This post is written by Cerasela Shiiba RN, BSN, a graduate student in Community/Public Health Nursing at Hunter-Bellevue School of Nursing where she received her BSN and the Sara Aronson Hunter College Alumni Award in 2013. As a professional registered nurse she is committed to advocating for the underserved, addressing gender inequality and gender violence. She attributes her passion for community nursing to her nursing education and growing up in a small village in Romania.
Waiting, I will not be here for long. My friend will return from seeing the doctor soon. Watching people makes waiting interesting. I have time to observe details. Grey chairs are lined up in rows. Monet prints with thin black wood frames give the room a French style. Vibrant golden frames would better reflect the time era.
Several patients are sitting and waiting.
I turn my head towards the “Welcome New Patients” sign placed on top of a glass window. A timid-looking middle-aged man slowly opens the door and enters. Ah, I can have a story now. The man stands in front of the reception desk and looks through the window glass. The medical assistant slides open the small window on the lower portion of the large glass. She is dressed in white scrubs. Her name is embroidered in grey calligraphic forms, Vera,B. From the middle of the room, I see only her upper body. She leans forward, trying to fit her red hair pulled in a bun through the small window.
“Your name,” she says quickly and in a voice loud enough for all to hear.
Jose has to bend down to answer her through this small opening.
“Jose.”
“What type of insurance do you have?”
“I don’t have one,” he says in a low voice.
Vera takes her eyes from the paper, while placing the clipboard on the desk. Click.
She turns her sight towards her colleague. She raises her eyebrows and continues her interview.
“Who told you to come here?” she says in an impatient voice.
The glass window acts as a barrier between Jose and health care.
“The doctor, two days ago, I went to ER. I had back pain. They told me, I have kidney stone.
The doctor said to come here today, for follow up.”
“Well, we don’t take people without insurance.”
Jose is one of 41 million immigrants, 46% of whom are Hispanic. Undocumented immigrants are close to 20 million and they are not covered by the Affordable Care Act, according to the Migration Policy Institute. Undocumented immigrants do not have access to insurance even when research shows that, “Undocumented immigrants may not be contributing to the increase in health care costs in the United States and that addressing health care needs of this population could in fact reduce expenditure.”
I strongly believe that everyone must have access to health care, including undocumented immigrants. Undocumented immigrants are not eligible for ObamaCare even if they work, live, and engage as members of our communities. In New York State undocumented immigrants do not qualify for private health insurance.
Why can’t people like Jose have access to health insurance?
Financial costs are always the first argument you hear against making health insurance available to undocumented immigrants.
But there are costs to be considered not making it accessible – financial and human.
Undocumented immigrants do not seek preventive care. They will wait until their symptoms are worse or their pain unbearable. Then they seek care in the emergency room. The cost of treatment and the management of an acute health issue can be complicated and costly. Sometimes it requires the person be admitted to the hospital to stabilize a newly diagnosed or unmanaged chronic illness. Perhaps preventable if this person had access to primary care.
It would make sense for undocumented immigrants to be included in the Affordable Care Act (ACA). Access to preventive care is crucial in reducing the cost of health care. Chronic diseases could be identified at earlier stages; therefore the cost of treatment will be reduced. These situations could had been avoided if the ACA would include all people, including undocumented immigrants. During the debates on the ACA Obama avoided discussing the inclusion of undocumented immigrants in the health care reform.
Immigration reform and lack of action in Washington impeded inclusion of undocumented people.
I believe there are no simple answers. However, one way to solve this problem is perhaps to extend Federally Qualified Health Centers (FQHC) in local communities that serve vulnerable population regardless of their immigration status. FQHC are part of the safety net providers such as: public hospitals, clinics, charity organization and local health departments. Safety net providers are financially strained due to limit on reimbursement for their services.
Or maybe, extending the access to Emergency Medicaid. At this time, undocumented low-income immigrants are only qualified for emergency Medicaid.
Increasing public awareness, taking an active role in advocating for this vulnerable population through debates, research, writing, blogging, participating in local and national government, and supporting bills that reform ACA to include this population.
It is vital for undocumented immigrants to have equal access to health care. The story does not end here. It is just the beginning of a greater mission, universal health care for all.
