It seems like nowadays unless an issue is framed under the banner of reform no social movement is moving through the system. Recently health care reform turned 3 years old and while we are fast approaching the 2014 mile marker in which some of the more drastic changes and provisions will take effect, I stopped to consider if there is an intersection where the Affordable Care Act and the current push of immigration reform meet?
I began researching for this intersection and I came across a news story that described a case in which two undocumented workers got into an automobile accident and were taken to the hospital as an emergency room visit. The hospital provided the emergency treatment per the law and determined they would need long term care. In a practice they called “medical repatriation”, the men, still unconscious were put on a hospital chartered plane and flown to Veracruz, Mexico. The family of the workers had no say in this and the hospital stated that the family didn’t approve the move and could not contest it either.
In the past, I have written about the potential impact of leaving 11 million undocumented immigrants out of the health system and that our success as a country hinges on everyone here coming here, growing roots, raising their children, loving this country and following the laws, and participating in the further development of this country. Reading that story made me set out to ask my friends working on the immigration side of things to get their input and what I found was interesting. One noted that the mixing of both the health care reform conversation and the immigration reform conversation was “sensitive.” She explained that the anti-immigration voices “usually stand on the premises that undocumented as well as documented are free loaders and they will burden or are burdening the system. They allege falsely that they don’t contribute to the system at all although, it has been documented that they contribute more to the system that they get out of it.” At this point I envisioned not an intersection but more a train track with two trains – a health reform train and an immigration reform train set traveling on a head-on collision path towards one another.
I get it, healthcare reform was meant to save money by reforming insurance practices and creating a system in which individuals contributed to their own healthcare either through their employer, or self-paid through the exchanges. Along with other ACA provisions, government would help healthcare cut wasteful spending by rewarding prevention and health outcomes rather than the flood of services when a person is sick. In theory, this shift does results in saving tax payer money. However as we shift to talk about the immigration reforms being crafted, we see that there is a large misconception that adding 11 million undocumented would add cost to the already burdened system of care.
This thinking is wrong on many levels. For one, an inclusive immigration reform policy would right the wrong that exists today. Right now, as my colleague pointed out, many undocumented immigrants who work do pay into the system without any way to access any services. As it stands right now the undocumented cannot even access Medicaid, and even with healthcare reform the undocumented continue to be “locked out of care” so the perception that immigrants takes from the system is flat out wrong!
Immigration reform should not be subject to an “either/or” solution but a “and” solution. The way I see it, movement on immigration reform compliments our healthcare reform efforts. I see that immigration reform would add many more people to the workforce, subsequently we would have more people legitimately paying into the system. Additionally as many undocumented are younger they will have a longer period of time to support the economy and the healthcare system. Naturally immigrants would more fully participate in our society, buy homes, raise children, and work for their dreams. As for their health, studies have supported the fact that new immigrants tend to be healthier than most Americans so it is likely that there is not as big a cost as is feared.
My vision of two colliding trains became one of a sail boat that caught a good wind. These reforms can work together if we deliberately craft them with the intentional equity.