Published by: Marsha Regenstein on 3/22/2011 9:54:13 AM
This post is the second in our series of guest entries marking the one-year anniversary of the passage of the health reform law.
Earlier this month, the Urban Institute published a report reminding all of us that more than 30 million people in this country will remain uninsured after health reform is up and running. About one in four will be undocumented immigrants, a group that has relied on safety net hospitals and health systems for much of their health care throughout our nation’s history. Will immigrant health continue to be a cornerstone of safety net hospital care post-reform?
Medicaid expansions are long overdue and will enable millions of previously ineligible adults to gain access to comprehensive health services. But not everyone is invited to the party. Legal immigrants who meet the income eligibility requirements have a five-year waiting period before they can be covered by Medicaid, and undocumented immigrants are barred from any federal support for Medicaid coverage. Immigrants, regardless of their legal status, face substantial barriers to accessible and high-quality health care that are only exacerbated for those who do not speak English fluently. In the US, 24 million individuals speak English less than “very well” and are said to be limited English proficient. As a group, these individuals get less health care, receive lower quality care, are less satisfied with their care, and have poorer adherence with their care recommendations, compared to patients who are English speakers.
Safety net institutions have responded to the needs of their immigrant communities in many ways, including making highly skilled interpreters available to facilitate communication for patients who do not speak English. Some of the largest and most advanced language services programs operate at safety net hospital systems and are supported almost exclusively as administrative, non-reimbursed expenses. About a dozen state Medicaid programs provide separate reimbursement for interpreter services, but the states with the highest numbers of undocumented residents (California, Texas, New York, Florida, and Illinois) are not among them.
As more and more Americans gain health insurance, lack of coverage may become a marker for immigrants to signal legal status, creating even greater impediments to their ability and willingness to access high-quality, timely, affordable and efficient health care. That means that low-income immigrants who need health care will rely even more heavily on safety net hospitals, emergency departments, federally qualified health centers, free clinics and public health clinics for free or discounted care. The safety net must continue its longstanding mission to care for immigrant populations in their communities. Immigrants aren’t the only people who need a strong safety net post-reform, but they certainly are among the most vulnerable groups who rely on the safety net now and in the next decades.
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Marsha Regenstein
Center for Health Care Quality, Department of Health Policy at the School of Public Health and Health Services
George Washington University