Immigrant Access to Health Insurance and Medical Care - Essay Example

Immigrant Access to Health Insurance and Medical Care The ever-increasing costs of health care coupled to the decrease in health insurance coverage have acted to pose a long-term challenge that affects all Americans. However, these problems are even direr for immigrants in the United States with very low health insurance coverage and minimal access to health care (Loue 779). Almost half of all immigrants, in fact, do not possess insurance, which is approximately thrice as high as those for native-born citizens. Since such a large number of immigrants do not have health care, they come up against serious barriers in pursuit of medical care and have to pay more from personal savings to receive care. In addition to these obvious humanitarian and health concerns with regards to poor access of health care, other social and economic reasons are causes for concern. Their ability to be involved in productive employment is seriously limited, especially since most of them are involved in menial jobs that portend high incidences of injury. Since many of them do not have health insurance, a single hospitalization is enough to drive most into financial insolvency and debt. Lack of health insurance in America approximately costs between $60 and $130 billion every year resulting from impairment of health and lost productive years of all uninsured people, let alone immigrants (Loue 780). Legal and illegal immigrants usually rely on a makeshift system of free hospitals and safety-net clinics, or even medical care at reduced prices, such as in the county and state owned facilities. They also have to rely on religious and charity-affiliated facilities. Immigrant reliance on these systems has led most communities and states, to voice their concern about health care costs that are uncompensated for these uninsured immigrants and the resultant local and state fiscal burdens. Access of Immigrants to Health Insurance Data from the US census indicates that it is more likely for immigrants to be uninsured than it is for native-born Americans. Non-citizen immigrants are thrice as likely to have no insurance at 44% as native-born Americans at 13% (Loue 782). Naturalized citizens come in at 17% being un-insured. Those who recently immigrated into the United States are more likely to be sans insurance with their rates of insurance increasing as their income increases. This can be explained by the fact that immigrants tend to get quality jobs with time and because their income increases with job experience and age. However, fewer immigrants tend to possess employer-sponsored insurance, which explains their lower insurance levels despite their high employment rates (Loue 782). The discrepancy between native-born citizens and immigrants persists in those that have income of less than $33,000 a year in a family of three (Loue 783). In the low-income category, 23% of native-Americans are uninsured when compared to 56% non-citizen immigrants. However, when low-income populations are considered, the reason for the insurance gap also changes. The main reason for this coverage difference among low-income citizens and immigrants has to do with fewer immigrants having access to public coverage for instance, Medicaid for the poor and Medicare for the elderly. Immigrants with low incomes also have minimal chances of possessing coverage sponsored by the employer or private means, although these gaps tend to narrow. Although, this data does not reveal the legality of these immigrants, it is vital that we recognize that sort of immigrants working and living in the US affects the profiles. Annually, the proportion of unauthorized immigrants has increased, which has caused the proportion of those who come in illegally to drop (Loue 783). These illegal immigrants are not eligible for state funded benefits and find it more difficult to secure private insurance. Private Health Insurance Access Insurance sponsored by the employer is the main form of health insurance for a majority of Americans, although this is not true for immigrants. The key reason for this has to do with most illegal immigrants, especially Latino immigrants, being lees likely to get insurance from their employer than native-born citizens. Health insurance offered by employers is given to 87% of white citizen workers with only 50% of Latino workers getting insurance (Loue 799). However, in the instance when both are offered insurance, 87% of native white Americans take it up, which compares favorably to 81% of Latino immigrants (Loue 799). Accepting insurance, in most cases, means that the immigrant workers are also going to carry some cost in the form of premiums to the employee, as well as other measures to cut cost. The rates of offer and acceptance for Immigrants, therefore, are approximately the same as those for white native-born citizens. One reason why employers offer immigrants lower rates of insurance is associated with the type of industry in which they work, which is less likely to have provisions for health insurance. These include hotels, restaurants, food processing, construction, agriculture, and other service industry jobs. However, immigrants are still likely to be given less insurance offers even when we factor in the type of job, and