosed in the U.S.
The bill also proposes cutting funding to the Minority HIV/AIDS fund by more than half — from $60 million to $28 million. According to HIV.gov, the fund supports prevention and care projects targeting disparities that affect communities of color.
Additional details about how these cuts could affect programs are detailed in a committee report that has not been made public. PolitiFact and some advocacy organizations obtained copies of the report, but the House Appropriations Committee did not respond to questions about it. The report we saw recommended cutting all funding for the Ending the HIV Epidemic initiative.
And House Democrats, advocacy organizations, and KFF Health News have each reported that the Ryan White program and CDC cuts result from a plan to eliminate the Ending the HIV Epidemic initiative.
“If they cut funding, it's going to have a dramatic and draconian impact on the ability of all of the people who are working in these jurisdictions to improve public health,” said Sturchio, the researcher.
Although the cuts would be dramatic, experts said, they would not eliminate all domestic HIV funding.
“There is certainly a demonstration and a commitment to some of the core HIV programs, but there are millions of dollars of proposed cuts in other areas,” said Lindsey Dawson, associate director for HIV policy at KFF. “These cuts would have a meaningful impact on the ability of programs to provide lifesaving interventions for both HIV care and treatment, as well as prevention.”
The cuts would mean a 16% cut to the CDC's division of STD prevention, a 9% cut to the Ryan White HIV/AIDS program, and a 53% cut to the Minority HIV/AIDS Fund from fiscal year 2023 to 2024.
These funding cuts are only proposals. They require a vote from the full appropriations committee and would have to pass the House and be negotiated with a Democratic-controlled Senate.
“We've heard for a long time that HIV is a bipartisan issue. But what some people forget, is that that bipartisanship was hard fought for over the first decade of the HIV epidemic,” said Dawson.
Other Challenges to HIV/AIDS Spending
The U.S. commitment to global HIV prevention, meanwhile, is also under scrutiny. Rep. Chris Smith (R-N.J.) challenged reauthorizing the President's Emergency Plan for AIDS Relief, also known as PEPFAR, without first making some changes. Started in 2003 by President George W. Bush, the program distributes funds in more than 50 countries for HIV testing, prevention, treatment, and medications. It also strengthens health care systems to fight AIDS.
Funding for the program has grown over the past 20 years, totaling more than $110 billion. The program reported 25 million lives saved by medical intervention.
Smith, who chairs the House Foreign Affairs subcommittee on Global Health, has expressed concerns that money is being given to nongovernmental organizations that support abortion rights and access.
U.S. law prohibits the direct use of overseas funding to provide abortions or to lobby for access to abortions. This has been the case since 1973. However, organizations that receive U.S. funding can do so with their own non-U.S. funding.
An official from the State Department, which runs the program, confirmed to PolitiFact that PEPFAR is legally restricted from funding abortion or lobbying for abortion access; the official cited the training of staff and partners and the monitoring of procedures to ensure compliance.
Other anti-abortion groups have favored a “Mexico City Policy,'‘ which has required foreign nongovernmental organizations to certify that they would not perform or promote abortion with funds from any source to be eligible for U.S. government funding. Trump applied the policy to PEPFAR, but Biden rescinded it.
The failure to reauthorize PEPFAR would not eliminate the program, and Congress can continue to fund the program without reauthorization, but it could cause some provisions to lapse over the next few years.
The lack of a reauthorization would have significant symbolic impact, said Kellie Moss, KFF's associate director of global health and HIV policy. “It could make the program more vulnerable during funding discussions without a clear signal of bipartisan support.”
Although reauthorization is being held up, funding has progressed. On Sept. 28, the House passed a State Department and Foreign Operations Appropriations bill, which would fund PEPFAR for another year but implement a Mexico City-like policy provision on all global health funding. This bill would also extend the lapsing provisions for another year.
Our Ruling
Biden said that Republicans in Congress are “trying to wipe out federal funding to end the HIV epidemic.”
A subcommittee of House Republicans has proposed cutting some HIV prevention programs anywhere from 53% to 9% in fiscal 2024, depending on the program.
