Tag Archives: undocumented immigrants

How much are immigrants really using our nations’ health care systems?

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THE DEBATE

The long standing popular narrative regarding immigrants and health care is that immigrants (legal and undocumented) have ready access to our nations’ health care systems and health insurance, so much so, that it has become a costly problem. However, I believe this not to be true. Healthcare and Health insurance is one of the major areas in which contemporary immigrants in the U.S. are facing heavy structural exclusion. Immigrants as a whole have significantly less access to health care and insurance in comparison to native-born citizens. The article that I have written aims at uncovering and elucidating the realities of immigrant utilization of health care and health insurance by identifying the major barriers to access for contemporary immigrants in the United States. To start, I have provided you with 3 videos that I feel highlight (to an extent) the current debate surrounding immigrants and health care usage.

In the 1st video, Dan Stein from FAIR (Federation of American Immigration Reform) points out that extending health care to undocumented immigrants comes at a cost for taxpayers. In the 2nd video, the news anchor questions the idea that undocumented immigrants should get health care by stating that there are plenty of “Americans” without health care. She also mentions firsthand accounts of border state emergency health facilities overwhelmed with undocumented immigrants coming in for treatment because they know they have the right to emergency medical service. Lastly she mentions that this is all unfair to hospitals and workers who have to deal with all of the undocumented immigrants and that they are not being paid in full by the federal government for their services. In the 3rd video, Bill O’Reilly (who is anchoring), states that the government, which is already going bankrupt, should not pay for health insurance for undocumented immigrants and refers to this idea as a “radical socialist agenda.” He also uses the word entitlement to describe health care concluding that health care is something that only citizens are entitled to and that undocumented immigrants shouldn’t even be in the U.S. in the first place but that they should be in their home countries. All of the videos center on the Emergency medical services (EMS) part of our health care system and portrays our emergency rooms to be littered and filled to the brim with undocumented immigrants. The whole debate clumps undocumented immigrants into one group and views them as one thing: unlawful leaches on the public sector.  They don’t see the children, they don’t see the families, the people who have been here for many years, and those who have tried or are trying to get legal status but are being road blocked by the process and the difficulty the government creates in obtaining legal status. They also portray immigrants, especially undocumented immigrants, as fully knowledgeable about their rights as evident by their “over usage” of EMS.

In 2009, FAIR published a study titled “The Sinking Lifeboat: Uncontrolled Immigration and the U.S. Health Care System in 2009” in which they claim that the U.S. government is spending nearly 11 billion dollars on health care for illegal immigrants. In the article it’s stated that “many illegal aliens are taking advantage of legislation that requires emergency rooms to treat all patients, regardless of ability or intent to pay for the treatment. The cost of uncompensated care to taxpayers and insured patients continues to rise. Uncompensated costs have caused some hospitals to reduce staff, increase rates, cut back services, and close maternity wards and trauma centers (p.2).” Included in the costs reported by FAIR are the costs of so called “anchor babies.” According to a CNS News Article by Matt Cover titled ‘Illegal Immigrants Account for $10.7 Billion of Nation’s Health Care Costs, Data Show’, U.S. FAIR Director of Special Projects and Writer of the report, Jack Martin, stated “each anchor baby costs taxpayers an estimated $10,000 each on average. These costs are usually paid through Medicaid, the federal program designed to aid America’s poor.” And of course all of this extends out of a long standing debate regarding immigrant usage of U.S. public assistance which includes health care programs such as Medicaid, CHIP, and SCHIP. Many anti-immigrant policy makers believe that these types of programs are too generous, that they extend benefits to people who are unlawfully here, and that it’s encouraging more and more immigrants to come the U.S. According to an article titled Health Care Utilization, Family Context, and Adaptation by Felicia B. Leclere et al., “The basic concern is whether new immigrants take more from public coffers through their use of services than they contribute in taxes and economic stimulation” (p. 371). To me, the current narrative is nothing more than a misrepresentation of the realities of health care usage for immigrants in the U.S. The question that I pose is: Are immigrants, legal or undocumented, really using federal health care as much as people think? If not, why not?