salary level (Loue 800). Employers, in some instances, may have the capability to treat immigrants differently, even for the legal ones, by classing them as part-time, temporary, or contract workers so that they do not have the rights to benefits. Additionally, instead of hiring the workers directly, for instance farm workers, some companies will pay a contractor for the labor because the contractor will lower his/her cost by withholding benefits from the employee (Loue 800). Regardless of citizenship, twenty-one percent of part-time, temporary, and contract workers have health insurance in comparison to seventy four percent of regular, full-time workers. Discrimination is not a clear cause of this phenomenon, which indicates that immigrants are not given the same health insurance that is offered to native-born citizens within the same company (Loue 800). It is also not clear if immigrants tend to find work in firms with no general policy for insurance cover. Under United States law, the employers are required to offer this insurance on equal terms for all their employees. However, it is plausible that most immigrants, especially those in the country illegally or with temporary visas, are not given the chance to choose health benefits on the same terms as other citizens (Loue 800). Public Health Insurance Access For a majority of low-income workers in the United States, Medicaid is a major part of their health insurance cover. However, not all immigrants can get Medicaid or SCHIP for children. The welfare reform law of 1996 prohibited majority of lawful residents living permanently in the US admitted after its enactment from getting federal SCVHIP or Medicaid over the first fie years of their stay in the US with similar prohibitions also barring them from benefits such as supplementary security income, welfare, and food stamps. Approximately 40% of lawful US citizens entered the country after 1996; therefore, they have been subject to this law (Loue 819). Immigrants who are unauthorized or hold temporary visas are not eligible for cover under Medicaid, except for emergency services. Despite being ineligible for Medicare as they have not worked in the US for enough time to qualify, elderly immigrants may be eligible if they meet some criteria like being poor enough. From the late 90s, the prohibition, in combination with fears that getting SCHIP and Medicaid for immigrants would hurt their chance of attaining lawful residence, naturalization, or staying in the country, discouraged most immigrants from participation, including those who were eligible for benefits (Loue 820). The US government subsequently had to clarify that getting SCHIP or Medicaid would have no bearing on an immigrant’s eligibility for residency in the US. However, since the enactment of welfare reform in 1996, immigrants with low-income have lost coverage by Medicaid and most are now uninsured. Some states took the option to cover some of them, especially pregnant women and children by use of state funds. Federal legislation passed in 2006 added a new requirement whereby native-born citizens already enrolled to Medicaid needed to prove their citizenship, for instance via the use of a birth certificate or passport (Loue 821). However, this provision was not meant to apply to those immigrants who were applying for Medicaid since they already had to show documentation of their status. Although this legislation was meant for citizens, it has the probability of having repercussions for immigrants if it caused many immigrants to believe that they needed to show that they were citizens to get coverage. Looking past the population of adult immigrants, gaps in coverage between citizens and immigrant children has widened in the last ten years (Loue 822). After the immigrant prohibitions of 1996, more children lost insurance. In contrast, SCHIP’s enactment in 1997 and the subsequent efforts by the state to expand coverage of children with Medicaid and SCHIP led to increased coverage of native-born children and citizen children. This resulted in a fall from 19% for all low-income children from native-born families to 16% (Loue 822). These expansions, however, did not benefit immigrant children mainly because they were not eligible to participate. The percentage of immigrant children from low-income families who had no insurance went up from 44% to 49% in 2004 (Loue 822). Even though, children born in the US were initially eligible, most of their parents dropped out due of SCHIP and Medicaid because they feared welfare reform. This problem, however, has eased because of educational efforts and substantial outreach from the state, community-based organizations, and local governments. Consequently, children under cover in families of mixed status has somewhat improved, although most still have no insurance when compared to children from native-born families. The prohibition on SCHIP and Medicaid coverage in 1996 was made based on a belief by some legislators that the sponsors of immigrants should take responsibility for their insurance cover (Loue 823). Immigrant sponsors, since 1997, need to agree to take responsibility for immigrants and are made aware that they could be held accountable for public assistance costs if the immigrants they sponsor receive benefits. However, expectations