A committee's draft report cited by advocacy and policy groups shows these cuts stem from the elimination of the Trump-era Ending the HIV Epidemic initiative, although the committee did not respond to questions about that.
Taken together, these cuts would not eliminate — or “wipe out” — all federal domestic HIV spending, but they do represent a significant cut.
Meanwhile, the House has not moved ahead to reauthorize PEPFAR, which supplies U.S. dollars for global HIV prevention, over Republican concerns about where organizations that receive the money stand on abortion access. But the House has passed one year of PEPFAR funding with some conditions about how it is distributed, which it can do without reauthorizing the program.
Biden's statement is partially accurate in that significant funding cuts have been proposed by House Republicans, but he exaggerates by saying these efforts would “wipe out” federal funding.
We rate this claim Half True.
KFF Health News Southern correspondent Sam Whitehead contributed to this report.
Our Sources
Email interview with a White House spokesperson, Oct. 17, 2023Â
Email interview with a State Department official, Oct. 18, 2023Â
Email interview with Michael Finan, communications director for Rep. Chris Smith, Oct. 16, 2023
Interview with Kellie Moss, associate director of Global Health & HIV policy at KFF, Oct. 17, 2023
Interview with Lindsey Dawson, associate director of HIV policy at KFF, Oct. 18, 2023
Interview with Nick Armstrong, manager of advocacy and government affairs at the AIDS Institute, Oct. 18, 2023
Interview with Carl Schmid, executive director of the HIV + Hepatitis Policy Institute, Oct. 18, 2023
Interview with Jeffrey Sturchio, senior associate of the Global Health Policy Center at the Center for Strategic and International Studies, Oct. 25, 2023
AHEAD, “The Six EHE Indicators — Incidence,” accessed Oct. 31, 2023
AIDS United, “The HIV Safety Net Is Under Attack,” accessed Oct. 31, 2023
The Associated Press, “Republican Opposition to Abortion Threatens Global HIV/AIDS Program That Has Saved 25 Million Lives,” Sept. 11, 2023
Center for Family and Human Rights, “Dear Colleague, President Biden has hijacked PEPFAR, the $6 billion a year foreign aid program designed to mitigate,” June 6, 2023
Center for Family and Human Rights, “PEPFAR Coalition Letter,” May 1, 2023
Center for Strategic and International Studies, “Can the Ending the HIV Epidemic in the U.S. Initiative Succeed?” Aug. 26, 2022
Centers for Disease Control and Prevention, “Core Indicators for Monitoring the Ending the HIV Epidemic Initiative,” Oct. 17, 2023
Centers for Disease Control and Prevention, “Dear Colleagues: What's New | About the Division of HIV/AIDS Prevention,” May 24, 2022
Centers for Disease Control and Prevention, “EHE Accomplishments,” Sept. 21, 2023
Centers for Disease Control and Prevention, “Transgender Women Urgently Need More HIV Prevention and Treatment Services, New CDC Data Show,” April 15, 2021
Centers for Disease Control and Prevention, “2021 HIV Incidence | NCHHSTP Newsroom,” May 23, 2023
Centers for Disease Control and Prevention, “Estimated HIV Incidence and Prevalence in the United States, 2017-2021: National Profile,” May 23, 2023
Congress.gov, “Senate Appropriations LHHSE Committee Report,” July 27, 2023Â
Fox News, “Biden Administration ‘Hijacking' George Bush AIDS Program to Push Abortion in Africa: GOP Congressman,” June 10, 2023
HIV.gov, “Ending the HIV Epidemic,” Aug. 1, 2023
HIV.gov, “Expanding PrEP Coverage in the United States to Achieve EHE Goals,” Oct. 18, 2023
HIV.gov, “HIV & AIDS Trends and U.S. Statistics Overview,” Oct. 3, 2023
HIV.gov, “Minority HIV/AIDS Fund in Action,” May 16, 2023Â
HIV.gov, “What Is the Minority HIV/AIDS Fund?,” Sept. 25, 2019
House Appropriations Committee, “FY24 LHHSE Appropriations Bill Summary,” July 13, 2023