THE ‘REAL’ DATA 

Firstly, the numbers would suggest that immigrants as a whole are not using health care services as much as people think.

Health Insurance Statistics2 Immigrants 2007

According to a March 2008 Current Population Survey (CPS) under U.S. Census Bureau conducted by Center for Immigration Studies, in 2007: 33.2% of all immigrants did not have health insurance vs. 12.7% of native-born Americans (table 1). 17.6% of legal immigrants were uninsured and 43.8% of illegal immigrants were uninsured (table 2). The number of uninsured immigrants is rising over time (Table 2).

 

According to the 2010 American Community Survey and 2010 Census, these numbers have held. 34% of immigrants were uninsured. 22% had public health insurance vs. 31% for   U.S. born.

FIGIMMIGRATION

You can also see in information from Gabrielle Lessard and Leighton Ku (2003), that a greater number immigrant children or children of immigrants are uninsured. Undocumented children use much less federal health care programs in comparison to citizen children.

THE BARRIERS TO ACCESS AND USAGE

So if immigrants are not using health care and are not generally insured then what are the reasons for this? I have simplified the major barriers to access for contemporary immigrants to what I call ‘The 3 Ls’. They are Legislation, Legal Status, and Language.

1. Legislation – PRWORA (Personal Responsibility and Work Opportunity Reconciliation Act)

  • This 1996 reform law significantly reduced eligibility to public health care and insurance programs for immigrants (Derose, p. 1261)
  • Provisions include: 5-year waiting period (after obtaining legal status) for immigrants before being eligible for Medicaid/TANF, states retain the ability to remove the 5-year waiting period and cover lawfully residing immigrants themselves, and Undocumented immigrants are completely ineligible for all services under PRWORA. (Derose, p. 1259).

Public charge – government retains the right to deem a person seeking admission to the U.S. or permanent residence (green card) as “inadmissible” if they are thought to become primarily dependent on government funded services including long term institutional care.

2. Legal Status – Undocumented immigrants are much less likely to use health care and are more likely to be uninsured than legal immigrants. Undocumented Latino/as, for example, obtain fewer ambulatory physician visits than U.S. born Latino/as (Berk et al., 2000).

3. Language – Immigrants with low English proficiency have much harder times accessing and obtaining health insurance and health care. Adults with limited English proficiency and their children are much less likely to have insurance and a usual source of care, have fewer physician visits, and receive less preventive care than those who only speak English (Derose et al., p. 1260).

As a result of legislation and legal status, all immigrants are discouraged from using publicly funded health care services because of fear deportation or fear putting their chances of citizenship in jeopardy if they seek health care (Derose, p.1263) Even children of immigrants are less likely to use health care (Lessard and Ku, p.101). Often this is the result of their parents’ language and legal status. Immigrant parents are often uninformed about eligibility and rules because of language and because of their legal status they fear being reported to INS. (p.101, 104). Due to language barriers, immigrants have higher feelings marginalization and discrimination, which further turns immigrants away from the health care system (Derose, p.1262) as well as more misdiagnosis, mistreatment, and poor medical care (Lessard and Ku, p. 108)

WHAT NEEDS TO CHANGE?

There are several things we could be doing to improve the health care situation for immigrants. These include, federal level action and reform including the revision of PRWORA, expand opportunities for legal residency and citizenship, lower health insurance costs, employer mandated health insurance, developing more qualified bilingual staffs that incorporate members of the community by creating more opportunities for them, extending eligibility to parents of eligible children (which will enhance access and usage), better enforcement of Title VI of the Civil Rights Act which requires providers who received Medicaid/SCHIP to provide those who speak limited English meaningful access (Lessard and Ku, p.111), and increase funding for community health centers and outreach organizations. Lessard and Ku express the same sentiment that culturally appropriate, community based outreach is important for having immigrant, especially children, involved in the health care system (p.110).

Read about a woman bringing local health care to immigrants in Oakland (http://www.contracostatimes.com/my-town/ci_26909381/oakland-woman-brings-health-care-and-sense-home)

WHY IS THIS IMPORTANT?

