Undocumented immigrants residing in the U.S. have less health care compared to someone who is documented

Jacqueline Cruz-Deodanes

Abstract

Everyone should have the necessary access to health care despite their circumstances. No individual deserves to die f rom a sickness simply because they could not af ford to get medical care. Many people in the U.S. see healthcare as a merit good. It continues to be a complicated matter for both the government and the public right now. Health care nowadays is seen as a signif icant business transaction where patients are consumers. Someone must be held responsible f or an expense acquired when seeking medical care by any health care institution. At the same time, most people depend on health insurance, whether private, public, or government-funded, there still is a percentage of uninsured individuals. While insurance is one of the many problems people f ace when seeking health care, what determines whether they can access it f rom the beginning is legally residing in the United States. Most undocumented immigrants who reside in the U.S. have less of a chance of accessing health care than documented immigrants.

Introduction

Who decides that a person's immigration status determines if they can access health care? It is common knowledge that U.S health care is a complex system. At the same time, most people classif y our health care system as high-priced yet least effective compared to other countries. We still have a relatively decent system when it comes to other countries. Our health care system has its strengths and f laws, “Our health care system has its just like any other health care system. strengths and flaws, just like any For example, the number of uninsured other health care system. ” individuals in the U.S., while the Af fordable Care Act (ACA) has helped decrease the percentage of people without insurance. What about the people who do not meet the qualif ications to obtain marketplace insurance? "To qualif y f or Obamacare subsidies, you must meet the f ollowing criteria: you are currently living in the United States, you are a U.S. citizen or legal resident, you are not currently incarcerated, and your income is no more than 400% of the f ederal poverty level"(Everything to Know About Obamacare (ACA)

Subsidies, 2020). Most individuals who are not U.S. citizens or legal residents are less likely to have access to healthcare. While some undocumented immigrants visit community centers only when completely necessary, others also refuse to visit a doctor f or many reasons. Not having access to health care affects a person's physical, mental, and social health status. Certain groups such as f amilies with low incomes, the working class, and the uninsured are more vulnerable when accessing health care. The quality of lif e tends to decrease over time resulting in poor health status. One of the most signif icant issues af fecting our health care system is the lack of access for minorities. "We f ound that undocumented immigrants in Calif ornia, and the uninsured among them, had f ewer or similar numbers of doctor visits, ED visits, and preventive services used compared to U.S. citizens and other immigrant groups"(Beck TL, Le TK, Henry-Okafor Q, Shah MK, 2017).

Undocumented vs. Documented

The immigrant population has shown continuous growth over the years. "The United States has more immigrants than any other country in the world. Today, more than 40 million people living in the U.S. were born in another country, accounting f or about onef if th of the world's migrants"(Budiman, 2020). There are two groups of immigrants in the U.S., documented and undocumented. Documented immigrants are classified as individuals that have entered the U.S. with a permanent resident visa or valid documentation that allows them to be in the United States. Undocumented immigrants do not have a valid visa or other paperwork that states the government has allowed permission to be in the country legally. It also includes those who entered with a legal visa but then expired, making it no longer valid. While certain immigrant groups have more access to health care even though they are undocumented than other undocumented immigrants, the majority still do not have quick access to health care services. So, that leaves the question, where do immigrants go to attain health care services? Documented immigrants can get access almost anywhere because they have the necessary documentation to purchase health care insurance. Many undocumented immigrants work jobs like agriculture, construction, and housekeeping that do not of f er employer-based health insurance. Undocumented immigrants can access Federally Qualif ied Health Centers (FQHCs), which are f ree or inexpensive. "There are approximately 12000 health centers operating around the country, providing primary health care, dental, mental health, and pharmacy services on a sliding-scale basis." (Beck TL, Le TK, Henry-Okafor Q, Shah MK, 2017). The Emergency Medical Treatment and Labor Act (EMTALA) passed by Congress allows the hospital to assist in urgent care despite their immigration status or insurance. Immigrants have several reasons f or migrating to a new country. Some of the reasons are f leeing violence, terrorism, oppression, and poverty to pursue a better lif e f or themselves and their f amilies. Others want to be reunited with f amily they have not seen in years. In most places, crime and violence are so big that many f amilies are lef t

with no option but to pack a f ew belongings to move to a new place. As tricky as moving might be, that is not the only issue they f ace once arriving in the U.S. Coming to a new place without knowing anyone and not being able to communicate is one of the most signif icant issues. Another issue is accessing services such as a doctor. They prefer avoiding any contact that will put them or their f amily in danger.

