What measures should be taken in order to increase immigrant’s access to and utilization of healthcare?

The United states is home to about 44.4 million immigrants making up 13.6% of the US population and second-generation immigrants who make up 12% of the US population¹. The immigrant population consists of foreign-born individuals, of whom 72.2% have been living in the United states for more than 10 years². The health care access and quality among these immigrant population are compromised due to policies creating unfavorable health care environment for this vulnerable population. Due to the immigrant’s language proficiency, eligibility restrictions, difficulty navigating the enrollment process, and fear and confusion surrounding immigration caused by the trump administration immigrants are lacking access and quality care when compared to US born individuals³.

While qualified immigrants such as Lawful Permanent Residents (LPR), Asylees and refugees are eligible for Medicaid LPRs have to wait 5 years before getting Medicaid and CHIP coverage⁴. However, 29 states, DC, and commonwealth of Northern Mariana Island have removed this 5-year waiting period for children and pregnant women regarding Medicaid and 21 states provide care to them through CHIP⁵. Even so, due to change in the “public charge” rule put forth by the trump administration that restricts immigrants using public benefits – including Medicaid, and housing programs- from gaining lawful permanent resident status an estimated 709,000 people could possibly disenroll from Medicaid and could possibly impact 2.6 million patients overall⁶. This further decrease access to health care and also reduces utilization.

Undocumented immigrants are ineligible for Medicaid, Medicare or coverage under the ACA marketplace, making them the least insured population in the US with the uninsured population being 45% for undocumented immigrants, 23% for lawfully present immigrants and 8% for US citizens⁷. Although Emergency Medicaid, public assistance for immunizations and treatment of communicable diseases and short-term in-kind emergency disaster relief are provided to undocumented immigrants they are not afforded public assistance for preventative care⁸ even though they contribute $11.74 billion a year to state and local taxes by paying 8% of their income as tax compared to 5.4% paid by the top 1%⁹. States should follow California, which has the highest population of immigrants (4.1 million) to provide undocumented adults ages 25 and younger access to Medicaid¹⁰.

To improve access to and utilization of health care by immigrants, it is important to reduce barriers to access. Barriers include cost of health care, lack of insurance coverage, fear of using public assistance. In order reduce these barriers we need to address lack of insurance. Although the federal government needs to implement policy changes that favors better immigrant health and welfare, individual states – due to the scatter of the immigrant population- are better suited at tackling this disparity to ensure that immigrants receive the same access and quality care as citizens. States should provide insurance to income eligible immigrants, remove the 5-year rule to access Medicaid, and also allowing undocumented immigrants to purchase health insurance under the ACA. Since, only 52% of immigrants are proficient English language speakers it is essential that health care providers are culturally competent, and resources be provided in various in easy to understand language. Complexity of getting insurance is also one of the barriers to health care access for legal immigrants, although there are resources available to help navigate these data base training should be performed according to the immigrant population in each state.  

California has already implemented a state funded Medi-Cal to provide health care to undocumented immigrants up to age 25. Even though California has the greatest number of immigrants they have extended health insurance coverage to its population increasing their access to care. Other states can follow suit and provide coverage to low income undocumented immigrants or give them an option to pay a co-pay for Medicaid coverage. The removal of the 5-year wait to be eligible for Medicaid would further increase access and utilization of health care by immigrants or have them pay a very minimal co-pay to receive care.

Each state can also employ individuals able to communicate in the language that immigrants in the state with low health care insurance coverage and create simple, easy to understand instruction on how to and where to get help while applying for insurance and advertising them in local communities- in pharmacies, doctors office, and through the internet. Training individuals to go into the local communities, clinics to help people apply for health insurance would also increase insurance coverage there by increasing access and utilization funded by state by increasing the health and human services budget by imposing higher taxes on the rich. These trained individuals can collect data on how many individuals signed up for insurance and take surveys on how to further improve communication by having them give feedback on the advertisement. If it is found that the information provided to them wasn’t clear, then they can be modified. Language barriers can also be reduced by creating a national wide data base where volunteers, healthcare workers and individuals work online to create informational data sheet about different aspect of health care – medication dosage, required testing etc. in different languages that providers can access and print out and provide to patients for better understanding. Providers can then keep track if patients are compliant when provided this information. While this may be a very big project and difficult to keep track of hospitals, clinics, health care workers and students can all work together to input information in this data base.

The utilization of healthcare by the individuals newly enrolled in insurance and their cost can be collected to adjust the budget in each state and the cost effect of providing undocumented immigrants with preventative care through Medicaid has been estimated to be more beneficial to states rather than just providing emergency care in the long run. The undocumented immigrant’s tax contribution can be used to provide Medicaid benefits to those who are income and medical need eligible.

Surveys taken from patients enrolling in insurance can help assess the usefulness and ease of understanding of the materials provided to them to improve health care access and assess health care utilization by checking data from providers keeping track of patients that have shown compliance after being provided health care information in their language from the database. Having these trained professionals in the field for a long period of time and using local communities as places for advertising would increase the health awareness of the community by increasing access and encouraging utilization.

The suggested policy of having trained individuals in every community may not be cost feasible however, in the long run this would pay for itself by having a healthier population. Also, it would face a lot of opposition to increase taxes to the rich however it is necessary to do so in order to increase access and utilization for the vulnerable immigrant population and have an overall healthier population.

References:

1. https://www.pewresearch.org/hispanic/2019/06/03/facts-on-u-s-immigrants/
2. https://www.kff.org/disparities-policy/issue-brief/health-coverage-and-care-of-undocumented-immigrants/
3. https://www.kff.org/disparities-policy/fact-sheet/health-coverage-of-immigrants/
4. https://www.healthcare.gov/immigrants/lawfully-present-immigrants/
5. https://www.nilc.org/wp-content/uploads/2015/12/CMS-Immigrant-Eligibilty-Presentation-2014-09-19.pdf
6. https://publichealth.gwu.edu/sites/default/files/downloads/GGRCHN/Public%20Charge%20Brief.pdf
7. https://www.kff.org/disparities-policy/issue-brief/health-coverage-and-care-of-undocumented-immigrants/
8. https://www.clasp.org/sites/default/files/publications/2019/07/PIF%20Research%20Guide%2006-19.pdf
9. https://itep.org/undocumented-immigrants-state-local-tax-contributions-2017/
10. https://www.npr.org/2019/07/10/740147546/california-first-state-to-offer-health-benefits-to-adult-undocumented-immigrants
11. Khullar, D., & Chokshi, D. A. (2019). Challenges for immigrant health in the USA—the road to crisis.The Lancet, 393(10186), 2168-2174. doi:http://dx.doi.org.york.ezproxy.cuny.edu/10.1016/S0140-6736(19)30035-2