The health care status of many immigrants, as a result of lack of access, is deteriorating which is why I believe this is an important issue. Immigrants are at a higher risk for poor physical and psychological health because of the barriers they face and given how the composition of our nation is changing and we’re becoming more and more populated with immigrants, we need to help the majority of the people beginning to build our nation. In “The Health Status and Risk Behaviors of Adolescents in Immigrant Families” by Kathleen Mullan Harris (1999), Harris examines the health status of immigrant children as an indicator of assimilation and acculturation and finds that for many immigrant children, the longer they are exposed to U.S. culture and institutions, the more they develop the health status and health risks associated with behavioral norms in the U.S. (p.311) She also points out that socioeconomic and legal status plays a role in bad health for immigrant children. This is also echoed in a Singh and Miller piece (2004) which states that the risks of disability and chronic disease morbidity during 1992-1995 among immigrants of various ethnic backgrounds increased with increasing duration of residence in the United States” (p.115) Ultimately at the moment, it appears that the U.S. government is forging a health care system in which contemporary immigrants have minimal access and structural inclusion and that doesn’t seem very “American” to me. FotoFlexer_Photo References

Berk, Marc L., Claudia L. Schur, Leo R. Chavez, and Martin Frankel. 2000. “Health care use among undocumented Latino immigrants.” Health Affairs 19(4): 51-64.

Camarota, Steven A. 2007. “Immigrants in the United States, 2007: A Profile of America’s Foreign-Born Population.” Center for Immigration Studies, Washington, D.C.

Derose, Kathryn Pitkin, José J. Escarce, and Nicole Lurie. 2007. “Immigrants And Health Care: Sources Of Vulnerability.” Health Affairs 26(5): 1258-1268.

Harris, K.M. 1999. “The Health Status and Risk Behaviors of Adolescents in Immigrant Families.” Pp. 286-315 in Children of Immigrants: Health, Adjustment, and Public Assistance, edited by D.J. Hernandez. Washington, DC: National Academiy Press.

Leclere, Felicia B., Leif Jensen, and Anne E. Biddlecom. 1994. “Health Care Utilization, Family Context, and Adaptation Among Immigrants to the United States.” Journal of Health and Social Behavior 35(4): 370-384.

Lessard, G. and Leighton Ku. 2003. Gaps in Coverage for Children in Immigrant Families. Health Insurance for Children 13(1): 101-115.

Ruark, Eric and Jack Martin. 2009. “The Sinking Lifeboat: Uncontrolled Immigration and the U.S. Health Care System in 2009.” Federation for American Immigration Reform, Washington, D.C.

Singh, G.K. and Barry A. Miller. 2004. Health, Life Expectancy, and Mortality Patterns Among Immigrant Populations in the United States. Canadian Journal of Public Health 95(3): I14-121.

http://cnsnews.com/news/article/illegal-immigrants-account-107-billion-nation-s-health-care-costs-data-show

No Place to Call Home: The DREAM Act and what it would do for the 1.5 generation and the U.S

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Each year in the United States, there are approximately 65,000 high school students who graduate and receive their diplomas, but find their options for their futures curtailed severely. Any aspirations these students may have to attend a four-year university, join the military, or find work are short lived the when reality sets in that these are not accessible to them. To any onlooker or researcher examining demographic data, the majority of these students are culturally American and indistinguishable from their peers. The U.S is their home.

These are the statistics and description given by the Immigration Policy Center regarding undocumented members of the “1.5 generation,” first generation immigrant children brought to the U.S at such a young age that they have been raised almost exclusively in the U.S (American Immigration Council 2011). For many students of this demographic, they are often just discovering their undocumented status as they attempt to fill out applications. In 1982, the Supreme Court ruled on the case of Plyler v. Doe, guaranteeing free and public K-12 education to all students, citizen or undocumented (Drachman 2006:91). By contrast, access to post-secondary education has several times been restricted at the national level.

