“I am an immigrant and I don’t get any benefits”— Three women discuss how their immigration status affects their health

In March 2020, Noemi’s husband lost his job. He was not alone in that job loss, with just over 700,000 jobs lost that month across the country. But the loss of his job represented not only the loss of income, but also the loss of health insurance. Insurance that he and his family relied upon for life-saving medications.

 

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Because they are immigrants, Noemi and her family are unable to access Medicaid or subsidies offered through the Washington Health Benefit Exchange. 

Immigrants are at high risk of being uninsured because they have limited access to coverage options. Their high uninsured rates reflect limited access to employer-sponsored insurance and eligibility restrictions that bar them from participating in Medicare, Medicaid, the Children’s Health Insurance Program (CHIP) and the Affordable Care Act (ACA) Marketplaces.

Noemi’s husband suffers from diabetes and because he needs insulin to keep his condition in check, they had to pay for these drugs out-of-pocket. To this day Noemi says they continue to receive bills anywhere from $200 to $400 that they are unable to pay.

“These bills are just accumulating. And in addition, it’s really impacted my family because we’re having to choose whether we are going to provide food on the table or pay for the medication that my husband needs. I think that we wouldn’t have been going through all of this if he or we had had access to health insurance.”

Noemi herself is unable to work due to an injury she received at work in 2019. While at her job of 20 years, she injured her knee on the job, but was not able to get medical treatment for that injury due to costs. She then injured her back because of the knee injury. She said if she had been able to afford a doctor or had access to affordable medical care she would have been able to return to work. 

“Not having access to the doctor or medical care made it so that my situation worsened and now my back still hurts because of that original injury.”

Noemi’s family’s story is not unique. According to a report from El Centro de la Raza, the Washington Immigrant Solidarity Network (WAISN), and Northwest Health Law Advocates (NoHLA) with support from the ACLU of Washington, as of 2018 an estimated 46% of undocumented individuals were uninsured in Washington. This is compared to a 7% uninsured rate in the overall population.

Immigration status restrictions, like the “Public Charge rule,” are a barrier to obtaining health care coverage and significantly reduce access to care. Compared to the insured population, those who are uninsured are less likely to have a regular doctor or get timely and routine care, and are more likely to be hospitalized for preventable conditions.

Specifically, the public charge concept was first established by Congress in 1882 in order to allow the U.S. government to deny a visa to anyone who “is likely at any time to become a public charge” — but without defining what “public charge” means. Under the Trump administration, the “Public Charge rule” was interpreted broadly to reduce the number of people who were eligible for green cards and other visas by redefining what made them dependent on government benefits — or “likely” to be in the future.

Huma Zarif, a lawyer who was formerly with NoHLA, said this rule has now been reversed. But a lot of people are still not accessing services due to the misinformation from the previous administration.

“And there are benefits that people aren’t accessing because they think they are subject to public charge. But services like WIC, Medicaid coverage for children or getting food benefits are not subject to this rule. Parents think that may impact their immigration applications and things like that. And so there is still a lot of education that needs to be done in the community to kind of distill some of that misinformation and confusion from the past administration.”

According to a survey done by WAISN, the public charge rule was cited as a reason the respondent or a family member did not seek care for a serious medical condition (15%), access needed health care services (12%), engage with a primary care provider (10%) and have health insurance (7%).

Zarif said the key barriers to accessing needed health care services are a lack of health insurance and the high cost of care. Noemi’s sister Sophia said that when she was injured at work she debated whether or not to go to the doctor.

“I suffered an accident where I spilled a pot of boiling beans on my leg. And when that happened, I had to debate whether I would go to the doctor just thinking of the high cost of treatment. But the pain was pretty strong and the burn was quite large. So even though I tried to take care of myself with cold water, ointments, medications, I ended up having to go to the ER.”

Under federal law, hospitals must screen and stabilize every patient who seeks emergency care, and Medicaid helps offset some of these costs for hospitals. When Sophia ended up having to go to the ER, she said the treatment she received was less than what a person with health insurance might have received. 

“But they only give you a certain level of treatment when you do not have health insurance. They’ll tell you, ‘this is all I can do for you.’ And they didn’t even explain the degree of burn that I had, they did give me a tetanus shot and antibiotics but then after that they did not want to treat me any further because I did not have health insurance. It is unfair to have to put ourselves through this and go through so much pain and then still have to debate whether we are going to go see a doctor.”

Most immigrants can obtain low-cost care through community health centers, but this care is often limited to preventative and primary care, leaving them with challenges in accessing specialty services. So even when they do seek out care, they may not be able to obtain the level of care they need to treat their condition. Recently Sophia experienced this situation.

