Letter to Conferees Reid

January 13, 2010

The Honorable Harry Reid
U.S. Senate
Washington, DC 20510

Dear Majority Leader Reid:

On behalf of the Latinos United for Healthcare (LUH), a coalition of the organizations comprising the National Hispanic Leadership Agenda (NHLA) and other Latino organizations and individuals committed to the passage of significant health care reform, we urge you to support critical provisions necessary for ensuring that a health reform bill serves the Latino community across the United States and its territories.

Health reform will be most successful at improving the health outcomes of all Americans and reducing costs if as many people as possible are included – both as recipients of services and contributors to the costs. As House and Senate leaders work toward a final compromise on health insurance reform legislation in the coming weeks, Latinos United for Healthcare believes that health reform which does not include the following three provisions is not true health reform for our community. Any health reform compromise must include these three provisions to earn our support.

Support House measures on Puerto Rico
LUH strongly supports equity for the U.S. citizens residing in Puerto Rico and wants to see provisions from the House bill that give Puerto Rico access to the exchange included in the final legislation. Such access would help the estimated 400,000 struggling working class U.S. citizens in Puerto Rico find affordable health insurance options, while also making good on President Obama's stated promise to provide healthcare equality for Puerto Rico.

The Senate has taken steps to improve funding for the Medicaid program, but the increases fall short of meeting the needs of uninsured Puerto Ricans. Given that current mandates under Medicaid continue to be circumvented in an effort to unjustifiably reduce funding levels to Puerto Rico, we strongly favor inclusion of the House bill's language to increase Puerto Rico's Federal Medical Assistance Percentage (FMAP). We also want to see equality for Puerto Ricans under the Medicare program since island residents pay fully into this program and are entitled to equal treatment under the program.

Include Menendez Amendment to lift the five-year bar for legal residents in Medicaid
Both the House and Senate bills require legal immigrants to have health insurance, yet neither bill allows low income legal immigrants to access Medicaid until after five years of legal residency. Legal residents pay taxes just as U.S. citizens do, and therefore deserve to avail themselves of these safety net services when they fall on hard times. In the reauthorization of CHIP last year, Congress gave states the option to remove the five year waiting period for participation in CHIP. LUH strongly supports inclusion of the proposed amendment by Senator Menendez which would follow that model and apply it to the Medicaid program. The CBO has scored the amendment as having a negligible cost as expanding preventive and other health services to low income families is offset by reducing emergency room visits which are costly to taxpayers.

Support House measures on access to the exchange
LUH opposes costly and ineffective verification requirements that prevent low income, elderly and minority American citizens and legal residents from accessing health care services they rightfully deserve. Such verification provisions especially have no place in blocking access to private insurance options, where no federal taxpayer subsidies are involved. We therefore urge you to support the House bill’s language on verification requirements to access the exchange.

Other Provisions
Latinos United for Healthcare recognizes the importance of health reform for the country. While we view the three issues referenced above as critical tenets of true reform for the Latino community and thus a benchmark for our support on a final bill, we also support other provisions of the House and Senate bills that will help make health insurance affordable and end health disparities. We are hopeful that these measures will also be included in final legislation.

Support House language to expand Medicaid coverage to 150% FPL
LUH supports measures to increase access to health services by making insurance coverage more affordable. Such measures are especially important since Latinos, like all Americans and legal residents, will be required to have health insurance. We therefore urge you to include in a final bill the provisions from the House-passed legislation that expand Medicaid to all individuals under age 65 with incomes up to 150% percent of the Federal Poverty Line (FPL).

Improve Affordability Credits
We also urge you to improve upon the affordability measures in both the House and Senate bill. Despite both chambers’ efforts to make private insurance affordable, we are concerned that it will remain out of reach for many Latinos if total out-of-pocket costs for medical expenditures exceed 10% of income for middle-class Americans and 5% for low3 income Americans. Anything above those levels will continue to keep health insurance out of reach for many families.

Support House funding level for prevention
Both the House and Senate bills included an increased emphasis on prevention, including guaranteed coverage of preventive services. In particular, LUH favors inclusion of the $33.9 billion funding level in the House-passed bill for the Public Health Investment Fund, which is $11.1 billion more than the Senate bill provides for both the Prevention and Public Health Fund and Community Health Center Fund.

Support Senate language on the Office of Minority Health
The Office of Minority Health plays an important role in coordinating efforts to overcome and end health disparities that affect Latino and other minority communities. Currently, Latinos suffer from higher rates of chronic disease and other conditions that can be addressed through culturally competent and linguistically appropriate care, outreach, and prevention. LUH supports the Senate bill’s elevation of the Office of Minority Health, which will strengthen its ability to serve our community.

Support Senate language on funding Community Health Centers
Both the House and Senate bills recognize the important role that community health centers often play in providing health services to low-income and minority communities. Additional resources to enhance the reach of these centers in underserved areas is important. LUH supports Senate language that would protect health centers from underpayment by ensuring that they not lose revenue when treating newly insured patients gaining coverage through the new health insurance exchanges the bill establishes.

Oppose Inclusion of Provisions Harmful to Small Businesses
The Senate bill contained a provision to require very small businesses with five or more employees in one specific industry to provide coverage to their workers or face a significant financial penalty. There are no such provisions for any other industry, which are otherwise required to provide a reimbursement for those workers receiving federal assistance. Discriminating against the smallest of the small in the construction industry, which represents nearly a quarter of all Hispanic owned businesses, aims to drive minority construction firms out of existence at the benefit of large corporate construction companies.

Additionally, LUH recommends that the House consider that financing structures are available that achieve the goal of shared responsibility without imposing unreasonable burdens on small business. Expanding coverage at the expense of employment is a losing proposition that ought to be avoided through a delicate balance of inducements and reimbursements.

Thank you for taking our views into account as you consider how to shape health insurance reform so that it best serves the needs of your state’s Latino population and all residents. We are hopeful that you will do what is best for Latinos and the nation as a whole, and would be pleased to work with you in advancing these goals. Your staff should feel free to call on Chris Espinosa at cespinosa@hispanicfederation.org or (202) 842-0235 to explore ways in which we can work together.

Sincerely,

Lillian Rodriguez-López             Brent Wilkes
Chair, NHLA                                 National Executive Director
                                                        League of United Latin American Citizens