IIRIRA and the Origins of DREAM

In 1996, Congress passed the Illegal Immigration Reform and Immigrant Responsibility Act (IIRIRA), a piece of legislation intended make immigration laws and regulations stronger and more efficient. Section 505 of this act is particularly important in regard to these aspiring college students. It stipulates that undocumented students living within a state can only be charged the more affordable in-state tuition rates if the state they resided in also allowed for U.S citizens from other states to apply for in-state tuition (Barron 2011). A large portion of undocumented members of the 1.5 generation come from low-income families, as their parents are also undocumented and can only get low-income, unregulated work where employers don’t ask for Social Security numbers or other documentation. This, in combination with the fact that they themselves do not have the paperwork required to complete college applications or apply for work to pay tuition, means these undocumented students are, for the most part, are left without support in  the country they believed was their home. While individual states have passed laws in recent years circumventing residency requirements for in-state tuition application, it is far from being the national norm.

Map-In-stateTuitionUndocumentedStudents.jpg

Figure 1 Source: National Association for College Admission Counseling.

In 2001, Republican Senator Orrin Hatch, identifying this issue, proposed the first version of the Development, Relief, and Education for Alien Minors (DREAM) Act to Congress. The stated goal of this legislation was to “allow children who have been brought to the United States through no volition of their own the opportunity to fulfill their dreams, to secure a college degree and legal status” (Barron 2011). In order to do this, the DREAM Act would repeal Section 505 of IIRIRA, and provide a path to citizenship for those undocumented members of the 1.5 generation who had arrived in the U.S under a certain age and had been in the U.S for a certain number of years. From 2001 until 2011, the DREAM Act has been proposed, with some variation, each year since, often coming close to but never actually receiving enough votes to pass both parts of Congress. 

What the DREAM Could Have Been

In order to begin the path to citizenship under the 2010 DREAM Act, which became the 2011 DREAM Act with very few parts changed, an undocumented immigrant would have to have entered the U.S prior to age sixteen, and have lived in the U.S continuously for a minimum of five years. Upon completion of high school or a GED program, along with proof of acceptance into a post-secondary institution, they may then apply for “conditional nonimmigrant status.” In order to be approved, the individual’s background check must show a lack of any disqualifying factors (health risk, criminal activity, national security risk, etc.), and must also demonstrate that they are of the “good moral character,” as defined by the Immigration and Nationality Act (Barron 2011). They retain this status for ten years. Nine years into this period, the individual may begin the application process for the status of “alien lawfully admitted for permanent residence,” which requires having earned either a degree from an institution of higher learning, completion of two years of a Bachelor’s program, or two years in the Armed Forces. After three years of having this status, the immigrant can begin naturalization procedures. Additionally, an individual with either status is allowed to work legally in the U.S, and also has access certain student loan programs and federal work study, but not affirmative grants such as Pell Grants, in order to support their post-secondary endeavors.

Not the Nightmare You Think It Would Be

Who Would Benefit from It

One of the biggest fears, and points of contention, regarding the DREAM Act which has prevented it from passing is the fear that it will somehow take away opportunities, seats, spots, positions, resources, etc. from American citizens and immigrants who are following the existing legal pathways to become citizens. In particular, the idea of rewarding “criminals,” so phrased, has been a major reason for reduced public support for legislation such as the DREAM Act. However, this is line of reasoning negatively generalizes all 1.5 generation students and members, when in fact it is very much a diverse and differentiated group. This generalization and stereotyping also extends to the type of economic impact they may have on the communities they live in, which is again far more complex and varied situation than is often purported.

The majority of the 1.5 generation youth and young adults who would be eligible for the DREAM Act, should it pass, are not undocumented through their own choice, and did leave one home country to exploit the U.S economy before returning. Rather, the U.S is their home country. Andrew Stevenson wrote, in regard to them, that “Because these youths had grown up and attended school in the U.S. since their early childhood, they felt almost no connection to their actual countries of citizenship” (2004:559). He uses the example of a community college student named Victor, who, having arrived here seven years prior with his family on a tourist Visa, has spent his formative years in the U.S, finished in education in the U.S, and even began post-secondary education here. However, because the Visa expires at age 21, his options were suddenly and severely limited. Without a legal visa, he would have to leave school, but also has little hope of being able to afford a new one, as without the documentation, he has no way of paying for new documentation, a crippling, paradoxical situation to say the least.