House Appropriations Committee, “House Approves H.R. 4665, The Department of State, Foreign Operations, and Related Programs Appropriations Act,” Sept. 28, 2023
House Democrats Appropriations Committee, “House Republican Funding Bill Kicks Teachers Out of Classrooms, Takes Away Job Opportunities, and Harms Women and Children,” July 13, 2023Â
KFF, “PEPFAR Reauthorization: The Debate About Abortion,” Sept. 21, 2023
KFF, “PEPFAR Reauthorization 2023: Key Issues,” March 13, 2023
KFF, “The Mexico City Policy: An Explainer,” Jan. 28, 2021
KFF, “The U.S. Ending the HIV Epidemic (EHE) Initiative: What You Need to Know,” Feb. 9, 2021
KFF, “The U.S. Government and International Family Planning & Reproductive Health: Statutory Requirements and Policies,” Oct. 27, 2023
KFF, “The U.S. President's Emergency Plan for AIDS Relief (PEPFAR)Â ,” July 26, 2023
KFF, “U.S. Federal Funding for HIV/AIDS: Trends Over Time,” March 5, 2019
KFF Health News, “In Move to Slash CDC Budget, House Republicans Target Major HIV Program Trump Launched,” Sept. 8, 2023
KFF Health News, “US Officials Want to End the HIV Epidemic by 2030. Many Stakeholders Think They Won't,” April 24, 2023
National Alliance of State and Territorial AIDS Directors, “FY2024 Appropriations for Federal HIV/AIDS Programs,” July 28, 2023
NBC News, “How Tennessee Axed Millions in HIV Funds Amid Scrutiny From Far-Right Provocateurs,” Feb. 2, 2023
NBC News, “Tennessee Blocked $8 Million for HIV, Now Ends Up With $13 Million, Stunning Advocates,” April 21, 2023
NBC News, “U.S. Progress in HIV Fight Continues to Trail Many Other Rich Nations,” May 23, 2023
NPR, “What's Behind the Debate to Re-Authorize PEPFAR, the Widely Hailed Anti-HIV Effort?” Sept. 29, 2023
Planned Parenthood, “The Quickie: Tennessee to Pull Federal Funding for HIV Prevention to Avoid Giving Grants to Planned Parenthood,” Jan. 27, 2023Â
Reuters, “US State Dept Slams Congress for Failure to Renew Anti-AIDS Program,” Oct. 3, 2023
Roll Call, “PEPFAR Reauthorization Debate Highlights Splits in GOP,” Sept. 21, 2023
Ryan White HIV/AIDS Program, “Available Care & Services | Ryan White HIV/AIDS Program,” Feb. 2022
Ryan White HIV/AIDS Program, “Home page,” accessed Oct. 31, 2023
Ryan White HIV/AIDS Program, “Ryan White HIV/AIDS Program Annual Client-Level Data Report 2020,” December 2021
San Francisco AIDS Foundation, “Devastating Cuts Proposed to Federal HIV Budget — San Francisco AIDS Foundation,” July 14, 2023
The Heritage Foundation, “Reassessing America's $30 Billion Global AIDS Relief Program,” May 1, 2023
The New Yorker, “Abortion Opponents Are Targeting a Signature G.O.P. Public-Health Initiative,” Aug. 24, 2023
The New York Times, “Tennessee's Rejection of Federal Funds to Curb HIV Alarms Prevention Groups,” March 24, 2023
The Washington Post, “Lifesaving PEPFAR Program Faces a New Threat: U.S. Abortion Politics,” July 29, 2023
The Washington Post, “Opinion | George W. Bush: Michael Gerson's Words Make the Case for Saving PEPFAR,” Sept. 13, 2023
The White House, “Remarks by President Biden and First Lady Jill Biden at the 2023 Human Rights Campaign National Dinner,” Oct. 14, 2023
U.S. Congressman Chris Smith (R-N.J.), “Biden Has Hijacked PEPFAR to Promote Abortion,” Sept. 28, 2023
U.S. Senate Committee on Appropriations, “FY 24 LHHS Report,” July 27, 2023
U.S. Senate Committee on Appropriations, “Senate Appropriations Committee Approves Defense, Interior-Environment, LHHS, and Homeland Security Bills,” July 27, 2023
U.S. State Department, “Results and Impact — PEPFAR,” accessed Oct. 31, 2023
U.S. State Department, “The United States President's Emergency Plan for AIDS Relief,” accessed Oct. 31, 2023
YouTube, “Biden Has Hijacked PEPFAR to Promote Abortion,” Sept. 28, 2023
——————————
By: Grace Abels, PolitiFact
Title: Do Republican Spending Cuts Threaten Federal HIV Funding? For Some Programs, Yes.
