VaccinationBy Sonal Ambegaokar, Health Policy Attorney at the National Immigration Law Center.

To date, policy discussions regarding immigrants and health care and other benefits primarily focus on negative stereotypes and myths. As a result, the default policy solution to any issue involving immigrants and benefits is to simply deny the benefits, even when the immigrants are in the U.S. lawfully.  Yet this solution is counter-productive for three main reasons: first, it is not cost-effective; second, it fails to actually address the systemic failures in our national health care and immigration policies; and third, it legally sanctions the exclusion and ostracizing of immigrants as the “other.”

This concept of immigrants as the “other” often helps policymakers and voters justify anti-immigrant policies and prevents us from having   a rational debate. By continuing to allow for exclusion of immigrants from basic, human necessities—health, food, and shelter—as the Senate proposal does, we seem to be conceding to the idea that immigrants are the “other” and that we are not created equal after all.

The Senate proposal requires aspiring citizens to wait 15 years before they can apply for anti-poverty programs such as Medicaid and SNAP (food stamps). They are denied eligibility for the length of their time in provisional status and must wait an arbitrary five years more after receiving a green card in order to apply for these programs. During these 15 years, these lawfully present immigrants will continue to contribute to our economy and help maintain the very programs that they are denied access to through their taxes. This exclusionary policy keeps immigrants in poverty and creates barriers to integration.

Moreover, despite evidence that immigrants come to the U.S. for jobs and family, the exclusion from health and benefits of immigrants—who already reside in the U.S.—continues to be justified as an effective immigration policy to prevent individuals from coming to the U.S. for benefits. Yet, even with tough restrictions and exclusions of immigrants from benefits in place since 1996, immigration grew and only decreased during economic downturns.  Based on recent history, denying health and benefits to immigrants as a way to fix our broken immigration system has proven ineffective and ignores the root causes of migration.

Most disheartening in the Senate proposal is the exclusion of aspiring citizens from affordable health care under Obamacare (Affordable Care Act (ACA)). After universal acknowledgement that the status quo in our health care system and expenditures is unworkable, we had a lengthy and contentious national debate on how to fix our broken health care system. In order to solve the problem we were told that more of us need to be able to: get and actually afford health insurance; invest in preventative care in order to prevent someone from falling ill in the first place rather than waiting to treat him in the emergency room after his condition becomes untreatable; and to pay our fair share for health care to reduce costs for everyone.

However, none of these sound health policy solutions seem to apply to immigrants—especially if they are undocumented and even after they obtain legal status through this Senate bill. How excluding all these “others” in our communities from access to affordable care will help achieve a healthier, integrated workforce, a strong economy, and will reduce the nation’s health care costs in the long-term is the question we all should be asking. Instead of talking about how we can’t afford to include immigrants in the ACA, Medicaid, and food assistance programs, let’s talk about how we can’t afford not to.

First, there is a loss of productivity to the overall economy and to individual employers when a worker or his or her child falls ill. Second, children who miss critical time in the classroom due to illness often fall behind, which over the long-term may affect their opportunities for higher education or their career ambitions. Third, forcing an individual to delay care when his or her condition worsens often results in the development of chronic conditions such as diabetes or asthma that become life-long health costs for the individual, as well as the system. And of course, the cost of treating illnesses in the emergency room that could have been prevented altogether, or that could have been treated by a primary care doctor if the individual had a medical home, is not only one of the more expensive long-term costs of exclusion of immigrants, but a predictable and almost certain cost that we all will have to pay for through higher premiums and reduced capacity to care for serious emergencies.

Finally, by exclusion of immigrants from federal health programs, the government is simply shifting the responsibility and cost of care for uninsured individuals to state and local governments and safety-net providers. As a result, the federal government is simply refusing to pay its fair share of the costs and incorrectly claiming there will be no costs associated with providing health care to immigrants. In the end, all of us will pay for the costs of exclusion one way or another, simply because you cannot prevent someone from falling ill or being injured. When it comes to health and well-being, there are no “others”; there are just all of us and our humanity to one another.

Photo by Sanofi Pasteur

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