Victor’s story also serves as a prime example of another distinction that must be made regarding this generalized “immigrants” group. Edward Drachman (2006) in Peace Review writes that “Most undocumented immigrants do sneak across this country’s borders from Mexico or enter with fraudulent documents, but many others come here legally and overstay their visa (98)”. In addition to most being brought to the U.S involuntarily, many of these aspiring college students were admitted into the U.S legally and, for an extended period, were treated the same as legal citizens, at least until their expired visa status was discovered. Hence, for the most part, members of this 1.5 generation who would be eligible for the DREAM Act are not the border-hopping, document forging, “illegals” that has often been represented in public opinion pieces. Rather, they are almost-citizens who have been in the U.S for a large portion of their lives, and intend to stay here, work here, and contribute the same as any other citizen. What prevents this are legalities, not their own choice.

How the U.S Would Benefit from Them

Another of the major arguments against the DREAM Act is that it would place additional burden on tax-payers by forcing them to subsidize the education of undocumented students. From a sociological perspective, increases in this seemingly xenophobic view could be due to economic downturns in recent years. Addressing this argument, Stevenson cites several studies which indicate that “…the tax burden in subsidizing these students’ education may in fact be insignificant” (2004:573). Quite the opposite, immigrants paying taxes substantially adds to local and state tax revenue. In Illinois, Stevenson notes that, despite being confined to low-income jobs, immigrants contribute seventy million in taxes annually, a figure which can only increase should there be more legal, college educated immigrant-citizens created under legislation such as the DREAM Act. Sandy Baum, professor at Skidmore College, and Stella M. Flores corroborate this statement in their piece, writing that immigrants “…who attend college pay higher taxes and are less likely to depend on public support than those who do not. Their increased productivity in the workplace is reflected in more rapid economic growth and higher earnings for their less educated co-workers” (2011:185).

Conclusion

Although the DREAM Act has not been re-proposed since 2011, legislation similar in effect should be enacted within the U.S. To not help these aspiring college students, soldiers, and workers is “to create a discrete permanent underclass continuing to live with an “enduring disability” (Drachman 2006: 94). Making these members of the 1.5 generation would provide numerous benefits to the U.S economically, and would also be a step toward allaying certain stereotyped fears about immigrants, as, in general, college educated students actually draw less on public services and the criminal justice system as well. Passing DREAM-esque legislation and providing a pathway to citizenship for these already almost-citizens is imperative. While certain individual states have enacted the own version of the DREAM Act to aid aspiring college students, only federal action can solve this pressing problem.

Michael Olivas on state-level DREAM Acts and DREAM Act related legislation in the absence of a national DREAM Act 

References 

Barron, Elisha. 2011. “The Development, Relief, and Education for Alien Minors (DREAM) Act.” Harvard Journal on Legislation 48(2): 623-625 (Retrieved from Web of Science on October 25, 2014).

*On Web Science, I was only able to retrieve this source in “article” form, not in the original journal format. As a result, the text was listed continuously on one long page, and I was unable to give page numbers for the in-text citations.

Baum, Sandy and Stella M. Flores. 2011. “Higher Education and Children in Immigrant Families.” Future of Children 21(1): 171-193.

Drachman, Edward. 2006. “Access to Higher Education for Undocumented Students.” Peace Review 18(1): 91-100.

National Association for College Admission Counseling. 2013. “Tuition Equity for Undocumented Students Gains Momentum.” April 10, Arlington, VA. Retrieved December 14, 2014 (http://www.nacacnet.org/research/PublicationsResources/bulletin/2013Bulletin/04-10-2013/Pages/TuitionEquity.aspx).

National Immigration Law Center. 2014. “FAQ: DACA.” June 13, Los Angeles, California. Retrieved October 25, 2014 (http://www.nilc.org/FAQdeferredactionyouth.html).