Sourced From: kffhealthnews.org/news/article/fact-check-biden-republicans-congress-hiv-aids-funding/
Published Date: Tue, 14 Nov 2023 10:00:00 +0000
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Kaiser Health News
Journalists Delve Into Climate Change, Medicaid ‘Unwinding,’ and the Gap in Mortality Rates
Sat, 04 May 2024 09:00:00 +0000
KFF Health News senior correspondent Samantha Young discussed Medicaid and climate change on KCBS Radio's “On-Demand” podcast on April 29.
- Click here to hear Young on KCBS
- Read Young's “AC, Power Banks, Mini Fridges: Oregon Equips Medicaid Patients for Climate Change“
KFF Health News contributor Andy Miller discussed Medicaid unwinding on WUGA's “The Georgia Health Report” on April 26.
- Click here to hear Miller on “The Georgia Health Report”
- Read Phil Galewitz' “Millions Were Booted From Medicaid. The Insurers That Run It Gained Medicaid Revenue Anyway.“
KFF Health News Nevada correspondent Jazmin Orozco Rodriguez discussed mortality rates in rural America on The Daily Yonder's “The Yonder Report” on April 24.
- Click here to hear Rodriguez on “The Yonder Report”
- Read Rodriguez' “City-Country Mortality Gap Widens Amid Persistent Holes in Rural Health Care Access”
——————————
Title: Journalists Delve Into Climate Change, Medicaid ‘Unwinding,' and the Gap in Mortality Rates
Sourced From: kffhealthnews.org/news/article/journalists-delve-into-climate-change-medicaid-unwinding-and-the-gap-in-mortality-rates/
Published Date: Sat, 04 May 2024 09:00:00 +0000
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Kaiser Health News
Oh, Dear! Baby Gear! Why Are the Manuals So Unclear?
Darius Tahir
Fri, 03 May 2024 09:00:00 +0000
Since becoming a father a few months ago, I've been nursing a grudge against something tiny, seemingly inconsequential, and often discarded: instructional manuals. Parenthood requires a lot of gadgetry to maintain a kid's health and welfare. Those gadgets require puzzling over booklets, decoding inscrutable pictographs, and wondering whether warnings can be safely ignored or are actually disclosing a hazard.
To give an example, my daughter, typically a cooing little marsupial, quickly discovered babyhood's superpower: Infants emerge from the womb with talon-strength fingernails. She wasn't afraid to use them, against either her parents or herself. So we purchased a pistachio-green, hand-held mani-pedi device.
That was the easy part. The difficulty came when we consulted the manual, a palm-sized, two-page document.
The wandlike tool is topped with a whirring disc. One can apparently adjust the speed of its rotation using a sliding toggle on the wand. But the product manual offered confusing advice: “Please do not use round center position grinding,” it said. Instead, “Please use the outer circle position to grinding.” It also proclaimed, “Stay away from children.” In finer print, the manual revealed the potential combination of kids and the device's smaller parts was the reason for concern.
One would hope for more clarity about a doodad that could inadvertently cause pain.
Later, I noticed another warning: “If you do not use this product for a long time, please remove the battery.” Was it dangerous? Or simply an unclear and unhelpful yet innocuous heads-up? We didn't know what to do with this information.
We now notice shoddy instructions everywhere.
One baby carrier insert told us to use the product for infants with “adequate” head, neck, and torso control — a vague phrase. (The manufacturer declined to comment.)