The U.S. Health Care System

The U.S. has more of a hybrid system than other countries such as Canada, Australia, and The United Kingdom, which have universal health care. It is common knowledge that the United States spends more on health care services than other countries. Health care is quite expensive. Most people have some health care insurance to pay f or the services received while under a doctor's care. Most individuals receive their health care insurance through their employers. Employer-sponsored plans are insurance plans purchased by an employer to give to their employees and their dependents. There is the option of paying out-of-pocket, but f ew people go that route simply due to the cost. Imagine paying thousands of dollars out-of-pocket to get an annual checkup; most individuals do not have that kind of money. Another way services can also be paid is by public payers: f ederal, state, and local government. This consists of programs such as Medicare, Medicaid, Marketplace Insurance, and the Children's Health Insurance Programs (CHIP). The benefit of having health insurance is that it saves the individual f rom owing a large sum of money to either hospitals or doctors and still receiving the best medical care possible. Medicare is classif ied as f ederal health insurance f or individuals that are 65 years of age and older. Medicare consists of 4 parts, and each covers certain services. Part A provides hospital (inpatient) and limited nursing home coverage. Part B provides coverage f or the hospital (outpatient) and doctor visits. Part C provides managed care coverage, and Part D provides coverage f or prescription drugs. "Medicare is an inter-generational transfer program primarily f unded by taxes f rom working people to provide services to aged benef iciaries"(De Lew. Greenberg & Kinchen,1992). In order f or an immigrant to qualif y f or Medicare, they need to be a lawf ul permanent resident. This is the dif f erence between being documented and undocumented. Documented immigrants can rely on Medicare to access the health care system. Medicaid is classif ied as both a state and f ederal health insurance program f or lowincome individuals, receive supplemental security income (SSI) and certain women and children who meet the necessary qualif ications. Medicaid covers care services ranging f rom acute to long-term services. The eligibility of Medicaid is based on gross income. "The law requires that immigrant five years af ter obtaining lawf ul permanent residency ("Green card") to apply f or f ederal benefits"(Okie, 2007). Medicaid is another program that undocumented immigrants are not able to access. The Af f ordable Care Act (ACA) was signed into law in 2010 by President Barack Obama. It provides access to healthcare coverage, emphasizes prevention and wellness, and administrative efficiency to help lower the price. The ACA has been f avorable to the

American people so f ar. There has been an uprising in the quality and cost of health care. Undocumented immigrants are not eligible f or ACA, although the uninsured rate has decreased mainly f or U.S. citizens and legal residents. The Children's Health Insurance Program is health coverage f or children in f amilies that make too much income to be eligible f or Medicaid. The CHIP program works alongside the Medicaid program. CHIP covers doctor visits, immunizations, prescriptions, laboratory, and x-ray services at a low cost. All the government-funded programs mentioned above are accessible f or documented immigrants.

Barriers

The number of people migrating to the U.S. continues to increase every year despite the ef forts to enf orce their borders. Immigrants are f aced with many barriers when coming to the United States. "Those without documents typically have lower educational attainment, household income, and health insurance coverage rates than US-born citizens and other immigrant groups" (Pourat, Wallace, Hadler, & Ponce, 2014). Some vary f rom language, culture, bureaucratic, and no knowledge of the U.S. health care system. These barriers inf luence immigrants not to seek health care services when needed, which overall creates f urther problems. The f irst barrier is the lack of insurance which leads to higher out-of-pocket costs. Health insurance offers financial assistance in emergencies, and it allows the purchase of prescription drugs at a reasonable price. Since undocumented immigrants are not eligible to buy health insurance due to not being U.S. citizens, they are most likely to pay high prices. While this, in the long run, will be more expensive compared to if they had accessed the care needed before their health progressed and got serious. In the article “Navigating a f ragmented health care landscape: DACA recipients' shif ting access to health care, ” the authors compared both a Def erred Action f or Childhood Arrivals (DACA) recipient and their sibling who was a U.S. citizen. They both had an ear inf ection, and the sibling was able to get treatment much quicker than the DACA recipient. This situation made it clear how dif ferent their access to care was according to their immigration status. Figure 1 gives an idea of the Number of Uninsured People in the United States. Immigrants make up about 20% of the uninsured.

Figure: Source: (Okie, 2007).