regarding the ability of the employer to provide private insurance or the ability of the sponsors to provide other forms of cover have been shown to be unrealistic. While sponsors could provide financial assistance, affording health care could prove too much for the sponsored immigrants. The average price of an employer-sponsored cover in 2005 for a family was more than $10,000, with the cost for an individual being $4,000 (Loue 823). If insurance is to be bought on a non-group basis, the prices go even higher. The latter is what those, not in the sponsors family would require to pay. Many Americans are not insured, and sponsors who have middle or low income cannot usually afford to pay for their sponsored immigrant’s health insurance cover. Medicaid prohibition means that immigrants, who are still in their initial phase, in the US, cannot get insurance even if they have a job and are seriously sick. Health Care Access Since most immigrants do not have health insurance cover, health care costs from their savings are normally higher than those that insured Americans pay. This makes immigrants less likely to afford the care that they require. Language barriers and other factors also impair the immigrant’s ability to access quality medical care that they need (Loue 825). This results in immigrants being less likely to use preventative and primary medical services, dental care, emergency medical services, and hospital services than citizens are, even after the effects of health status, insurance status, income, race, and ethnicity are controlled. Immigrant adults with low income can seemingly report lack of a regular health care sources compared to native-born Americans (Loue 825). Similarly, immigrant children from low-income families are more likely to be without a source of care as native-born American children from low-income families. Ethnic and racial disparities are gradually narrowing in health care between white Americans and African Americans. However, the gap seems to be widening between non-Hispanic Americans and Latinos (Loue 825). Poor access to health care for the immigrant Latinos acts as one of the major reasons that there is a widening gap as far as health care is concerned. While there is not a lot known about access to health care for illegal immigrants, what little information is available suggests that it is quite poor. In California, only a sixth of immigrant farm workers were given health insurance by their employers with one third of those receiving cover saying that they cannot afford the offered insurance (Loue 825). A third of females and one-half of the males had not been to see a physician in the previous 2 years, even when they suffered from chronic health problems like anemia and high blood pressure or occupational illnesses. In a survey of casual day laborers made up mainly of illegal immigrants, there was a significant level of occupational illnesses and injuries with a fifth of them having suffered from an injury related to their work (Loue 826). However, less than a half of these immigrants were recipients of medical care for the suffered injuries. Since most public facilities providing health care ask about the status of immigration, most immigrants are of the belief that should they seek treatment in these facilities then this could lead to them being in trouble with immigration officials. This causes some of them to turn to health care sources in the black market, for instance, unlicensed providers of health care and some even purchase drugs smuggled from outside the US. Worries that emergency care costs, and other health care costs for immigrants puts a heavy burden on the United States’ health care service have been proved to be unfounded. Dr. Sarita Mohanty, using data from 2001, found that medical expenditure per capita for immigrants accounted for less than half of that accrued by native-born citizens (Loue 826). The expenditure for the publicly insured and uninsured immigrants was found to be approximately less than half of that used by their native-born counterparts. Immigrants are also less likely to need emergency rooms compared to native-born citizens. In fact, border areas that have a concentrated population of immigrants might have to deal with uncompensated and high costs of care since most of these immigrants are not insured. However, some progress exists in addressing the plight of hospitals that have to deal with uninsured immigrants. The United States government has started to reimburse hospitals for their emergency costs that go uncompensated because the recipients are illegal and uninsured immigrants. The federal government, in fact, paid $58 million to hospitals in order to assist them (Loue 829). A bigger share of health care costs, which are not compensated are borne by local and state governments or religious and charitable organizations that run the facilities. Additionally, some costs are transferred indirectly to holders of private insurance bearing a somewhat steeper cost of health care when facilities such as hospitals cross-subsidize losses that they incur from uncompensated services to immigrants who are not insured via charging more money to private health insurers. Works Cited Loue, Sana. Enyclopedia Of Immigrant Health. New York: Springer, 2012. Print. Read More