The Other Fight in Health Reform: Immigrants’ Access to Medical Coverage

Outrageous, incredible, unbelievable.
We’ve heard these words quite a lot from reproductive rights groups and pro-choice advocates, still in shock over the U.S. House of Representatives’ decision to pass an amendment banning most abortions from all public and privately funded health plans in the insurance exchange.  The idea that women would have to plan for an unplanned pregnancy is ludicrous and simply a red herring as anti-choice advocates attempt to make Roe null and void.
The National Latina Institute for Reproductive Health shares this outrage, and is working to generate Latino calls to ensure women’s right to access abortion care–and to decide for themselves how to spend their private health care dollars–is a part of the final Senate bill.
However, abortion discussions in the media have obscured an equally important debate in health care reform: immigrant access to medical coverage. For years, immigrants in this country have faced a two-tier health system.  Legal immigrants and residents are banned for the first 5 years they are in the country from accessing public health benefits including Medicaid.
Even worse, widespread stigma, discrimination, and fears of deportation prevent many undocumented immigrants from ever seeking medical care, even in cases of extreme illness. Despite being the economic backbone since the nation’s founding of much of the work done in our economy, immigrant health is viewed by many as a non-necessity; a “privilege”, not a human right. 
Working to counter this pervasive belief, last week the Congressional Hispanic Caucus and Latino advocates met with the Obama administration and other Congressional leaders to emphasize the critical health priority of including immigrants’ coverage in the final reform bill. And thanks to their hard work, the House included language that permits undocumented immigrants to buy into the public health insurance exchange with their own money.  While this is a compromise over full and equal access to the insurance exchange by undocumented immigrants, it is still an improvement from some of the draconian anti-immigrant amendments that some Congress members have threatened to put forward.
Now, the fight has moved to the Senate bill, which in its current state would deny millions of undocumented immigrants from using their own hard-earned money to buy coverage for themselves and their families, as well as prevent them from receiving any subsidies, affordability credits or federal Medicaid assistance.
And the 5-year ban for immigrants’ access to health care remains intact.  What is lost in the anti-immigrant rhetoric is reality. Over half of all immigrants are women and 53% of all immigrants are from Latin America.
By 2050 one in every 4 women in the United States will be a Latina. Latinas are the fastest growing segment of small-business owners. These women, the heart and soul of our families and communities, currently make up the highest group of uninsured (38 percent), and many of their children live in poverty as families are often denied access to a full-range of health services due to discrimination and immigration restrictions.
Yet once again, in their approach to legislation on health reform, politicians are basing decisions on ideology rather than common sense, public health strategies.
For example, just looking at the Latina teen birth rate, many politicians would prefer to promote a “just say no” mentality to Latina teen sex rather than look deeper at the correlation between health insurance and teen births. As our recent white paper asserts, it’s not that white girls have greater sexual restraint or prefer contraception, but that many Latina teens have little information about their health and rights. Our interviews with Latina community leaders revealed that children and teens in mixed-status immigrant homes are less likely to understand the U.S. health care system as well as non-immigrant teens, especially how to access safety net and youth-oriented services, like Title X clinics.
Research also shows that Latinas are much less likely to seek prenatal care. By excluding undocumented parents from insurance coverage, and scaring them from even accessing free clinics, we effectively bar future generations of Americans from health care and economic opportunity.
No one questions that the bills before Congress represent the greatest overhaul to our health care system in recent history. But if the final bill doesn’t recognize and appreciate the changing face of American demographics, it will be outdated before the President’s ink even dries. At a minimum, undocumented immigrants should be allowed to buy health insurance in the exchange and the 5-year ban for legal permanent residents to participate in programs like Medicaid should be lifted.  
All of our futures, and the health of the nation, depend on it.

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