Maria Portela Martinez, MD, MPH

Maria Portela Martinez, MD, MPH

2013-2014

Branch Chief of Medical Training and Geriatrics, Division of Medicine and Dentistry, Bureaus of Health Workforce - HRSA, Rockville, MD

Maria Portela Martinez, MD, MPH, was most recently a Mongan Commonwealth Fund Fellow in Minority Health Policy. Prior, she was a Family Medicine Resident at Duke University Medical Center in Durham, North Carolina. In 2010, while Dr. Portela Martinez was pursuing a Ponce School of Medicine Health Policy Sub Internship, she drafted a document assessing the health and education sectors for President Obama’s taskforce on Puerto Rico’s economic development. This work, along with other efforts and Dr. Joxel’s Garcia’s leadership, resulted in more than tripling Medicaid’s federal funding for Puerto Rico.

Dr. Portela Martinez also worked on the documentary “En Sus Zapatos: Challenges of the Primary Care Physician,” which aimed to raise awareness among providers of the barriers to health care faced by the Hispanic population. From 2012–2013, she served as health policy chair for the National Hispanic Medical Association Council of Residents. Dr. Portela Martinez completed her medical degree at Ponce School of Medicine in 2010. She is interested in increasing access to high-quality health care services, particularly for the Latino immigrant population.

May 5, 2014 | Harvard T.H. Chan School of Public Health Video Series

Undocumented Immigrants, waiting for Health and Immigration Reform

Objectives:     

To explore the intersection between Immigration and Health Reform. To examine ways of protecting and increasing health care services and access that undocumented immigrants receive in order to preserve safety net hospitals viability and provide quality care to all.

Background:     

We are at a particular moment in history that can be transcendental for immigration legislation. In addition, in 2010 we just recently passed the Affordable Care Act (ACA) the most significant piece of Health Care Legislation for Americans since 1965. Previous to the ACA an estimated 50million people were uninsured in the United States1, of these an estimated 15% are undocumented immigrants2. The ACA translates into some positive gains for legal immigrants10. However, undocumented immigrants are excluded from the ACA provisions and might fare worse off10. There are over 11 million undocumented immigrants in the US2. The ACA includes some significant cuts to public subsidies such as Disproportionate Share Hospital that has traditionally helped fund safety net hospitals where many undocumented immigrants receive health care services3,10. In states that are not expanding Medicaid, these cuts threatens the viability of safety net hospitals3,4,8 whereas much as 77% of the total discharges belong to Medicaid and uninsured patients versus <30% of discharges in Academic Centers5,4,6. In addition to the care they provide to the poor, >25% of safety net hospital own over 85% of the market share for some sub-specialty services that the whole community utlizes7.

Methods:    

Conducted a literature review regarding undocumented immigrant health care access. Conducted expert interviews and a review of immigration and health reform policies for the past 30 years

Results:     

We are at an interesting point in history where an Immigration Reform bill  S.744-Border Security, Economic Opportunity, and Immigration Modernization Act10 is on in the House of Representatives and a health care bill introduced in March, 2014 H.R.4240 “Health Equity And Access Under The Law For Immigrant Women And Families Act Of 2014″11 (HEAL) proposes including DACA eligible individuals to be included in the exchanges, to have Medicaid eligibility, and bans the five-year waiting for lawfully present individuals from receiving federal subsides11 are both in Congress. Commonalities of previous national insurance expansions have all been incremental. Products of this project include a policy brief, a position statement, and an informational advocacy guide

Future Directions:     

Some opportunities for gains can be achieved by advocating and creating a coalition that supports H.R.4240 initiatives. By focusing on incremental insurance expansions and compromising by choosing a subset of the population such as children, DACA eligible individuals or other vulnerable populations we can have achieve legislative change.

Preceptors:    

Bruce Siegel, MD,MPH, Chief Executive Officer, America’s Essential Hospitals and Shawn Gremminger, Vice President of Advocacy, America’s Essential Hospitals