Rural Routes/Joan Retsinas

Immigrants: Keeping them Healthy

They are here — legally, or almost. Some are “naturalized.” Some are not yet citizens, but have green cards. Some languish in limbo — maybe they are overstaying a tourist visa, maybe they are not here legally, but have family who are legally here. Some are the DACA “Dreamers” who have lived their lives here, but — unfortunately for citizenship status — were born outside our borders. Some are “refugees” who immigrated here under the strict rubric for refugee status.

They work. They pay taxes. They pay rent. Some own homes (though a lender might consider “undocumented” status a poor risk). And they get sick — maybe not as often as non-immigrants, since, statistically speaking, only the healthiest manage to make it to the United States. Besides, we do medical screening at the borders.

They need normal health care, vaccinations, checkups, well-baby visits. They may need X-rays, MRIs, surgeries. medications. They have the same needs for “health care” as citizens.

Yet the system falls short.

Refugees are fortunate: they are immediately eligible for eight months of health insurance. But the criteria are stringent. Even now, as we open the “refugee” gates to Afghanis, those would-be refugees must wait up to a year for processing, all the while staying gainfully employed.

Most immigrants, however certain they are to return to mayhem if not death in their home countries, don’t qualify as refugees.

Instead, they enter the maul of immigrant health care.

People here without documentation are not entitled to Medicare, Medicaid, the state’s Health Insurance for Children (CHIP), or to enroll in the Affordable Care Act exchanges. If they do not need this government subsidy, they may — if they qualify for private insurance from their employer — be enrolled under that employer’s group health plan. Yet low-wage employers are not likely to cover their part-time, temporary itinerant workers, regardless of immigration status.  And — a major caveat — federal law makes it illegal to hire an “illegal alien.” An ITIN (Individual Taxpayer Identification number) is not a work permit. So those workers often try to stay under the bureaucratic radar.

People here without documentation can go to hospital emergency rooms, but only for emergency treatment, not for the continuing care, the medications, the therapy that the rest of us take for granted.

As for “legal immigrants,” the road-to-insurance depends to a great extent on states. Before the Children’s Health Insurance Program Reauthorization Act (CHIPRA) (2009) let States provide Medicaid and CHIP coverage to “lawfully residing” children and pregnant women, the federal law required those immigrants to wait five years before enrolling in Medicaid and CHIP (though states could use their own money to cover these immigrants). For Medicare, the wait is ten years.

Today, using federal funds, states may — or may not — open their Medicaid gates and CHIP gates; but some states open them only for children, not mothers. (Utah and Texas, for instance, cover only children, not pregnant women, under Medicaid).

And some physicians simply say “no” to Medicaid patients — not surprisingly, since Medicaid pays as much as a third less than Medicare or commercial insurers. The challenge for immigrants: find a specialist willing to accept Medicaid. In addition, some physicians consider patients who don’t speak English, who don’t understand Western medicine, whose social problems dwarf the medical, too time-consuming.

Ironically, although COVID has made many Americans blame “the others” for importing the virus, COVID has also made healthcare, not just vaccines and testing, essential for those “others.” They staff our restaurants, our factories, our farms, our hotels, our offices, our nursing homes, with or without documentation. When they suffer, the nation suffers.

Joan Retsinas is a sociologist who writes about health care in Providence, R.I. Email retsinas@verizon.net.

From The Progressive Populist, November 1, 2021

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