The immigration reform bill currently winding its way through the Senate provides a much needed and long overdue framework for creating a pathway to citizenship for the approximately 11 million undocumented immigrants living in the U.S. today. But among many important components, one piece that should not be overlooked is whether aspiring citizens will finally have access to affordable health care.
When immigrants were left out of health reform—by maintaining a waiting period for low-income lawful residents and by banning undocumented immigrants entirely from the overhauled market—several lawmakers promised that immigrants’ health care and coverage needs would be addressed in immigration reform. But unless steps are taken to amend the Senate bill, that promise will not be kept.
Numerous myths and stereotypes have led to immigrant women in particular being punished for their reproductive capacity and their presence in this country, regardless of whether they came here through legal channels. Unfounded concerns that women migrate to the U.S. in order to have children and utilize public benefits have led to draconian measures that are not based in reality and that undermine public health, economic productivity, and social integration. As a result, a number of unjust laws have denied immigrant women access to health services including prenatal care, contraception, breast cancer and cervical cancer screenings, and abortion care.
Perhaps the single largest barrier to affordable care for immigrants has been a five-year bar on Medicaid, our nation’s health program for low-income individuals and families, for otherwise eligible, lawfully residing immigrants (undocumented immigrants are excluded altogether). While some states have taken advantage of waivers to cover pregnant women and children, that has led to a patchwork system and left many behind. Nothing in the Senate immigration bill lifts the five-year restriction.
Instead, the Senate bill places aspiring citizens into a temporary “Registered Provisional Immigrant,” or RPI, status for a minimum of 10 years while they work, pay fines and taxes, learn English, and meet other requirements. Only after that ten year period can they earn green cards, at which point two new clocks start ticking: three years to apply for citizenship and five years to obtain Medicaid coverage if they qualify for the program.
There is no bar on public benefits for citizens, but because of likely delays and expense in the citizenship application process, it is entirely possible that many low-income immigrant women will not be able to obtain Medicaid coverage until they hit the 15-year mark—unless the immigration bill is changed to eliminate the five-year ban or to subsume it within in the 10-year RPI period.
Yet another problem remains for those who earn too much income to qualify for Medicaid. Once the health reform law is fully implemented next year, lawful residents will be able to purchase private insurance in the new health insurance markets known as exchanges and will be eligible for tax credits and subsidies that make insurance more affordable. But undocumented immigrants will not be allowed to buy health insurance in the exchanges, even if they can afford to pay the entire premium themselves.
The Senate immigration bill would remove that prohibition for those with RPI status. But even so, moderate income provisional immigrants who cannot afford premiums on their own will still have to go 10 years without meaningful access to health insurance.
Ten to 15 years without health insurance can be a death sentence. It is exactly because of barriers to affordable health coverage and care that many immigrant women have significantly higher adverse health outcomes. For instance, while cervical cancer has been on the decline for U.S. born women, incidence and mortality rates have risen for immigrants.
This disparity is due to low screening rates among the latter. Only 61 percent of foreign-born women residing in the U.S. for less than a decade have received a Pap smear in the past three years versus 83 percent of women born here. Not only are these policies morally wrong, they are fiscally short sighted: treatment for cervical cancer costs between $20,000 and $37,000, compared to $13 to $66 for a Pap test.
A clear majority of Americans believe that immigrants pursuing citizenship should be eligible for Medicaid (63 percent) and premium assistance on the exchanges (59 percent). The Senate proposal is out of step with most Americans’ values and should be fixed to address these concerns as soon as possible.
The time has come for lawmakers to keep their promise and protect the health needs of immigrant women and their families.