Affordable Care Act Communities with Limited Health Resources
Affordable Care Act & Communities with Limited Health Resources Samantha Herrera, ‘Ilima Ho-Lastimosa, Pam Ozenberger, Summerly Botelho-Jamorabon, Pu‘u Zablan 10/08/2014
Agenda ●What is a “Community with Limited Health Resources” (LHR)? ●How does the ACA address these issues? ●Case Study: Wai‘anae ●Community Based Interventions
Define: “Communities with LHR” ●Groups of people who has trouble accessing the health resources they need. This could be because of: o Geographical hurdles o Lack of availability of resources o Financial constraints o Others?
Pre-ACA issues resulting in LHR ●Many Americans were uninsured ●Pre-existing conditions precluded many from access to insurance or capped coverage, making healthcare too expensive ●High cost of healthcare (average of 16% of GDP) ●Many of low-use persons were paying out of pocket or not at all (young and healthy) (Blumberg, 2012)
How does the ACA help communities with LHR? ●Tax credits for low-wage employees to gain access to insurance; for small businesses to provide insurance ●Expansion of Medicaid program to low-income nonelderly and incentives to reduce Medicaid costs ●Overall reduction in healthcare costs by incentivising efficiency and quality improvement ●Increased cost-sharing via higher enrollment of low-use persons (young and healthy) (Blumberg, 2012)
Which communities in Hawai‘i have LHR? Neighbor Islands: Fewer resources (specialty and acute care) per capita than O‘ahu Higher cost of service (about 10%-43% higher) than O‘ahu Rural/Isolated communities (Example: Hana, Maui) SHPDA Health Care Utilization Report, 2010
Which communities in Hawai‘i have LHR? Those living in poverty: ●Less likely to have coverage ●Less likely to seek care due to cost and stigma http: //www. hawaiihealthmatters. org
Which communities in Hawai‘i have LHR? And many more… Those with cultural and language barriers Those with mental health issues Other marginalized populations
Neighborhood Disparities ●Individuals of a particular ethnicity or cultural background often prefer to live near others of similar ethnicity or background ●Influenced by discrimination ●Racial segregation o White Americans typically live in neighborhoods heavily populated with white Americans ●Employment discrimination ●Unequal distribution of resources Gehlert, S & Browne, T. A. (Eds. ) (2012). Handbook of health social work, second edition. Hoboken: John Wiley & Sons.
Neighborhood Features/Resources Affecting Health ●Healthcare resources ●Presence of green space for exercise ●Accessibility of healthy foods ●Quality of housing ●Norms and values ●Crime Gehlert, S & Browne, T. A. (Eds. ) (2012). Handbook of health social work, second edition. Hoboken: John Wiley & Sons.
Wai`anae ●One of the highest concentrations of Native Hawaiians ●Health behaviors: highest rates of smoking, heavy drinking, and low physical activity ●Highest rates of death from heart disease and cancer, and a higher occurrence of obesity, diabetes, and high blood pressure ●Social determinants and community resources Look, M. A. , Trask-Batti, M. K. , Arges, R. , Mau, M. L. , & Kaholokula, J. K. (2013). Assessment and priorities for health & well-being in Native Hawaiians and other Pacific Islanders. Honolulu, HI: Center for Native and Pacific Health Disparties Reserch, University of Hawaii.
Courtesy of Google Maps
Wai‘anae Case Study ●Video – Summerly
Community Based Interventions ●‘Ilima
Implications for Social Work ●Policy Advocacy o How can we advocate for more culturally relevant/aware health care options? o How can we incentivize more balance of resources throughout the islands? ●Community Education o How the Affordable Care Act benefits clients o What hurdles still exist and how to mitigate o Pōkā’s acronym: S. T. E. P.
Mohala i ka wai, ka maka o ka pua Flowers thrive where there is water
Mahalo!
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