Access Denied: Immigrants and Health Care

Nationally, 46% of low-income immigrant children who were not citizens lacked health insurance in 1999, compared to 20% of children whose parents were native born. Scher discussed the implications of lack of health insurance for immigrant children.

By Abby Scher

This article is from the May/June 2001 issue of Dollars & Sense: The Magazine of Economic Justice available at

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This article is from the May/June 2001 issue of Dollars & Sense magazine.

Any supporter of public health who visits Sister Pietrina Raccuglia's of ice at Cabrini Immigrant Services in New York City is likely to become enraged at the modest tools she has to work with. Hers is a small office in the worn rectory of a church on Henry Street on the Lower East Side, with two computers, a few desks and clean, nearly folded clothes in two boxes by the door ready to be given away. This is what devolution looks like, since Sr. Pietrina is trying to plug the holes ripped out of the social safety net by the anti-immigrant welfare reforms passed in 1996.

That was when Congress barred documented immigrants who arrived in the United States after August 22, 1996, from receiving federally funded Medicaid until they had been in the country for five years. (Even when the five years are up, their chances of gaining Medicaid are iffy because of other rules.)

Since then, the proportion of low-income non-citizens without health insurance has grown, according to an Octoher 2000 study by the Center on Budget and Policy Priorities. Nationally, 46% of low-income immigrant children who were not citizens lacked health insurance in 1999, compared to 20% of children whose parents were native-born.

Ten states have stepped in with their own money to cover Medicaid for immigrants who have been cut off, but in New York, the campaign for state funding has just started. The tiny, privately funded Cabrini office is struggling to find doctors willing to donate care for the sick immigrants coming to its door. In the past, Sr. Peitrina referred the ill to the nearby Cabrini Medical Center, which had founded the immigrant counseling office in 1999.

But now Cabrini Medical is in financial straits and, according to Sr. Peitrina, unable to help out. She is looking forward to the summer, when it might be possible to run a clinic with incoming medical interns. "But if the patients need blood tests, who is going to pay for it?" she asks. "I have a man who has terrible pains in his head, and I can't get him an MRI." TB, she says, is also rampant.

"You harm the whole country by not attending to these people," Sr. Peitrina says, echoing a century-old argument for public health that no longer seems to inspire policymakers.

New York is one of 23 states that have agreed to cover documented immigrant children who arrived in the country after August 1996, by paying the cost of either Medicaid or the State Children's Health Insurance Program. But there are 100,000 adult immigrants in the state who are low-income enough to qualify for Medicaid but cannot receive it, according to a February study by the Commonwealth Institute.

Last fall, the New York Immigration Coalition hired a health-care coordinator to launch a statewide fight for the modest funding needed to cover the adults. Both the Greater New York Hospital Association and the health-care workers' union 1199 (affiliated with the Service Employees International Union) have signed on.

The trendsetter in this struggle, surprisingly, is California, the breeding ground of the anti-immigrant movement. Immigrant-rights activists were primed and ready after the legal fight over the state's Proposition 187 in 1994, which cut public services for immigrants but which the courts eventually blocked as unconstitutional. In 1997, right after the federal cuts were made, five groups formed the California Immigrant Welfare Collaborative and succeeded in filling the federal holes with state money.

Nationally, advocates are trying to win back federal funding of care for documented children and low-income pregnant women (only labor and delivery are covered now). They also are pushing to restore food stamps for documented residents, another basic health issue. Rini Chakraborty, policy analyst with the Collaborative, is hopeful that the national effort eventually will succeed and perhaps go beyond these two proposals. "Even Congress realizes the cuts in '96 were too deep," she says. Her optimism wasn't shared by Sr. Pietrina and others in New York who haven't seen a local victory yet.

Where they do agree is on the poor chances of reversing another damaging reform: "sponsored deeming." Under a 1996 law, sponsors of immigrants can be held financially liable for the public benefits used by those they sponsor—even if immigrants are legally entitled to receive them. Emergency room visits under Medicaid are explicitly exempted, as are housing and food stamps, but it is not clear whether non-emergency Medicaid is. "We encountered a woman with schizophrenia whose sponsors don't want her to get medication because they're afraid they'll be sued," says Chakraborty. "In California we were able quite early on to make sure we covered all immigrants, no matter their date of entry," she continues. "The big problem for us right now is folks are still scared to access [care]."

Abby Scher is director of Independent Press Association-New York and former co-editor of D&S.