Immigrants’ Invisible Presence in Health Care Debate

By Michelle Chen Feb 20, 2010

You might be sick of hearing about health care by now, The politics of medicine grow messier by the day, dripping with empty jargon and industry lobbyists determined to eviscerate any substantive effort toward reform. Now imagine if you’ve just arrived in the country, speaking little English, working off the books and paying half your income toward rent. In that case, you’re likely not all that bothered by the national debate on health care; you’re too busy living through the crisis to give it much thought. Aside from the occasional use of "illegals" as an obstructionist propstirring up racist fears about the government caring too much about "those people"–immigrants are all but invisible in the struggle to pass reform in Washington. Well before the current meltdown in Congress, immigrants (both with and without legal status) faced a labyrinth of restrictions, including draconian waiting periods for green card holders. The exclusion of undocumented immigrants from the main legislative proposals is a clear sign that the Democrats are not willing to expend political capital on the issue of insurance for people without legal status. Immigrant-advocacy groups too are putting health care aside as they strain to keep their main issue, comprehensive immigration reform, afloat in the partisan horse trade. With the Senate stalemate, lawmakers might want to revisit the issue of immigration and health care, and how moving forward on both issues in tandem is necessary for either to go forward. A study published by New Yorkers For Accessible Health Coverage and the New York Immigration Coalition examines barriers to health care that immigrants face and finds that even those eligible for publicly subsidized coverage may find it virtually impossible to obtain quality care. The political terror pulsing through immigrant communities is becoming a public health hazard:

• Many have been advised erroneously that receipt of public health insurance benefits could lead to their being considered a “public charge,” which would disqualify them from adjusting their status to lawful permanent resident…. inappropriate public charge findings by immigration officials have significantly compromised New York’s ability to enroll lawfully present immigrants in Medicaid, even though they are eligible for the program. • Some lawfully residing immigrants believe that their ability to sponsor relatives for admission to the United States would be adversely affected by their own public insurance enrollment. Others who are themselves sponsored by relatives refuse to enroll in government insurance because they have been deterred by the prospect that their sponsors could be asked to repay the government for care they receive. … • Some noncitizens who lack authorization to reside in the U.S. fear that enrollment in a government sponsored health insurance poses risks of disclosure and reporting of their presence and status to immigration authorities. To the extent that individuals are uncertain about their legal status, or the status of their family members, the fear of reporting engenders more reluctance to enroll, especially among children, who are eligible for affordable health insurance in New York regardless of their immigration status. • Some noncitizens do not enroll because cultural, linguistic, and navigational barriers prevent them from understanding or overcoming obstacles to the insurance system. Particular obstacles are immigrants not knowing their rights to enroll or being unable to successfully complete what can be a confusing if not bewildering enrollment process, even for native-born New Yorkers.

The groups’ recommendations should factor into any vision of universal coverage: remove the five-year ban on federal benefits for many categories immigrants; provide statewide universal access to care and ensure that critical services are targeted to non-English speakers and underserved communities. A health care overhaul that works for immigrants may be off the table in Congress for now, but the report at least helps counter the mythology of the parasitic foreigner, hell bent on draining the social service system while stealing jobs and lowering property values. Even people with legal status can end up shut out of the system, falling through bureaucratic cracks produced by human error or outright prejudice. Fear of law enforcement alone may be enough to turn people away; you’re willing to take a chance on your health when you feel like you face even higher odds of exposing a loved one to immigration authorities at the doctor’s office. One interviewee’s comment in the report reflects the risk calculation that drives people to forgo benefits:

I used to have Medicaid, but terminated it when someone told me that I shouldn’t use such public benefits. It made sense, later when I go in for an [immigration] interview, such record wouldn’t work in my favor. I even have diabetes, and need more than $150 just to pay for my medications. When I had Medicaid, I only had to pay $5. Now, $150, month after month…

How many U.S.-born citizens could imagine giving up their health insurance for fear of provoking the disapproval of a bureaucrat? If we start with the premise that health care is a human right, immigrants are one group that typifies how pitifully the country fails that principle. Health is an afterthought as they wade through a legal fog in which asking for any kind of help, even legally entitled services, could expose them to fatal risks. The immigration crisis and health care crisis are lethally interlocked–two national maladies, each one a symptom and cause of the other. Image: Migrant mobile clinic (John Moore/Getty Images)