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Undocumented immigrants struggle for access to health care Date: 06/17/14

By Tammy Worth

When the Affordable Care Act passed in 2010, there was a lot of talk about who would be covered under the legislation. Medicaid would expand in some states and more individuals would have private insurance coverage. But there were a few groups that were exempt from the requirement to purchase insurance including Indian tribal members, individuals eligible to opt out because of religious beliefs, and undocumented immigrants.

In fact, undocumented immigrants were ineligible for both of the main provisions of the law meant to extend coverage to 32 million Americans, the Medicaid expansion and the state insurance exchanges.

I wanted to look at how the law would affect care for this population as well as the providers who treat them. That was my goal initially. But what I quickly found was that the issue was so complex my head spun because there are so many social, political and economic factors that affect how and where undocumented immigrants get care.

So I decided to focus my reporting on three different areas: the economics of immigration, the effect of the law on providers and the health care community and immigrant health stories.

Finding sources

I knew it was going to be difficult finding undocumented immigrants who would talk with me for the series. Most of them want to stay below the radar completely. Many of the interviews I set up fell through.

To overcome this problem, I began at the outside and moved inward. I spoke with a lot of economists, professors and organizations that deal in this realm of work. This reporting helped me get a good understanding of the issues about which I could be writing.

Then I moved inward. I reached out to every local organization I could think of that had contact with immigrants. I was lucky to find Axel Fuentes, who lives in Milan, Mo., and whom I profiled for the series. He came to Missouri from the Center for New Community, a racial justice organization in Chicago. His job is to defend the rights of immigrants in meatpacking towns and he has become a liaison for those Hispanic-Americans in the workforce and the community’s health care organizations and the meatpacking companies.

Through him, I lined up interviews with a handful of workers at the plant. He acted as translator and was integral in helping me understand the way the community functions. Through my interviews with immigrants, I found that the only way to get these sources to speak with me was to have some sort of go-between they trusted.

But even getting interviews with hospital officials, those at safety net clinics and other providers was a challenge. No one wants to talk about this issue. Hospital administrators just didn’t want to discuss it. Even those who work in safety net clinics, whom I thought would want to talk about the topic, went mum for fear funding would be pulled if they went on record saying they treated undocumented patients. The only tip I have is to call around and very nicely ask every organization in the area; eventually, I found sources at a couple of organizations who would talk with me.

Stories to be told

Here are some potential story ideas to pursue in this area:

• Where are immigrants getting care? Where are the gaps in the system? I found that nearly anything outside the scope of hospital emergency rooms and clinics was out of reach, particularly cancer care, dialysis and transplantation, for these patients.

• What groups are helping immigrants get care? How are they funded and how do they provide this care? Most of the organizations in my area were those who had doctors volunteer their time or charge Medicaid rates for immigrants who can pay cash for treatment.

• Is there a difference between rural and urban communities? Not too surprisingly, smaller towns here in the Midwest tended to have fewer resources coupled with some residual prejudice that led to poorer care.

• What are the economics of the issue? Nearly everyone claiming that undocumented immigrants shouldn’t get care think undocumented immigrants take more from the system than they contribute. Mostly, however, this idea is a myth. Immigrants typically create economic activity in the communities where they live. Particularly at the federal level, they pay heavily into the system through payroll taxes for Medicare and Social Security (funds they don’t qualify to receive as citizens do). It is less clear at the local level how things shake out. Some studies show they come out behind, but others have found undocumented immigrants receive more benefits in education and health care than what they contribute in state and county taxes. One note on this topic is, as with all studies, you have to watch the numbers. Both sides are very likely to skew figures to get a favorable result. For instance, one conservative group in a 2010 report found that undocumented immigrants cost the system $113 billion. Of that, $52 billion came from local educational costs. Looking closely at the numbers, I found they included children born in the U.S. to undocumented immigrants, who are legal residents.

While reporting on this series I found that many of the topics are universal and that these like these could be reported in nearly any area populated with undocumented immigrants.

Tammy Worth (@TammyWorth1) is an award-winning freelance health and business writer in Kansas City, Mo. This series was possible in part by an AHCJ Reporting Fellowship on Health Care Performance. For the project, Worth worked as a special correspondent for the Hale Center for Journalism at KCPT, an NPR station in Kansas City. See a video of Worth discussing her project.