Healthcare bill raises fear of denied coverage among legal immigrants

As Congress moves closer to passing legislation that will expand health insurance coverage to 30 million Americans, many immigrant rights advocates worry that proposed reforms will leave large numbers of legal immigrants without insurance.

At issue is whether Congress will retain a 1996 welfare reform law requiring legal, non-citizen immigrants to wait five years before they become eligible for federal benefits and extend it to a waiting period for subsidies as well. If retained, (as proposed in the Senate bill) it could affect more than one million legal immigrants, according to an October 2009 report by the Migration Policy Institute (MPI).

Also worrisome are strict screening processes proposed in the House bill used to prevent undocumented immigrants from obtaining benefits. Immigrant rights advocates question the effectiveness of these processes, which they say will force legal immigrants to “jump through hoops” to prove their eligibility and could delay critical medical services to those who need them most.

Francisco I. and his family emigrated from Chile seven years ago. As legal residents who are not yet citizens, they pay the same taxes as citizens and are subject to the same laws. Last year Francisco’s father, an engineer, lost his job and with it the family healthcare benefits. He has since found work but his employer does not offer insurance.

When Francisco recently became ill with a high fever, the family could not afford a doctor. After several days, his father found a doctor who agreed to treat Francisco for less than a normal office visit.

“We still ended up paying about $150 just to get somebody to see what was wrong with me and another $150 for medicine,” he says.

Now he worries about what would happen if something more serious were to happen.

“It’s not just getting sick - it’s accidents that worry me the most. Like if I fall and break an arm or get something like a concussion or get in a car crash.”

Current U.S. Census Bureau figures show that 24 million immigrants now live in this country. About 12 million are legal residents, like Francisco. Although most legal immigrants are employed, the MPI report found that 38 percent work at small firms of 25 employees or less. Only one out of three of these workers is insured compared with seven out of 10 U.S.-born workers in similar-sized firms.

While Congress will likely mandate employers to provide insurance for their workers, small firms will probably be exempted from these mandates.

Experts say this will force millions of immigrant workers, many who live below the federal poverty line, to purchase health insurance themselves or turn to already jammed emergency rooms and clinics for medical care.

“Let them buy their own healthcare,” Evelyn Miller, a spokesperson for the California Coalition for Immigration Reform argues. “Why should they go on public benefits?”

The CCIR, established in 1992, is a group who seeks to have current immigration laws enforced, borders secured and illegal aliens deported, Miller explains. She believes that the five-year waiting period should be retained and that only citizens should be eligible for federal healthcare benefits.

“When people come to this country legally to join a family member or they are sponsored by somebody who is a citizen, the sponsor signs an affidavit claiming that the legal immigrant will not be a drain on our public benefits,” Miller says. “So they’re not supposed to get public benefits.”

She says that legal immigrants get a lot of benefits that U.S. citizens do not.

“They go in and try to get food stamps or housing subsidies and all they have to do is show that they have no funds and no income and they get it right away. It’s really a travesty,” she says.

And what about those immigrants who can’t afford to purchase health insurance?

Some will turn to free clinics like the Lestonnac Free Clinic in Orange County, Calif., which sees more than 3,500 patients with about 14,000 visits a year, according to Executive Director Ed Gerber.

Founded in 1979 by a Catholic nun, Lestonnac is funded primarily by private foundations and community donations, with about five percent of the funding coming from the state. Medical services are donated by thirty physicians and fifteen dentists, whom Gerber calls “the backbone of the clinic.”

The clinic’s primary mission is to help the uninsured, whether they are in this country legally or not, Gerber says, so they never question a patient’s documentation.

“We’re not a government agency; we don’t care what their issue is,” he says.

He stresses the importance of providing medical treatment and testing to all immigrants.

“We don’t know who is in line in front of us in the grocery store. We don’t know if this person has tuberculosis or if this person has the swine flu, which is so prominent today,” he says. “We really need to try to take care of these people, especially the new population of immigrants coming in to California, so that we’re not spreading disease to everybody else.”

