APIA
ASIAN & PACIFIC ISLANDER
AMERICAN HEALTH FORUM
www.apiahf.org
Health Care Reform: Likely Impact on the
U.S. Territories and the Freely Associated States
The United States is on the brink of historic health care reform. Reforms to the nation’s health
care system will increase options for affordable health coverage, critical for low-income, high
health disparities populations. While Congress has not completed the final version of health
care reform legislation, the Asian & Pacific Islander American Health Forum expects that these
reforms will include key advancements for Americans living in the United States Territories
and the Citizens of the Freely Associated States, who reside in the U.S. With serious health
disparities affecting Pacific Islander communities such as the incidence of cervical, lung, and
stomach cancer, breast cancer mortality, and suicide, these advancements carry the potential
for significant changes. (Asian American Communities and Health)
Disparities Affecting Access to Affordable Health Coverage
70.00%
64.76%
60.00%
55.50%
50.00%
40.00%
Non Hispanic
NHPI
30.00%
20.00%
10.00%
19.89%
16.48%
10.81%
8.64%
0.00%
Uninsured
Employer Sponsored Insurance
Poverty
Current Populcation Survey, Annual Social and Economic Supplement (2009), available at http://www.census.
gov/hhes/www/cpstc/cps_table_creator.html (using CPS data for calculations by the Asian & Pacific
Islander American Health Forum.)
Access to Affordable Options
Over 16% of Native Hawaiians and Pacific Islanders lack health coverage and almost 20% live
in poverty. The emerging legislation will likely expand coverage through:
• Medicaid Expansion for the Territories: Provisions have been included to increase
Medicaid funding allotted to the Territories along with an enhanced Federal Medical
Assistance Percentage (FMAP). The U.S. Territories operate their Medicaid programs
under statutorily set caps, unlike the States. They also have the lowest FMAP at 50%.
• Medicaid Expansion for FAS Migrants: Under the House bill, Citizens of the Freely
Associated States (FAS) residing in the U.S. States and Territories would once again benefit
from federal Medicaid funding, from which they were excluded in 1996. FAS migrants
would be eligible for Medicaid enrollment without a waiting period.
January 2010
• Access to Exchange-based Plans: The Exchange(s) would provide affordable, private
health insurance options, essential for those seeking to purchase coverage in the
individual and small group markets. Under the House bill, the Territories would have
access to the Health Insurance Exchange. The Senate bill, however, only provides
Exchange access to citizens, nationals, and aliens lawfully present in the United States.
Thus, under the Senate provision, Exchange eligibility would vary by Territory.
• Affordability Credits: Affordability credits would help many low- and lower-middle
income individuals purchase coverage through the Exchange(s). Under the House bill,
the Territories would receive an approximate $4 billion allotment for the provision of
affordability credits to their residents. The Senate bill only provides such credits for tax
payers and excludes the U.S. Territories from participating.
APIA
ASIAN & PACIFIC ISLANDER
AMERICAN HEALTH FORUM
Individual Mandate
Health care reform legislation will impose requirements for individuals to purchase health
coverage. This requirement, however, does not apply to bona fide residents of the Territories.
Consumer Protections
Current health insurance industry practices such as exclusions due to pre-existing conditions,
lifetime-spending caps, and premium hikes due to factors like gender have prevented many
from attaining affordable health coverage. Health care reform will remedy these practices
through a number of consumer protection provisions. Unlike the Senate bill, the House bill
applies these provisions to the Territories.
Works Cited
Asian American Communities and Health : Context, Research, Policy and Action 139, 141, and
168 (Chau Trinh-Shevrin, Nadia Shilpi Islam, and Mariano Jose Rey eds., 2009).
CURRENT POPULATION SURVEY, ANNUAL SOCIAL AND ECONOMIC SUPPLEMENT (2009),
available at http://www.census.gov/hhes/www/cpstc/cps_table_creator.html (using CPS data
for calculations by the Asian & Pacific Islander American Health Forum).
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For more information contact:
Deeana Laurie Jang, JD
Policy Director
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