How Does Immigration Status Affect Health?

The U.S. Supreme Court’s decision to uphold the bulk of the Affordable Care Act last week was a victory for many people currently unable to access care. But one group was excluded from the innovations and improvement of access to care. Undocumented immigrants make up 11 million of U.S. residents. They are also several million of the 49.1 million uninsured in this country.

Maybe that seems all well and good. After all, undocumented immigrants receive none of the protections afforded legal immigrants by design. But immigrants—documented or not—get diabetes. They have heart disease. They suffer broken bones and food poisoning and workplace injuries and sinus infections—just like everyone else in this country. And they are a group of people whose health mirrors the health needs of all U.S. residents. If we care about public health, we care about undocumented immigrants.

The case of undocumented immigrants’ access to healthcare is interesting both in human terms and health outcomes terms. Unlike legal immigrants, undocumented immigrants are not eligible for Medicaid, the federal health coverage for low-income Americans, or for the Children’s Health Insurance Program (CHIP). New state health insurance exchanges, being established to help people find better, more affordable healthcare, are unavailable to undocumented immigrants. Then again, undocumented immigrants are not beholden to the individual mandate. And while undocumented immigrants are eligible for private health insurance, premiums are likely largely out of reach. The average annual income of non-citizens in the U.S. is $25,000—but is likely far less for undocumented immigrants, who work under the table.

Banned from hospitals aside from the subjective category of emergency care, under intense scrutiny in states with “self-deportation” and “show me your papers” statutes, banned for the most part from private health insurance, and sometimes exposed to toxic chemicals and workplace safety issues that can cause or exacerbate chronic health conditions, undocumented immigrants often pay for healthcare in cash, often in their own neighborhoods. Like any group largely exiled from access to care, they find other ways to cope. And they are at greater risk of health outbreaks that could be avoided with preventative care or a prescription for antibiotics.

I will be using my grant from the Dennis A. Hunt Health Journalism Fund to explore the shadow healthcare system in which undocumented immigrants get healthcare for themselves and their families. This project will aim to describe the healthcare disparities between not just undocumented immigrants and citizens, but the powerful difference in health outcomes between undocumented and documented immigrants. Research suggests that becoming a U.S. citizen has an immediate impact on income and employability. I want to look at whether the same holds true for health outcomes both for individuals and for public health.

While I’m still working out which parts of the country to feature in my reporting, I’m clear on one thing: I don’t want to talk about immigrants as victims. I want to talk about the creativity and determination of families to get the care they need without arousing the suspicion of immigration officials, and talk to healthcare providers who serve this community despite the laws.

In my work as a freelance journalist for the past eight years, my focus has been more on people than diseases. Yes, I have written about the effect of excess salt on our overall health for Better Homes and Gardens, the approval last year of the first drug ever designed specifically for lupus, for Lupus Now Magazine, and effect of the closure of hospital-based skilled nursing facilities on the people who rely on them, for National Nurse Magazine. That last piece won an Award for Excellence in Health Care Journalism from the Association of Health Care Journalists this year.

But what unites my coverage is people. More than anything, I write about health as a way to talk about what motivates, inspires and confounds people’s efforts to care for themselves and those closest to them. As such, I’m interested in healthcare access and its corollary—how people without access to needed health services manage despite barriers. I look for stories that allow me to talk real people about how healthcare policy and their own decisions affect their health and their lives. I’m interested in how people make tough trade-offs and decisions, all while maintaining their dignity. I’m looking forward to discovering more about how to report these stories, what challenges I have to overcome to address these issues fairly and sharing them with this community.