Fear is a daily part of life for illegal immigrants who fear deportation and for legal immigrants who fear legal entanglements with their citizenship process, so they seek medical care less often than citizens.

A 1997 study by The Kaiser Commission found that citizen children, on average, had over three times as many visits to the emergency room as non citizen children of non citizen parents.

Recently, Gerber has seen a proliferation of minority-run clinics that exploit the fear of newly-arrived immigrants by charging enormous prices for lab work, x-rays, ultra-sounds and other often unnecessary services.

“I find it deplorable that there are doctors out there that start clinics and they rip off their own people,” he says. “These people are afraid to come to community clinics like us because they’re illegal and they’re uncomfortable and they’re afraid we’re going to turn them in. To me, this is an enormous problem that’s happening here in Orange County. They’re just raping their own people and it needs to stop.”

Chilean immigrant Francisco knows people who have avoided going to the emergency room out of fear. They think that a border patrol agent is going to show up at the emergency room. And after they’re done getting their healthcare they’ll get kicked out,” he says.

His own fear of jeopardizing his pending citizenship is so strong that he refused to be identified for this article.

Recent government figures show that more than 20,000 people immigrated legally to Orange County last year, bringing the total foreign-born population to more than 900,000. To meet the growing demand for healthcare, Lestonnac has opened two new clinics – one in Santa Ana and another in Los Alamitos. Plans are underway to open two more in January 2010.

Despite the fact that President Obama’s goal of “healthcare for all Americans” may soon become a reality, Gerber is skeptical that the programs will impact the people he treats at his clinics.

“My hope is that it will make healthcare better. That’s all of our dreams – that whatever Congress does, it actually works,” he says. “As far as impacting us, I don’t particularly see how any of this funding is going to come to our facility. It’s not designated to come to free clinics-it’s going to hospitals and medical groups and FUHC clinics.”

So Gerber’s work providing healthcare to the uninsured will continue.

“Even if this passes there’s still going to be a large gap of people that are still gonna need help.”

College students and grads face tough challenges with health care

Amber Singam, 30, and her husband, Shankar, 34, are ready to start a family. They have waited for years, so when Singam graduated from Cal State Fullerton (CSUF) with her master’s degree in May, everything seemed ready for a new addition to their family. All she needed was insurance coverage.

Back in August, Singam applied for private health insurance. She filed the paperwork, gave her medical history and any medical procedures she had undergone, but two months later she still hadn’t received an answer. Singam called the insurance company and discovered that she had been denied coverage.

A letter from the insurance company arrived the next day, stating she was denied based on her “high risk for HPV,” or human papillomavirus. For years, Singam had abnormal PAP smear tests, a routine gynecological exam of cells scraped from the cervix to detect cancerous or pre-cancerous conditions. She underwent a procedure four years ago to remove the abnormal cervical cells.

Since the procedure, Singam has received normal results from her PAP tests and has maintained a healthy lifestyle, so when she was denied insurance, it came as a surprise.

Singam is one of the 21 percent of Americans who apply for insurance and are denied health care coverage based on what the insurance industry considers as “pre-existing conditions,” an issue that has come under fire in the recent health care reform introduced by President Obama.

As talks of improving health care focus on seniors and children, much of the debate has neglected the burgeoning population of college-aged students and recent graduates who may not be able to afford private insurance or seek jobs that offer health benefits in this recession.

The number of Americans insured through employers is 164 million, according to the Kaiser Family Foundation (KFF). However, with the economic recession and the new batches of graduates joining the work force every semester, looking for employers that offer health benefits are harder to find.

Though Singam was hired as a part-time instructor at a community college in September, her health benefits will not begin until next fall. She faces eleven months without health insurance coverage, but said she is willing to pay for private insurance, especially with their plans to have a baby.

