Article taken from the November/December 2013 issue of the Women's Health Activist Newsletter.
Neither Sophia's nor her husband’s employer offers health insurance and, although her family would qualify for Medicaid coverage on the basis of income, they are barred from participating in the program because they are undocumented. They are too afraid to enroll their children, who are U.S. citizens. While a handful of Texas clinics serve undocumented women’s health needs, none are easy to get to, and even the sliding scale fees are beyond Sophia’s reach.
A few years ago, Sophia experienced a painful gynecological problem and needed care. Without options, however, she suffered without care until she finally became desperate. Eventually, she was forced to cross the border into Mexico to seek care there; pay a coyote to bring her back into the U.S. by swimming across the Rio Grande; and risk the dangers of sexual assault, violence, and deportation.
Because immigrant women often live in the shadows, it is hard to know how many share Sophia’s story — but we do know that millions of immigrant women share her circumstances. As Congress debates immigration reform, many women’s health advocates and immigrants are watching closely to see how reform efforts might address this population’s barriers to accessing health care. Unfortunately, the proposals currently under consideration in the U.S. House and Senate perpetuate — and even exacerbate — these barriers, making stories like Sophia’s the heartbreaking status quo of immigrant women in the United States.
A Troubling History
Immigrants have long faced restrictions in accessing health insurance and services, but a proliferation of policies in the last few decades have made access even harder. In 1996, Congress passed the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA, more commonly known as “welfare reform”). PRWORA instituted a mandatory five-year delay for lawfully present immigrant women who qualify for Medicaid to get covered. So, an immigrant woman with legal permanent resident (LPR) status has to wait for five years before she can get Medicaid coverage.
The 2009 Patient Protection and Affordable Care Act (ACA, also called “Obamacare”) explicitly left immigrant families out of the expansion of health care access for millions of Americans. Under the ACA, undocumented women cannot receive subsidies or tax credits to participate in the Health Insurance Marketplaces, and they are barred from buying plans at full price (although it is not likely many could afford to do so).i This restriction undermines the ACA’s spirit, which was to ensure access to quality, affordable health care for all uninsured people in this country.
One of the few ways an immigrant woman can get limited health care, for a limited amount of time, is if her state is one of the few that has opted to use its own funds to provide Medicaid coverage for pregnant, immigrant, low-income women. In 15 states all immigrant women qualify for coverage, regardless of their immigration status; in another 20 states, only LPR women are eligible.ii A major problem with this policy is that the health coverage is limited to care directly related to the pregnancy, so a woman with an unrelated health condition (like a broken bone) cannot get care for that condition.
Immigration Reform Debate Leaves Health Care Behind
Earlier this year, and after months of intense negotiation, the U.S. Senate passed a historic comprehensive immigration reform bill. The Border Security, Economic Opportunity, and Immigration Modernization Act of 2013 (S. 744) provides a pathway to citizenship for millions of undocumented people and addresses several of the immigrant communities’ key concerns. Yet, the bill also includes severe restrictions on health coverage for the very immigrant families it seeks to bring out of the shadows. S. 744 adds to PRWORA’s terrible legacy by withholding health care for people on the pathway to citizenship for up to 15 years.iii The law requires aspiring citizens to pay taxes, fees, and penalties; take English classes, which are hard to find in many communities; demonstrate regular employment, which is challenging in this economy; as well as other requirements. During this 15-year timeframe, they are excluded from affordable health care.iv
We should note that several lawmakers championed immigrant women’s health and well-being during the Senate debate, including Senators Hirono (D-HI), Boxer (D-CA), Leahy (D-VT), and Murray (D-WA). Senator Hirono introduced the “Taxpayer Fairness” amendment (ultimately withdrawn), which would have prevented any immigrant woman who fulfilled her tax obligations from being barred from Federal programs, including health programs, based on her immigration status.v
Under the Senate bill, immigrant women on the path to citizenship would be denied access to Medicaid services for 15 years (or longer if their change in status is delayed), which could be the difference between life and death for a woman with breast or cervical cancer. For many immigrant women, getting — and staying — on this path to citizenship will be a daunting challenge. Many will not be able to achieve it. Meanwhile, their health and that of their families will be in jeopardy.
The Fight Isn't Over Yet
The current national conversation about immigration reform largely fails to recognize the contributions that immigrant women make to their families, communities, and our nation’s economy, or the vital need for them to be able to access health care. The good news is that there is a crucial window of opportunity to influence the nation’s discourse and policies on immigration reform. As the House of Representatives considers several proposals for immigration reform, it is critical that policymakers hear from women (immigrant and citizen alike) who believe that access to health care is a human right and should not be restricted simply because of a person’s birthplace.
If you believe that immigrant women are the backbone of their families and their communities, please stand with the National Coalition for Immigrant Women's Rights’ efforts to ensure they get the health care they need.
Join our Congressional postcard campaign, “I'm Fighting #4immigrantwomen,” at http://nciwr.org/campaigns/im_fighting_for. Learn more about how you can support immigrant women's health and rights, by following us online (www.nciwr.org) or on Facebook (https://www.facebook.com/NCIWR). After all, would you want your mother or sister to wait 15 years to see their doctor?
Candace Gibson is the Law Students for Reproductive Justice Second Year Fellow at National Latina Institute for Reproductive Health, a Steering Committee Member of the National Coalition for Immigrant Women’s Rights.
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i. National Immigration Law Center Website. “Immigrants and the Affordable Care Act (ACA).” Los Angeles, CA: National Immigration Law Center. March 2013. Retrieved September 15, 2013 fromhttp://nilc.org/immigrantshcr.html.
ii. Hassedt K. “Toward Equity and Access: Removing Legal Barriers to Health Insurance Coverage for Immigrants.” Guttmacher Policy Review Winter 2013; 16:2-8. Retrieved October 1, 2013 fromhttp://www.guttmacher.org/pubs/gpr/16/1/gpr160102.html.
iii. National Immigration Law Center Website. “The Senate Immigration Reform Bill (S.744) What's Good, What's Bad.” Los Angeles, CA: National Immigration Law Center. July 11, 2013. Retrieved September 15, 2013 from http://nilc.org/s744goodbadtable.html.
iv. National Immigration Law Center Website. “The Senate Immigration Reform Bill (S.744) What's Good, What's Bad.” Los Angeles, CA: National Immigration Law Center. July 11, 2013. Retrieved September 15, 2013 from http://nilc.org/s744goodbadtable.html.
v. Sen. Mazie Hirono, Press Release: Hirono Introduces Amendment to Immigration Bill to Fix Provisions that Unfairly Penalize Immigrant Taxpayers, Washington, D.C.: US Senate, June 18, 2013. Available online at: http://www.hirono.senate.gov/press-releases/hirono-introduces-amendment-... last visited September 15, 2013.