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The Bush Legacy on Access to Care for Latinos: Our Grade F+
By admin | November 2, 2008
By Olveen Carrasquillo MD
Jaime R. Torres, DPM, MS
During the last eight years Latinos have experienced a dramatic decline in access to care. From 1999 to 2006 the number of uninsured Latinos increased from 11 to 15 million. Federal reports show that on other measures of access such as not having a regular doctor and not receiving health care when needed, health care access has considerably worsened for Latino populations under the George W. Bush.
Perhaps the most appalling aspect of the administration has been the assault on Medicaid and the Children’s Health Insurance Program (SCHIP). With data showing dramatic increases in the Latino uninsured, Bush has steadfastly opposed any expansions to Medicaid and SCHIP. Instead, the administration has come forward with numerous proposals that would have dramatically limited the scope of covered services or numbers of persons enrolled in these programs. The administration even established regulations forbidding states such as New York from expanding their SCHIP program to children in lower middle income families. Further, on numerous occasions Bush had the chance to reverse laws barring recent legal immigrant children from participating in these health programs but refused.
Many Bush supporters would cite Bush’s Medicare Modernization Act giving the 20% of Latinos elders with Medicare but no drug coverage access to medications as a significant health accomplishment. Although everyone agreed that Medicare needed to cover prescription medications, many organizations advocated for one simple plan administered by the government which would have been easy for Latino elders to understand. Unfortunately, Bush favored the plan proposed by the pharmaceutical industry which was hundreds of billions of dollars more expensive, extremely complicated and has led to massive confusion. Elders have to choose from hundreds of very different drug plans each covering a different set of medications and told to go to the Internet if they need help. Indeed, the plans are so confusing that many low income elders eligible for government subsidies have not joined.
Further, for the 30% of low income Latinos with Medicare and Medicaid, the program actually made things worse. In many states, such as New York, Medicaid previously paid for medicines without any co-payments. Under the new Medicare Act, low income elders now have to co-payments to pay. This means that for a typical person having diabetes, cholesterol and high blood pressure, they now pay from $10-$30 a month for medicines that were previously free.
Bush has also tried to push Latinos into private Medicare Advantage Insurance plans. Rather than getting health care delivered by any doctor or hospital as happens under Medicare, these private plans limit the choices of doctors, hospitals, medical tests and procedures patients have access to. Since these plans cannot compete with regular Medicare, Bush made sure these plans got paid billions of dollars more than regular Medicare. In return, some plans pay enrollers hundreds of dollar for every elder they get to sign up. This had resulted in widespread unscrupulous, unethical and even illegal marketing. In the Washington Heights community, Latinos are made false promises such opening clinics in Santo Domingo to provide US style health care or that elders will get $100 a month to buy groceries. Sadly, such tactics have been successful at attracting many Latinos. Advice: Almost all Latinos with Medicare should avoid joining these private Medicare plans; before you do please check with your doctor.
Bush also severely reduced funding for programs that support the training of Latino physicians. While many of these programs including the Hispanic Centers of Excellence have a proven track record in increasing the number of Latino physicians, every year the Bush administration has pledged to try to end these critical programs and two years ago nearly succeeded. This begs the question, why not an F minus. Probably the only positive development under Bush administration has been the expansion of the Nation’s Community Health Centers. These provide primary and preventative care for uninsured and vulnerable populations. With increased funding under Bush, the number of persons cared by these Center’s has nearly doubled to 2.8 million. While this has been an important development, we would argue that a priority for the Bush should have been increasing the number of Latinos with health coverage rather than increasing the number of clinics that provide care to the uninsured. Nevertheless, for this effort, we give him an overall grade of F+ and not an F-.
Olveen Carrasquillo, MD, MPH
Associate Professor of Medicine and Health Policy
Columbia University Medical Center
VP, Latinos for a National Health Insurance
Jaime Torres, DPM, MS
President, Latinos for a National Health Insurance
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