“I can afford to pay for private insurance, but I can’t afford to give birth without insurance,” Singam said. “I am also not able to afford pre-natal care prior.”

Resources and services narrow when students graduate and lose the student status many insurance companies require. But currently enrolled students traverse an equally overwhelming path. They often rely on student clinics or government and public health programs.

College students who have medical conditions that require treatment, like Patrick Cruz, a 23-year-old living in Alameda, may not have the money for private health care.

Diagnosed with psoriasis - a non-contagious autoimmune disease that appears on the skin as raised patches or lesions - Cruz has been fighting for insurance to get treatment.

He was a working student, employed at a local Starbucks, and attending Alameda Community College when he was diagnosed last October. At that time, Cruz was insured by his employer and was able to get some treatment. But he lost coverage when he wasn’t able to meet the quarterly 240-work hour requirement to continue receiving health benefits.

“I was missing a lot of hours because there would be days…when I didn’t feel well,” Cruz said. “I had to quit because [the lesions] were all over my face, too.”

In December, he applied for Medi-Cal, but would not be seen by a specialist until February. By that time, his condition worsened and his plans of applying to the Respiratory Therapy program in a nearby college were put on hold.

Unemployed and short on money, Cruz and his family decided to go to the Philippines where his medicine and treatment would be cheaper. He returned to Alameda three months later with his skin partially cleared.

But flying back and forth to the Philippines isn’t much of an option.

“I can’t keep getting a quick fix. I need something that’ll last longer,” he said. “My condition gets so dependent on medications.”
Though he has received treatment on and off in the past year, his condition hasn’t improved. Regardless, he remains positive and hopeful that Medi-Cal will help him get the treatment he needs when he finally sees a dermatologist at the end of this month.

Until he gets private insurance, he relies on Medi-Cal and other low-cost options.

Knowing what’s out there

Many alumni associations offer discounted health insurance for association members and some grads may qualify for public programs for low-income individuals and families.

Most colleges and universities also include health fees in registration and tuition fees for enrolled students. This gives students access to the on-campus health clinics which usually offer basic medical tests and procedures for free or for a small fee.

Roughly 55,000 student appointments are scheduled per year at CSUF, said Mary Becerra, the director of health education and promotion at the Student Health and Counseling Center on campus. The health clinic is a full-functioning medical clinic, able to perform many basic lab tests and examinations, provide affordable medications through its own pharmacy, offer reproductive health services, and family planning services.

CSUF has an enrollment of 37,000 students and the school’s clinic is the most highly utilized student clinic in the entire CSU system, according to Becerra. Most students come during the high-stress times in their semesters - midterms and final examinations. With the flu season, the student clinic has also seen many upper respiratory issues.

About 70 percent of the students the clinic surveyed said they have some type of insurance, while the remaining 30 percent are the ones that are seen regularly - students who have limited or no access to any type of health care, Becerra said.

Though the student clinic offers a wide range of services, it is still limited. It is not equipped to handle medical emergencies and other serious conditions.

It is the emergencies - a broken arm or a chronic condition - that put students in financial troubles. This is where insurance becomes indispensable - for the “what-ifs.”

Becerra also noted that the University of California requires all students to have insurance coverage - either from a private provider or through the university. But based on tightening budgets of the CSU system and the recent tuition fee increase, it may be tougher to require insurance coverage for all students.

“Mandatory insurance may be out of the question,” she said.

Health care reform in the works

On February 4, President Obama spoke at the joint session of Congress and emphasized the need for a comprehensive health care reform. This speech marked the beginning of the heated debate about the condition of the nation’s health care system. Touted to be the biggest health care reform in decades, the reform aims to extend coverage to more Americans and control the sky-rocketing costs of health care.

About 46 million non-elderly Americans are uninsured, the KFF reports. This could be because of many reasons including unemployment, not meeting employer’s qualifications for insurance coverage or denied health insurance. Some college-aged students fall under these categories who, either willingly or not, forgo insurance coverage.