Another manual, this one online and for a car seat — a device that's supposed to protect your kid — informed readers with words and images that a model baby was “properly positioned” relative to the top of the headrest “structure” when more than one inch from the top. Just pixels away, the same model, slumped further down, was deemed improperly positioned: “The headrest should not be more than 1” from the top of her head,” it said, in tension with its earlier instructions. Which was it, more than one inch or not? So we fiddle and hope for the best.
I acknowledge this sounds like new-parent paranoia. But we're not entirely crazy: Manuals are important, and ones for baby products “are notoriously difficult to write,” Paul Ballard, the managing director of 3di Information Solutions, a technical writing firm, told me.
Deborah Girasek, a professor of social and behavior sciences at the Uniformed Services University of the Health Sciences, told me that for decades, for the young and middle-aged alike, unintentional injury has been the leading cause of death. That's drownings, fires, suffocation, car crashes. The USU is a federal service academy training medical students destined for the armed services or other parts of the government.
Some of these deaths are caused by lack of effective communication — that is, the failure of instruction about how to avoid injury.
And these problems stretch from cheap devices to the most sophisticated products of research and development.
It's a shortcoming that's prompted several regulatory agencies charged with keeping Americans healthy, including the Consumer Product Safety Commission, the Food and Drug Administration, and the National Highway Traffic Safety Administration, to prod companies into providing more helpful instructions.
By some lights, they've had success. NHTSA, for example, has employees who actually read manuals. The agency says about three-quarters of car seats' manuals rate four or five stars out of five, up from 38% in 2008. Then again, our car seat's has a five-star rating. But it turns out the agency doesn't evaluate online material.
Medical product manuals sometimes don't fare too well either. Raj Ratwani, director of MedStar Health's Human Factors program, told me that, for a class he teaches to nurses and doctors, he prompted students to evaluate the instructions for covid-19 tests. The results were poor. One time, instructions detailed two swabs. The kit had only one.
Technical writers I spoke with identified this kind of mistake as a symptom of cost cutting. Maybe a company creates one manual meant to cover a range of products. Maybe it puts together the manual at the last moment. Maybe it farms out the task to marketers, who don't necessarily think about how manuals need to evolve as the products do.
For some of these cost-cutting tactics, “the motivation for doing it can be cynical,” Ballard said.
Who knows.
Some corners of the technical writing world are gloomy. People worry their jobs aren't secure, that they're going to be replaced by someone overseas or artificial intelligence. Indeed, multiple people I spoke with said they'd heard about generative AI experiments in this area.
Even before AI has had its effect, the job market has weighed in. According to the federal government, the number of technical writers fell by a third from 2001, its recent peak, to 2023.
One solution for people like us — frustrated by inscrutable instructions — is to turn to another uncharted world: social media. YouTube, for instance, has helped us figure out a lot of the baby gadgets we have acquired. But those videos also are part of a wild West, where creators offer helpful tips on baby products then refer us to their other productions (read: ads) touting things like weight loss services. Everyone's got to make a living, of course; but I'd rather they not make a buck off viewers' postpartum anxiety.
It reminds me of an old insight that became a digital-age cliché: Information wants to be free. Everyone forgets the second half: Information also wants to be expensive. It's cheap to share information once produced, but producing that information is costly — and a process that can't easily or cheaply be replaced. Someone must pay. Instruction manuals are just another example.
——————————
By: Darius Tahir
Title: Oh, Dear! Baby Gear! Why Are the Manuals So Unclear?
Sourced From: kffhealthnews.org/news/article/baby-product-instruction-manuals-confusing-technical-writing/
Published Date: Fri, 03 May 2024 09:00:00 +0000
Kaiser Health News
California Floats Extending Health Insurance Subsidies to All Adult Immigrants
Jasmine Aguilera, El TÃmpano
Fri, 03 May 2024 09:00:00 +0000
Marisol Pantoja Toribio found a lump in her breast in early January. Uninsured and living in California without legal status and without her family, the usually happy-go-lucky 43-year-old quickly realized how limited her options were.
