It Shouldn't Be This Hard For Immigrants to Access Health Care
For clarity, these show notes and this podcast episode will be inclusive of undocumented immigrants and immigrants with legal status.
In the United States today, there are more than 8 million citizens who live with at least one family member who may be undocumented. Yesenia Chavez with the National Latina Institute for Reproductive Health (NLIRH) and Jaclyn Dean with the National Asian Pacific American Women’s Forum (NAPAWF) talk to us about the fight for access to healthcare for immigrants.
Children make up the majority of the millions of citizens who live with at least one family member. In fact, 6 million of these citizens are children. This means that many types of immigration enforcement actions come with severe emotional, mental, developmental, physical and financial repercussions for both the children and the undocumented individuals.
Immigrants are not able to legally access public benefit programs until they have proven their permanent resident status, and only after five years of having that status. These programs can help provide housing, food, and health security to these communities. It is important to note that this same five-year bar also prevents access to the Affordable Care Act insurance marketplace. This means that opportunities for immigrant individuals and families are already limited, and immigrants often rely on a patchwork of insurance sources to cover healthcare. If their employer does not cover insurance or if they do not qualify for Medicaid, then immigrants often have to turn to paying for emergency care out of pocket, or seeking help through a community health center.
46% of immigrant, non-citizen women of reproductive age in the U.S. are privately insured, 19% rely on Medicaid for their insurance, and 34% are completely uninsured. The uninsured rate for immigrant women of reproductive age who are living in poverty is 48%. Nearly half of all immigrants in the U.S. are women and children.
About two thirds of Asian American and Pacific Islanders (AAPI) are foreign-born, and 35% of AAPI individuals in the U.S. have limited English proficiency. This means that communicating about one’s medical needs in the English language may not be an entirely comfortable scenario. There are also many differing cultural and spiritual values that don’t exist in Western medicine that AAPI individuals are not comfortable sharing. These medicine types may also cost more if they are not covered by insurance. AAPI individuals, of all racial groups, feel that they are most looked down upon by their providers and the least likely to feel that their background is understood by their providers. On top of these barriers, reproductive healthcare is not widely referenced or perceived as a valid health need among AAPI individuals. The pre-existing stereotypes, biases, miscommunications and lack of trust in the Western medical system makes accessing reproductive healthcare difficult for AAPI individuals and families.
Nearly 1 in 3 non-elderly Hispanic individuals lack insurance coverage in the United States. Given the lack of access to insurance coverage as well as susceptibility to lower wages based on immigrant status, Hispanics are half as likely as non-Hispanic whites to have health insurance. Hispanic and AAPI communities can face similar (and different) battles when it comes to receiving healthcare in the U.S., and the base issues include language barriers and lack of culturally competent care. For many undocumented Latinos, accessing care can be stunted due to fear of legal repercussions due to immigrant status.
Public charge is a legal determination that U.S. immigration officials use when immigrants are seeking legal entrance to the U.S. or looking to change their legal permanent residence status, and is essentially a tool that will determine whether or not an immigrant will heavily rely on the government for support for basic necessities. In October of 2018, the administration published a proposed rule to drastically expand the definition of public charge to include Medicaid, SNAP, TANF, and many other public benefits, including Section 8 Housing vouchers. If this proposed rule went into effect, it would likely force immigrants to choose between the well-being of themselves and their children and their status in the U.S. Because Medicaid is now included in the public charge test, many immigrant women would likely forgo health care including contraception, family planning, maternity and post-partum care and STI testing and treatment.
In order to ensure immigrants are able to access affordable healthcare, the five-year bar preventing immigrants from accessing public benefit programs and insurance needs to be removed. The Health Equity and Access Under the Law Act (HEAL) seeks to repeal this five-year bar.