“I had to go to the doctor recently again because I didn’t feel well and it was the same situation — there was only a certain level of treatment that they were able to do. I was having a pretty heavy menstrual period and they recommended two doctors but I know I won’t be able to go. I won’t be able to go because I don’t have health insurance. We work and pay taxes and it’s not fair that we don’t have access to health insurance.”

Often, immigrants take a chance leaving their country of origin. They come to the U.S. in hopes of finding a better life for them and their family. Patty said leaving her home country was the most difficult decision she has made.

“The most difficult decision as immigrants that we make when we decide to come to this country is having to leave our family, our roots, our beloved country. But we do it seeking a better life for ourselves and the next generations.” 

But because of the lack of social service programs for immigrants in the U.S. they oftentimes end up living in subpar conditions because that is all they can afford. Patty said these conditions they are forced to live in are causing chronic conditions for her son and nephew.

“I live in a mobile home park and that is in bad condition. But that’s the only thing that my family can afford. My child and my nephews are experiencing some medical situations that are unexplained so far, but include asthma.”

But during the pandemic, immigrants not only had to worry about the possibility of their home causing illnesses, but the increased likelihood that they would contract COVID-19 and bring it home to their families.

As of April 28, Washington State Department of Health data shows that Latinx people make up 30% of the COVID-19 cases in the state, despite only representing 13% of the population. This disparity is in part due to Latinx people and immigrants working essential jobs, like construction and food production. 

Patty said she has family and friends who have died from the virus because they were unable to afford treatment.

“My family and friends have contracted COVID and have died from COVID because they did not have the money to be treated, so they brought the virus back to their home. The pandemic has helped a lot of people see that we are the most vulnerable, that immigrants are the most vulnerable. And we have many needs, especially around health care and how our immigration status impacts our ability to get any kind of support… I’ve also met people that have diabetes, who did not have access to medication and were considered high risk but yet still have to keep going to work and risk getting exposed to COVID. We all have to pay rent and other bills, otherwise we’ll end up homeless.”

The survey from WAISN said that during the pandemic, 95% of the respondents couldn’t work from home and many worked in positions that may not have enforced workplace safety regulations.

Patty said the way a lot of Latinx people are able to get help is from their community. They rely on their community to help shield them from medical bills that would otherwise bankrupt them.

“The fastest way that immigrants are able to get some sort of health care is by getting help from another immigrant. Latinos, we tend to help each other and we’re the ones that sort of help each other find where we can get help. And in this country we live to work and to pay those bills. We fear those large payments and large bills and that our bills will end up in collections because they’re confusing. We have to make choices such as to keep a home and have food or take care of our health.”

Representative My-Linh Thai, who introduced a bill this session to ensure equity in health coverage, said the physical and mental toll of not having coverage is excruciating.

“As a refugee myself, I lived through a period of time when we didn’t have any health coverage. And I have seen people, not just in my own community, but marginalized communities living without health coverage. And then when I graduated university and joined the health profession, and meeting and helping some of the individuals, like our patients, who have no health coverage I understand what it’s like. On one hand, we were trying to help reduce or cure some of the physical health of individuals, but we have no power when it comes to reducing that mental health toll, the stress of not having health coverage.”

All three women say they have earned the right to coverage, not only because health care is a human right, but because they have worked in this country and paid taxes to support programs they cannot access.

Noemi said they are considered essential workers but they aren’t given the equal treatment they have earned through their work.

“I would ask that just as we are considered essential workers during the pandemic, that we’d be treated and included into this country that we contribute to the economy of. I ask that you help fix the immigration situation so that we’re able to fix our immigration status and have access to benefits and services like everyone else. We come to the country because we don’t find opportunities in our own country. And it would just be fair to see that everyone has the same opportunities. I am just asking for equal treatment for everyone. Just like we are paying equal taxes. I think that we should have the opportunity to have access to all the other services as well.”

Sophia said all they are asking for is equal treatment, so they can take care of their families.

“I ask that we are able to be given that opportunity to be heard and to be included in access to health insurance so that we can take care of ourselves and our families and move forward with our lives like anyone else.”

Patty said if she was able, she would tell politicians and policymakers they need to listen to the community.

“I would tell all politicians out there that they need to listen to the community, listen to the people that elected them. When they were elected, the community expected integrity. They thought that they were voting for someone with integrity, and that would respond to their needs. What they need to do is listen to the working people that shape the economy of this country. But instead, they listen to the rich. I believe that our struggle is real. They need to be able to see that our lives and the daily lives that we have are difficult. We have to work hard every day. And what we need is equity. And we need to be treated equally and without our immigration status mattering.”

Names have been changed to protect identities.