Social justice requires health care access for undocumented immigrants

June 1, 2013

Common stereotypes and negative attitudes about immigrants have U.S. health care policy implications where lawmakers restrict or prohibit benefits particularly to undocumented immigrants; however, a Catholic social justice response calls for care providers to recommit to serving immigrant populations who are often most in need, say two speakers who recently presented a CHA webinar.

Mark Kuczewski, a medical ethics professor with Loyola University Chicago, and Patricia Cassidy, senior vice president and chief strategy officer for Alexian Brothers Health System in Arlington Heights, Ill., co-taught the April webinar called "Our Immigrant Neighbors, Catholic Health Care, and the New World of Health Care Reform."

Undocumented immigrants are ineligible to participate in the Affordable Care Act's two vehicles for insuring 30 million plus Americans beginning in 2014 — state-based insurance exchanges and Medicaid expansion.

"Immigrants who are here with lawful status for greater than five years will be eligible to gain insurance either (of these two) ways: they can purchase their insurance on the exchanges, if they don't make enough money to pay full price, they'll get subsidies for it; and if they don't make enough money to buy it on the exchange, they'll be eligible for the expanded Medicaid provision," Kuczewski said. (States have the option to participate in the Medicaid expansion, and it is not yet clear how many will.)

Immigrants with lawful status in the U. S. for less than five years also will be eligible to receive income-based subsidies for plans purchased through the exchanges, but they will continue to be ineligible for Medicaid coverage, including in states that expand Medicaid.

The law will not impact documented immigrants who receive health insurance through their employers, or who buy their own policies, Kuczewski said.

Undocumented immigrants who came to the U.S. before their 16th birthdays became known as "DREAMers," during the national debate over the DREAM Act proposal, which would have given this cohort a quicker path to citizenship. The legislation did not pass. However, under President Barack Obama's deferred action program which began last year, DREAMers can identify themselves as living in the country without documentation and receive a reprieve from deportation as well as apply for a legal work permit. But "even if they have money to pay full price on the insurance exchanges, they cannot buy on the exchanges," and they are ineligible for coverage under Medicaid expansion, Kuczewski said.

He said a Catholic social justice response calls for Catholics to recognize the benefits insurance coverage provides to communities as a whole, that having more people with health insurance supports the common good. People with insurance would pursue care sooner and not wait until they need costlier care. This care would likely minimize the spread of infectious disease and allow people to remain healthy and productive, he said.

Cassidy spoke about practical ways hospital and health system administrators can engage in mission-based care for immigrants. She suggested organizations take the time to learn more about not just the demographics of their area, but the subgroups of ethnicities in their region, paying attention to different dialects, prayer rituals, food preferences, clothing choices and how they should be considered in a patient's care experience. For example, culturally sensitive, modest hospital gowns may be offered. Some styles include long pants or head coverings.

It's important for hospitals to have pastoral care staff who understand the nuances of various religious beliefs, and have the ability to draw on cultural and religious resources in the immigrant communities they serve as the need arises, Cassidy said.

Culturally competent care is good business, she said. She noted in Illinois, where she works, the largest immigration population is Latino. The Latino population represents about $46 billion in purchasing power in the state, according to a report by the Selig Center for Economic Growth at the University of Georgia.

She said hospitals can work to increase the diversity of their staff, making a particular effort to recruit employees from the cultures and ethnicities represented in their patient mix. They can provide diversity training and have a diversity leader, which is an employee who works on diversity-related issues. Hospital administrators can make sure signs are understandable and that interpreter services are available with people who are medically certified to translate. Applications such as iTranslate allow hospitals to use an iPad for more general, non-medical communications, such as providing foreign language speakers directions inside a facility, she said.

Cassidy also said clinical programs should be responsive to the needs of immigrants in a hospital's service area and responsive to health issues and diseases with a higher incidence in those populations. As the nation continues to diversify, such responsiveness will become increasingly important. "Our business will be the business of caring for immigrants," she said.

Copyright © 2013 by the Catholic Health Association of the United States
For reprint permission, contact
Betty Crosby or call (314) 253-3477.

Copyright © 2013 by the Catholic Health Association of the United States

For reprint permission, contact Betty Crosby or call (314) 253-3490.