Recently, the House of Representatives passed an expansive health care bill that would guarantee medical coverage to 96 percent of Americans. The bill would place a tax surcharge on wealthier Americans as well as new taxes on individual and family plans whose values exceed the set amount, according to CNN. The plan would cost under $1 trillion in ten years.

Last week, the Senate Finance Committee introduced a health care reform bill that will cover 30 million Americans and would cost $849 billion over the next ten years. It is aimed to cut costs to individuals, companies and the government and increase efficiency.

Both bills include a public option plan, but with varying provisions and conditions. The House bill requires individuals to buy insurance, with steep penalties for not complying, which could reach up to 2.5 percent of the individual’s income. The Senate bill is a bit more forgiving with fines that could reach up to $750 for not having coverage.

Though both houses have different bills in the works, both agree on broad changes including cutting down costs and preventing insurance companies from denying coverage based on past medical histories.

The Senate bill moves to the floor after Thanksgiving recess for a full debate by lawmakers, giving them an opportunity to introduce amendments to the bill. A long process awaits and a final version of the two bills would have to be approved before the president can sign it into law.

Working with what they have

Currently, CSUF offers insurance coverage for purchase through Anthem Blue Cross. The student insurance offers low-cost group insurance coverage to uninsured students and their dependents on either an annual or semester basis.

Nathan Fletcher, 32 and his daughter have been insured through CSUF’s student insurance for two semesters now. Previously employed by a furniture store in Lake Forest, Fletcher was let go in February because of the recession and was concurrently attending college to fill pre-requisites for the credential program.

When he lost his job, he immediately signed up for health insurance through the university. It cost him $2,000 for health coverage. The fees include $1,100 to cover his daughter and another $1,000 for himself under the Domestic Student insurance plan.

Though he receives financial aid and works part-time as an Instructional Aide, Fletcher admitted that paying the fees at the beginning of every semester is stressful.

“I have no choice. If I have to be prepared [for next semester's payment], I will be,” he said. “It’s expensive to purchase, but the alternative is unfeasible.”

Despite the price, it is still cheaper than private insurance premiums and the school’s insurance gives him sufficient coverage for the price he’s paying, Fletcher said.

Fletcher is one of the lucky ones able to navigate the options available to him and could afford coverage. Also, since the insurance on campus is a group insurance, whoever enrolls will get covered regardless of past medical history.

But depending on the students’ age, status and dependents, premiums range from $500 to over $2,000. All the fees are payable on the day the student signs up for insurance.

Students who don’t have the money risk having no coverage and sometimes utilize the student clinic. Others see the fees and say no altogether, despite the ample coverage and low deductibles of student insurance. Some students just don’t know where to begin.

Most students who have no access to insurance would have to figure it out for themselves, said Joe Vargas, whose Populations in Multicultural Health class at CSUF studies the disparities in access to health care for different groups.

Many undergraduate students are covered through their parents and guardians’ health insurance but some, who are no longer eligible because of insurance requirements, are left with a difficult decision.

“Students today would have to learn how to maneuver the system,” Vargas said.

He noted that students with families, such as expecting mothers, face an even harder challenge.

“It must be challenging to balance pre-natal care, school, jobs and many other things,” he said.

The battle of costs and available resources forces many college students to gamble with their health. Many of them would have to rely on faith. Faith that their immune systems don’t fail and faith that nothing happens to them until they get a job with health benefits, or until the promise of a comprehensive health care reform becomes a reality.

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Francesca Gacho holds a B.A. in English from Cal State Fullerton. She is an intern at Minority Dreams Magazine, where she hopes to spread her journalistic wings, explore and hone her writing ability, and gain insight into the myriad of issues in today’s soundbite-focused world. Her writing interests include human interest pieces that delve into culture, arts, current events, and community service.

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This article was republished at New America Media on Nov. 26.