The ACA and the Undocumented
Last March 2010 President Obama signed a law called the Patient Protection and Affordable Care Act (ACA) to provide health care access to under- and uninsured individuals in the United States. The goal is to decrease the number of uninsured Americans, to reduce the cost of healthcare and to provide a quality and affordable health care for all Americans. It gives the individual control of their health care. In the provision, the law did not include one key group of uninsured people which are part of the vulnerable population: the undocumented or illegal immigrants. Undocumented as define by Jerome-D’Emilia and Suplee “are those foreign-born individuals who have come to live in the United States but lack legal residency requirements. They have either overstayed or violated a visa (entering as a student and staying after graduation, for example) or entered the country without providing documentation.” The law will not allow undocumented individuals to buy health insurance or be eligible for Medicaid, Medicare, or CHP (the children’s Health Insurance Program) or be allowed to purchase insurance on state run exchanges under the law which is to be established by 2014. This means these individuals will not have any access to health insurance or affordable care. Because of the exemption of this vulnerable population, utilization of charity care will significantly increase as this is their only main source to access health care. Charity care or known as “uncompensated care” provides free or reduced rate of service provided by not-for-profit or public hospitals, clinics, community health centers and state health department. The Institute of Medicine (IOM) describes health care safety net as “those providers that organize and deliver significant level of health care and other vulnerable patients.” Individuals regardless of immigration status, total house hold income that falls below the poverty line, unable to pay and ineligible for Medicaid is the major user of charity care. The uninsured, underinsured, individuals that do not meet criteria for Medicaid and individuals that are not old enough to qualify for Medicaid are examples of individuals that utilize uncompensated care. Legal residency is not required when applying for charity care. Hospitals and non-profit hospitals that provide care to these individuals get reimbursement from the state and federal funds such as the Medicaid and Medicare disproportionate share hospital (DSH). Hospitals greatly rely on these funds for profit and to continue their services. “In 2009 total uncompensated care (charity care plus bad debt) in the United States was 39.1 billion, a $17 billion increase since 2000” (American Hospital Association as cited in B. Jerome-D’Emilia & P. Suplee). “Responding to a recent federal requirement that nonprofit hospitals detail their expenses for charity care, hospitals reported that on average 2.5 % of their expenses went to providing charity care.” CITATION Jer12 \l 1033 (Jerome-D'Emilia & Suplee, 2012) . As the new health care reform get implemented by the year 2014, funds for the charity care will be reduced due to the projected number of individuals that will be insured. These leaves a big impact on the payments received by some safety net without any additional funding to meet the need of these vulnerable populations because a large number of population they serve are the undocumented in which their only way to get health care service is through emergency care. ACA has provisions to protect charity care in which hospitals are not allowed to overcharge under- or uninsured individuals and that hospitals must make every effort that individuals applying for charity care are qualified enough to receive financial assistance and hospitals must have a policy as they provide financial assistance. “A significant provision is the requirement that nonprofit hospitals work with other community providers and