The second barrier is the f ear of deportation. Most undocumented immigrants that have come to the U.S. have done so illegally. As mentioned earlier in the paper, there are various reasons why immigrants decide to leave their home countries. "Undocumented persons have always had reason to f ear that use of publicly f unded services might lead to the discovery of their undocumented status; recent initiatives may only serve to exacerbate longstanding concerns within the undocumented population"(Berk & Schur, 2001). The f ear of going to the doctor and not receiving the necessary medical services simply because a person does not have the proper documentation to be in the United States, still deters undocumented immigrants from going out and acquiring the care needed.

Language and culture also present challenges f or immigrants seeking to use health care services. Many cannot communicate because they either do not know or understand English, which is the primary language in the U.S. "May result in poor symptom recognition, f ailure to provide appropriate medical treatment, and low service utilization"(Chin, Kang, Kim, Martinez, Eckholdt, 2006). Since undocumented immigrants do not understand the language, they could not communicate any health problems to the physicians, or the doctors misunderstood them. "For example, in one article, undocumented immigrants f elt that the emergency room physicians did not f ully believe their symptoms." (Hacker, Anies, Folb, & Zallman, 2015) This language barrier is one of the main reasons why they do not seek the needed services. When it comes to culture, being aware of cultural dif ferences is vital to providing high-quality health care. Culture af fects the way a patient responds to the disease and the care received. Confusion and misinterpretation can result f rom many different customs, which overall will result in mistrust.

Discrimination is something that some immigrants f ace when interacting with health care providers. While discrimination is not as signif icant as a f ew years back, some individuals still experience this problem. Discrimination can be classif ied as when an individual has had a bad interaction with a health care provider where it resulted in unf air treatment. "Discrimination on the basis of documentation status resulting in stigma experienced by undocumented immigrants.". (Hacker, Anies, Folb, & Zallman, 2015). Individuals that have experienced or seen discrimination are more hesitant to seek health care. Their satisfaction and trust in the healthcare system are low. Some immigrants experience shame and stigma. These barriers reduce their chances of going out and seeking care while increasing their vulnerability to diseases. Bureaucratic issues are another reason undocumented immigrants do not have access to healthcare. The increased migration of undocumented immigrants has brought new immigration policies and laws to be enacted f actors such as political, racial, terrorism, and economic inf luence immigration laws and policies. Immigration policies exist so that government can measure and manage the volume of immigrant migration. Immigration laws and policies explicitly provide or restrict access to health services. Three categories were identified regarding access to health services: (1) laws and

policies restricting rights to access health services, (2) laws and policies granting minimum rights to health services, and (3) law and policies granting more than minimum rights to health services. (Martinez et al., 2013) Many laws stop immigrants f rom going out and receiving primary health care. Most of the immigration policies require that health care providers report the immigration status. Being "undocumented" means not receiving the same healthcare access compared to being a documented immigrant. This made undocumented immigrants more hesitant to seek health care f or f ear of facing deportation or harassment from authorities. These policies are seen as threats to both them and their f amilies. Seeking health services would put their f amily in harm's way, and they see it as a risk they are not willing to take.

Summary

Most undocumented immigrants who reside in the U.S. have less of a chance of accessing health care than documented immigrants. A f ew evident factors mentioned previously, such as language, lack of insurance/cost, and f ear of deportation, contribute to the likelihood of undocumented immigrants seeking health care. These factors will continue to restrict immigrants until there is a good solution in place. Documented and U.S.-born individuals with health insurance have better access to health care than undocumented immigrants without insurance. Most undocumented immigrants' number one reason f or not seeking health care is f ear. "Combined with f ears in the immigrant community that getting Medicaid or SCHIP could harm an immigrant's chance of getting a lawf ul residence, remaining in the United States, or being naturalized- discouraged participation even among those eligible f or public benef its"(Ku, 2019). this f alse inf ormation will not af f ect an immigrant chance of getting their permanent residency; this is something that the immigrant community believes. They do not want to be seen as a burden on the health care system. This brings the issue of still needing to be treated despite all the health care policies towards immigrants so that the risk of disease and inf ection does not spread to other community members. Certain immigrant groups have more access to health care even though they are undocumented than other undocumented immigrants. Those with more access to health care are due to their spouse having some f orm of health insurance. Those that are more f ortunate receive health services at community centers at a low cost. An undocumented individual would use f ewer resources on health care services compared to a U.S. citizen. This is because they have minimal access. At the same time, the community center of fers primary care and preventive services, which still leaves how they have access to any specialty services they might need. Overall, undocumented immigrants do not have as much access to health care depending on both internal and external barriers.

References

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