By: Carmen Alvarez, PhD, RN, CRNP, CNM and Valentina Bolanos, MSN, MPH, RN
Gabriel* felt like he was in a fog. The case manager across from him was communicating a lot of information through the medical interpreter. Although he could hear and understand the words, he still felt lost and was unsure of everything that was happening. A few weeks ago, paramedics brought him to the emergency room for severe chest pain and feeling faint while at work. It turns out he had major blockage to his arteries and needed a coronary artery bypass. As if having had a heart attack was not enough to change his life, he was now also learning that he had type II diabetes.
Gabriel was uninsured, undocumented, unable to return to his job in construction, and was being discharged with only a month supply of medication. How was Gabriel going to manage his diabetes and heart disease while uninsured? Where was he going to receive ongoing medical care?
Gabriel is one of millions of undocumented immigrants whom experience a myriad of social inequities, including limited access to health insurance, that increase their risk for poorer health outcomes. And when compared to Latinos who are citizens or documented, undocumented Latinos report poorer health and have less access to medical care.
Regardless of documentation status, Latinos make significant contributions to the US economy and are projected to continue contributing in the coming decades. Using data from the US census, analysts found that Latino households earned approximately $902.8 billion, which contributed an estimated $215 billion to local, state, and federal taxes. These tax dollars also help fund entitlement programs such as Medicare (approximately $25B) and Social Security ($101B). Even undocumented Latinos make contributions through payroll tax deductions and their filling of federal income taxes.
But, despite their contributions, undocumented Latinos are not afforded the health care options provided through the Patient Protection and Affordable Care Act (ACA).
Undocumented immigrants should be offered accessible options for health insurance and consistent access to care. Some possible solutions include:
Increasing funding for safety-net clinics.
Federally qualified health centers (FQHCs) are vital sources of primary care for underserved populations including undocumented immigrants. These community health centers rely on federal funds to provide care to the uninsured, as well as wrap around services like pharmacy and dental care. Given the function of such clinics, more funding is necessary in order to be able to reach a larger network of Latinos and best serve their unique healthcare needs. Although federal funds comprise approximately a fifth of the total health center revenue, threats or delays to this funding are enough to interrupt services and threaten access to care. Congress should increase and prioritize long-term funding for community health centers so that they may consistently serve the most underserved populations.
Supporting partnerships between private and safety net clinics to support specialty care.
While FQHCs provide quality primary care services, patients such as Gabriel often need specialty care. The cost of specialty consults can be prohibitive for low-wage workers – often the case for undocumented immigrants. In a model partnership with a FQHC in southwest Detroit—the CHASS Clinic—the Henry Ford Health System established a voucher program that allows low income and uninsured CHASS patients access to affordable specialty care within the Henry Ford system. Kaiser Permanente Northwest has also established similar partnerships with community clinics. Such collaborations maximize sustainable access to care, and state governments should incentivize these partnerships to better care for underserved populations and support their optimal well-being.
Expanding Medicaid to undocumented immigrants.
Medicaid agencies in the United States can play a more proactive role in the management and prevention of disease among Latino immigrants. By expanding regular Medicaid to undocumented people with chronic diseases, more individuals needing secondary and tertiary care can have access to these services. A common misconception is that providing expanding health insurance to the undocumented will result in increased use of health care. However the evidence suggests that both documented and undocumented immigrants use less care and pay more out-of-pocket for care received. State governments should provide funding to include undocumented immigrants in Medicaid programs.
Despite their contributions to US, undocumented immigrants remain a marginalized and underserved population. Their lack of access to health insurance causes many to delay or go without essential care. In today’s world, government barriers and COVID-19 also likely exacerbate these delays. However, in the midst of an ongoing pandemic, knowing if one has COVID-19 is a critical component of implementing measures to prevent transmission of the virus.
The loss of life due to COVID-19, particularly among the Latino population, demonstrates the inhumane reality of health disparities. Access to quality care and health insurance are critical for decreasing the disparities and should be provided to both citizens and non-citizens. Inaction on this issue means we will continue to feel the burdens of disenfranchising members of our community.
This blog is a part of the “Dialogues in Health Equity” series by the Health Equity Faculty Interest Group. They are committed to decreasing health disparities experienced by local and global communities by promoting social justice and health equity through nursing practice, research, education, and service.
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ABOUT THE AUTHOR
Carmen Alvarez, PhD, RN, CRNP, CNM focuses on the development and implementation of health promotion and risk reduction interventions primarily for underserved ethnic-minority women with a history of trauma—specifically adverse childhood experiences (ACEs) and intimate partner violence (IPV). Dr. Alvarez’s research goals are to identify and better understand intervening variables in the relationship between ACEs/IPV and poor health to inform culturally tailored interventions for this population. Her most recent work—“Improving Psychosocial Well-Being among Immigrant Latina Survivors of ACEs”—is supported by the RWJF Harold Amos Medical Faculty Development Program. Her BSN and MSN are from Emory University and her PhD is from the University of Michigan.
Valentina Bolanos, MSN, MPH, RN is a graduate of the MSN (Entry to Nursing) program at the Johns Hopkins School of Nursing. She holds a Master’s degree in Public Health and has worked in social behavioral and clinical research. She currently works as a consultant for the Pan-American Health Organization and as a clinical nurse at Sibley Memorial Hospital in Washington DC. Her research interests include health equity and incorporation of social behavioral practices for the improvement of health among the Latinx community in the US.