1. Texas Uninsured and ACA Latino Impact Families USA Annual Conference Hyatt Regency on Capitol Hill Washington, D.C., January 23, 2014 Juan H. Flores juan@ix.netcom.com

2. HEALTH CARE REFORM ENVIRONMENT  Historical Context [Texas ‘On-the Brink’ Anti-Social Determinant Policies - Marginalization of POC]  Current Political Environment  ACA Implementation Barriers Medicaid Expansion Health Insurance Exchange Texas [TDI & DHHSC]  Consumer & Navigator Adverse  DSH/Waiver

3. OVERALL: INSURANCE COVERAGE & HEALTH CARE ACCESS  Impact on Insurance Coverage and Health  Health Care Status = So – So  Health Care Quality Not The Best  Health Care Costs Are High

4. LATINO HEALTH STATUS AND INSURANCE COVERAGE ENVIRONMENT  Mexican-American Health Paradox  Health Status Challenges  Insurance Coverage Trend

5. DEMOGRAPHIC & SOCIO- ECONOMIC CHARACTERISTICS HEALTH PROFILE ISSUES AND CHALLENGES HEALTH INSURANCE ISSUES HEALTH CARE POLICY TRENDS High Population Growth, Young, & Large Immigrant Subgroup Highest Uninsured Rates No Health Insurance = Greater Health Risks & Poor Health ACA Focus: Access, Quality, Prevention, and Costs Below Average Education and Income Levels Worsening Health Disparities No Health Insurance= Access Low Quality Healthcare Reductions in Federal & State Safety-Nets Increasing Local Reliance Employment in Small Businesses & Low Wage Job Industries Differences in Chronic and Infectious Diseases Significant Drop in Employment Based Health Insurance Medicaid Waivers to Improve Access, Quality, & Costs High Employment GrowthBehavioral Health, Substance Abuse & Teen Pregnancy Low/Middle Class Offered EBHI 2-3 Times Less Consumer-Driven Care Consumer Behaviors and Responsibility High Growth in Age 65+ Population Health Literacy Risks: English and Spanish Insurance Take-Up Rates Lower: By Wage, Firm Size & Industry Marketing To Hispanics - Expansion of Low/High Risks Health Plans Growing Middle ClassSub-group Issues and Ethnic Diversity 24% of Uninsured Growth Attributed to Middle Class Market/Tax-Base Efforts: Bus. & Consumers to Increase ‘Skin in the Game’ [O-O-P Costs] Bilingual Bicultural Diverse Sub-Groups Environmental Determinants Conditions of Inequality 27% of Low/Middle Income with Credit Card Debt Hispanics 64% Higher Health Information Transparency & Pay- For-Performance Severely Under Represented in Health Professions Bilingual Bicultural Health Perspectives 2/3 rd Parents with Medicaid /SCHIP Enrolled Children No EBHI Business and Privilege to Health Care More Dominant

8. Source: U.S. Census, Community Population Survey 2011

9. PopulationTotal Uninsured Number Below 100% FPL Percent Below 100% FPL Percent of Total Below 100% FPL Total 6,067,9031,765,61729%100% Hispanic 3,733,5191,161,42731%66% White 1,450,050322,07622%18% Black 573,274221,95139%13% Other 311,06060,24319%3% Texas ACA Gap Number and Percent Uninsured Below 100% FPL Source: U.S. Census, Community Population Survey 2011

10. ACA CHALLENGES AND OPPORTUNITIES  Political and Policy Barriers  Communications and Outreach Strategies  Organizing & Political/Policy Advocacy  Closer Collaboration With: Coalitions [Multiple Sectors] Public and Non-Profit Hospitals CHCs/Free Clinics