Stevenson, Andrew. 2004. “DREAMING OF AN EQUAL FUTURE FOR IMMIGRANT CHILDREN: FEDERAL AND STATE INITIATIVES TO IMPROVE UNDOCUMENTED STUDENTS’ ACCESS TO POSTSECONDARY EDUCATION.” Arizona Law Review 46(551): 551-580.

 

Undocumented Immigrants’ Mental Health

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Undocumented immigrants, the majority of whom are Latino and of Mexican-origin, face poor health outcomes in the United States. The stigmatization and barriers that come along with undocumented legal status affect immigrants’ mental health. Moreover, immigrants face additional barriers as a result of linguistic, cultural, and socioeconomic disadvantages. As a result of these disadvantages and the limitations that undocumented legal status poses, this vulnerable and marginalized population faces adverse health outcomes and is at a higher risk for mental and emotional problems.

Many undocumented immigrants come to the United States for family reunification, improved economic opportunities, and to escape poverty, or to flee political oppression. However, the very act of immigrating to another country or crossing the border results in separation from loved ones, discrimination, uncertainties, and even death. In addition,  immigrants experience stress while trying to navigate a new culture, language, and customs, and to gain access to needed resources in a new country. Along with these circumstances, undocumented immigrants are confronted with restrictive U.S. immigration policies, anti-immigrant sentiments, and the uncertainties that comes along with their legal status. This has placed undocumented immigrants in a situation where they are threatened with deportation, overly criminalized, and severely disadvantaged in the United States.

Along with these various social and economic hardships that undocumented immigrants experience, their legal status also affects their access to healthcare, which has major implications on their mental health. Many undocumented immigrants lack health insurance and are ineligible for Medicaid. Therefore, a lack of health insurance means that this vulnerable population’s health care needs are unmet. In an article titled “U.S. Immigration Policy and Immigrant Children’s Well-being: The Impact of Policy Shifts,” Androff et. al state that “[t]his deficiency in basic material supports and institutional resources has been associated with negative economic and psychological consequences for parents as well as lower levels of cognitive development among infants” (2011:88). Without these needed health services, undocumented immigrants must confront the stigmatization that comes with their legal status and many psychological consequences on their own.

Sullivan and Rehm’s article, “Mental Health of Undocumented Mexican Immigrants” states that “[t]he psychological burden of being blamed and stigmatized by media and the larger society is manifested in the daily experiences, perceptions, and actions of [Undocumented Mexican Immigrants]. They are at risk of low self-esteem, guilt, shame, fear, and insecurity” (2005:248). Undocumented immigrants are exposed to inadequate occupational safety and health conditions, and they are unable to speak out against these conditions because of their legal status.  In addition, their legal status often leads many undocumented immigrants to live in fear, and to isolate themselves, which further marginalizes them from society. Furthermore, they are confronted with their representation in the media, which portrays them as criminals who take jobs from U.S. citizens and exploit public assistance. The limited agency that undocumented immigrants have in the United States and the ongoing stressful experiences they experience has many psychological health implications, such as depression. Sullivan and Rehm’s article goes on to state that depression “can be incapacitating, rendering individuals unable to fulfill daily responsibilities. It is associated with other medical conditions, anxiety, eating disorders, and use of alcohol and illicit drugs” (2005:242). Therefore, the barriers that undocumented immigration status pose affects immigrants’ mental health and would render them incapable of making meaningful contributions to their families, the United States, and society. Granting undocumented immigrants access to quality health care would be a first step towards improving the welfare of this vulnerable population.

 

References:

Androff, D., Ayón, C., Becerra D., Gurrola M., Salas L., Krysik J., Gerdes K., and Segal E.  2011. “U.S. Immigration Policy and Immigrant Children’s Well-being: The Impact of Policy Shifts.” Journal of Sociology & Social Welfare, 38(1):77-98

Rehm R. and Sullivan M. 2005. “Mental health of Undocumented Mexican Immigrants: A  Review of the Literature.” Advances in Nursing Science 28(3):240-251