Undocumented People Left Behind in Affordable Care Act

Sep. 19, 2013 / By

Perla Flores, 27, knows first-hand what barriers exist for low-income, uninsured immigrants seeking healthcare.

Flores has experienced chronic acid reflux since she was 14-years-old, a condition that causes pain in the esophagus. Because of her immigration status and a lack of money, however, getting adequate care was not an option.

Though sweeping changes to healthcare are on the horizon through the implementation of the Affordable Care Act (ACA), undocumented immigrants will still be barred from benefitting from any of the ACA’s reforms – a move some see as further alienating those who already face the greatest challenges to accessing care.

“A lot of the services… are not affordable. [I needed] to go to a specialist, and it’s really difficult to pay for a specialist,” explains Flores, who hasn’t seen a doctor in since her college offered insurance eight years ago.

Flores’ story is hardly unique. A 2012 report by the Kaiser Family Foundation found that nearly 48 million people under 65 lacked health insurance in 2011.  Another 2011 study by the Urban Institute estimated that about 14.6 percent, or almost 7 million, of those uninsured were undocumented immigrants.

The Affordable Care Act: Affordability for Whom?
“A lot of times [undocumented people] don’t get to say how they feel about certain things and with the Affordable Care Act coming into affect in 2014, we kIMG_1767now that undocumented folks aren’t included in that conversation about healthcare,” said Amanda Em, 18, Long Beach resident and intern for the UCLA Labor Center’s Healthy California Survey Project, a statewide research project that looks at how undocumented immigrants are accessing, or not accessing, healthcare.

Beginning Oct. 1, American citizens and legal residents can begin enrolling in state “health benefit exchanges” (marketplaces to buy health insurance), and by Jan. 1, 2014, eligible individuals are required to have some form of health coverage or pay a penalty fee.

These changes also mean more people will qualify for Medicaid, and that the public will have more affordable options for health coverage and consumer protections that prevent insurance companies from denying coverage because of pre-existing conditions or putting annual limits on coverage.

Yet despite all the fanfare accompanying these changes, the ACA will not reach everyone. Federal law prohibits undocumented immigrants from purchasing insurance through new health benefit exchanges, and from being covered by Medicaid.

President Obama announced that even individuals who are eligible for Deferred Action, “dreamers” who are given permission to live and work in the United States legally, will not be able to receive any federal benefits through the ACA.

Barriers to Getting Care
Em found that undocumented immigrants she talked to said language barriers stopped them from getting adequate care and many tried to take preventative measures like eating well to stay healthy because they know that they won’t be able to see a doctor if they get sick.

The fear of possible detention or deportation is yet another challenge for undocumented immigrants seeking services.

“Families are scared to break up because of that stuff,” explained Em. The Dream Summer research project allowed participants to participate anonymously in their surveys in order to protect individuals from any repercussions associated with revealing immigration status.

This spring the Associated Press broke news about the practice of some hospitals that deported undocumented patients as way to relieve themselves of the high cost of caring for long-term patients.

The AP reported that, “at least 600 immigrants were removed over a five-year period, though there were likely many more.”

[pullquote]“Healthcare should be considered a human right,” Em said. “You have the right to see a doctor and be cared for. You deserve healthcare no matter what country you’re from and no matter what country you’re staying in.”[/pullquote]

Affordability, and the inability to purchase insurance, remain the biggest barriers to getting healthcare, as was the case for Flores.  “When I was in college I was able to meet up with a specialist because I had insurance through school,” said Flores, “I haven’t done it since 2006 when I was 19 years-old because I haven’t had access to insurance and those procedures are pricy.

Undocumented immigrants who work and are paid ‘under-the-table’ won’t receive healthcare from employers, and federal law generally bans undocumented immigrants from being covered by Medicaid.

Resources for Undocumented Immigrants
With an estimated 2.6 million undocumented immigrants, California is leading the way in implementing the ACA and finding ways to expand coverage for immigrant communities.

California is unique in providing more healthcare access to those who are undocumented through its state-funded Medicaid program.  Through this loop-hole those who are ‘DACA-mented’ may qualify for health coverage through Medi-Cal.

The Children’s Clinic (TCC) in Long Beach prides itself as a unique leader in the Long Beach community, providing healthcare to low-income and diverse populations while putting an emphasis on providing culturally relevant care.

“Most community clinics offer services to anyone who needs them,” explained Dr. Elisa Nicholas, TCC’s Chief Executive Officer. “We serve the community and whoever is in the community.”  Individuals or families without insurance and seeking affordable healthcare can qualify for a sliding scale based on income.  Those at or below poverty line can qualify for additional programs that help cover the costs.

“If people have better access to primary healthcare they have less visits to ER and less hospitalizations,” explained Dr. Nicholas, “We can control asthma, and the same with diabetes and hypertension.  It’s better to treat hypertension than to have a stroke.”  Preventative care is also more cost-effective than treating patients in the emergency room.

Even with these resources, there can be a long waiting period before receiving care at clinics like TCC and outreach must be done to keep Long Beach’s diverse communities informed about their health and services available.

Long Beach was recently reported as the most diverse city in a USA Today study of the 65 largest U.S. cities.

“I think Long Beach was perfect because it’s so diverse,” said Miguel Montalva, 29, another dream summer intern who was placed with the Long Beach Immigrant Rights Coalition, “Its important that we collect as diverse an example as we can because the more voices the more representative it is of our communities.”

The Dream Summer program came to a close on Aug. 23. At the end, interns and UCLA Labor Center staff came together to analyze the data collected from over 400 surveys of youth ages 18-32 who identify themselves as undocumented, or who qualify for Deferred Action (DACA) and came up with recommendations to solve the health gap undocumented youth currently face.

They will release a finalized report in the beginning of 2014.

“Healthcare should be considered a human right,” Em said. “You have the right to see a doctor and be cared for. You deserve healthcare no matter what country you’re from and no matter what country you’re staying in.”

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Justine Calma

Justine Calma

Justine is a journalist with a passion for social justice: her experience as an immigrant woman of color have led her to pursue issues in women’s empowerment, and be guided by the principal “think globally, act locally.” She graduated from UC Irvine in 2010 with degrees in International Studies and Literary Journalism. While in college she was involved with the Filipino student organization, Kababayan, and was part of the student movement for affordable education. After college she joined Public Allies LA, an Americorps program that provides individuals with personal and professional development to lead in the nonprofit sector. While at Public Allies Justine interned with Khmer Girls in Action, where she now works full-time as a media & program coordinator.