“I said, ‘What am I going to do?'” she said in Spanish, quickly getting emotional. She immediately worried she might have cancer. “I went back and forth — I have [cancer], I don't have it, I have it, I don't have it.” And if she was sick, she added, she wouldn't be able to work or pay her rent. Without health insurance, Pantoja Toribio couldn't afford to find out if she had a serious condition.
Beginning this year, Medi-Cal, California's Medicaid program, expanded to include immigrants lacking legal residency, timing that could have worked out perfectly for Pantoja Toribio, who has lived in the Bay Area city of Brentwood for three years. But her application for Medi-Cal was quickly rejected: As a farmworker earning $16 an hour, her annual income of roughly $24,000 was too high to qualify for the program.
California is the first state to expand Medicaid to all qualifying adults regardless of immigration status, a move celebrated by health advocates and political leaders across the state. But many immigrants without permanent legal status, especially those who live in parts of California where the cost of living is highest, earn slightly too much money to qualify for Medi-Cal.
The state is footing the bill for the Medi-Cal expansion, but federal law bars those it calls “undocumented” from receiving insurance subsidies or other benefits from the Affordable Care Act, leaving many employed but without viable health insurance options.
Now, the same health advocates who fought for the Medi-Cal expansion say the next step in achieving health equity is expanding Covered California, the state's ACA marketplace, to all immigrant adults by passing AB 4.
“There are people in this state who work and are the backbone of so many sectors of our economy and contribute their labor and even taxes … but they are locked out of our social safety net,” said Sarah Dar, policy director at the California Immigrant Policy Center, one of two organizations sponsoring the bill, dubbed #Health4All.
To qualify for Medi-Cal, an individual cannot earn more than 138% of the federal poverty level, which currently amounts to nearly $21,000 a year for a single person. A family of three would need to earn less than $35,632 a year.
For people above those thresholds, the Covered California marketplace offers various health plans, often with federal and state subsidies, yielding premiums as low as $10 a month. The hope is to create what advocates call a “mirror marketplace” on the Covered California website so that immigrants regardless of status can be offered the same health plans that would be subsidized only by the state.
Despite a Democratic supermajority in the legislature, the bill might struggle to pass, with the state facing a projected budget deficit for next year of anywhere from $38 billion to $73 billion. Gov. Gavin Newsom and legislative leaders announced a $17 billion package to start reducing the gap, but significant spending cuts appear inevitable.
It's not clear how much it would cost to extend Covered California to all immigrants, according to Assembly member Joaquin Arambula, the Fresno Democrat who introduced the bill.
The immigrant policy center estimates that setting up the marketplace would cost at least $15 million. If the bill passes, sponsors would then need to secure funding for the subsidies, which could run into the billions of dollars annually.
“It is a tough time to be asking for new expenditures,” Dar said. “The mirror marketplace startup cost is a relatively very low number. So we're hopeful that it's still within the realm of possibility.”
Arambula said he's optimistic the state will continue to lead in improving access to health care for immigrants who lack legal residency.
“I believe we will continue to stand up, as we are working to make this a California for all,” he said.
The bill passed the Assembly last July on a 64-9 vote and now awaits action by the Senate Appropriations Committee, Arambula's office said.
An estimated 520,000 people in California would qualify for a Covered California plan if not for their lack of legal status, according to the labor research center at the University of California-Berkeley. Pantoja Toribio, who emigrated alone from Mexico after leaving an abusive relationship, said she was lucky. She learned about alternative health care options when she made her weekly visit to a food pantry at Hijas del Campo, a Contra Costa County farmworker advocacy organization, where they told her she might qualify for a plan for low-income people through Kaiser Permanente.
Pantoja Toribio applied just before open enrollment closed at the end of January. Through the plan, she learned that the lump in her breast was not cancerous.
“God heard me,” she said. “Thank God.”
This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.Â
——————————
By: Jasmine Aguilera, El TÃmpano
Title: California Floats Extending Health Insurance Subsidies to All Adult Immigrants
Sourced From: kffhealthnews.org/news/article/california-legislation-medicaid-subsidies-all-adult-immigrants/
Published Date: Fri, 03 May 2024 09:00:00 +0000
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