Immigration and Healthcare Access
Updated: Jun 6, 2020
November 27, 2019 ⋅ 7:30 P.M ⋅ Cate Schroeder⋅ Editor: Guadalupe Sandoval
Sometimes there’s truth to the reality that we cannot help everyone who seeks medical attention. There are diseases without a cure; some people run out of time; some patients refuse treatment; there are many efforts that go unresolved. These represent legitimate reasons why healthcare might fall short of the “save anyone and everyone” dream. But someone being unable to get through the door, to take that very first step toward care? That isn’t a valid reason.
This challenge is blatantly evident in the intersection of immigration and healthcare access. Health is not a pawn to be thrown around in controversy nor a privilege earned only by select groups. Health is a human right, and it is constantly threatened by the discrimination, restrictive policies, and ineffective resources that immigrants face when seeking medical care.
Health insurance is the first hurdle. Since immigrants work a higher proportion of low-pay jobs that do not offer insurance, that avenue toward coverage is often already blocked off. In addition, immigrants often face restrictions under the Affordable Care Act and DACA—which make lawfully present immigrants wait five years for Medicaid and which outright exclude undocumented immigrants from it. With those and numerous other barriers, a horrifying gap exists among people’s ability to afford medical care. In the U.S., 45% of undocumented immigrants lack insurance, versus 23% of documented immigrants … compared to only 8% of American citizens. And perhaps most strikingly, U.S.-born children of immigrant parents are also less likely to be health insured, despite being citizens. The disparities here are grave and immense, and they trickle down to hurt even children.
For immigrants who are health insured or manage to seek care through the limited options accessible, language barriers often inhibit them from receiving the highest standard of medical care that they need. It’s hard enough to learn and speak a second language, but comprehending medical terms in a non-native language is another level of difficulty—especially in chaotic, unfamiliar, often impersonal environments like busy hospitals or clinics. Furthermore, if translation is offered—which legally must happen and realistically often doesn’t—it is often done via the “summarization method.” This method often leads to information being left out, added in, and warped based on the translator’s ability, medical knowledge, and even bias. Despite this being the most inaccurate form of translation, it is the method most often employed. And again, I point out: this is if professional, skilled interpreters are provided at all. The disconnect caused by language barriers leads to diminished trust between the patient and physician, as well as misunderstandings and skewed power dynamics. Doctors in these instances tend to share less information with the patient and start making decisions for them—which is not only a violation of personal dignity and choice but potentially very dangerous.
Over the summer, I saw for myself the potential harm a language barrier (and the healthcare system’s lack of effort to overcome it) can pose to a patient. As part of an EMT training program, I shadowed trained EMT’s on their shifts. I witnessed two instances where the patient spoke Spanish and not much English. En route to the hospital, EMT’s should ideally question the patient about things like their medical history and allergies. I would have expected there to be measures in place to overcome a language barrier, considering how important information like this is from the beginning of treatment, even before reaching the hospital. However, for these two patients, the ambulance became a glorified taxi, and the EMT’s said very little, if anything, to them. The most effort given to overcome the language barrier was the statement, “Do you speak English?” I don’t blame the EMT’s in particular, but the healthcare and pre-hospital systems that fail to emphasize the importance of translation and communication options, as well as basic foreign language training for providers in these fields.
Perhaps one of the more powerful (and more invisible) challenges to immigrants accessing medical care is the discrimination and stigma they face. Whether documented or undocumented, immigrants must confront controversy and hate in our society constantly. This can make them hesitant to seek medical treatment. Though not necessarily true, fears of prejudiced physicians administering a poorer level of care and concerns that seeking healthcare increases the probability of deportation are powerful. These fears prevent many immigrants from even attempting to secure healthcare, even when they legally can.
The obstacles rooted in flawed policies, systems, and societal attitudes seem insurmountable to many immigrants—and it is true that options are limited. However, there are means to receiving at least a basic level of healthcare that everyone should be informed of. In many areas, for instance, community health centers offer cheap care at the preventive and primary level, though any specialty services are rare here. Furthermore, any U.S. hospitals that take Medicare or Medicaid must, under law, give stabilizing emergency medical care to everyone—without regard to immigration status or a patient’s capacity to pay. During medical treatment, too, medical and ethical rules demand confidentiality of a patient’s personal information, which includes immigration status. There are also steps physicians can take to safeguard that information. For example, if they must mention a patient’s status during the process of care, they can do so verbally, leaving it off written documentation, or record it indirectly. A patient should feel completely in the right to request this protective measure be taken.
Given the current administration’s attitude toward immigration, as well as divisive policies, an overwhelmed and faulty system, and societal prejudices, the challenge for immigrant populations to build stable, secure lives here in the U.S. is immense. And the difficulties likely won’t be quickly or perfectly resolved anytime soon. One factor that absolutely must be held above the chaos, though, is every human being’s right to health. That we can and must work to safeguard, amidst all the other uncertainty.
About the Author
Cate Schroeder is an undergraduate at University of California - Los Angeles.