The 1996 Personal Responsibility Work Opportunity Reconciliation Act (PRWORA), or “welfare reform” (which repealed federally-funded social services for millions of people), was a turning point in health access for many populations in the U.S. In particular, title IV restricted access to federally funded public services for immigrant populations, by changing eligibility requirements. This policy shift changed the way newcomers to the U.S. (people who may asylees, refugees, immigrants, legal or illegal aliens, migrants, international adoptees, and others) accessed healthcare, by creating new barriers.
State governments began taking up health care as primarily a state-issue during the Regan administration, an era of relinquishing federal responsibility for many public goods. State, local governments and private insurance companies became primarily responsible for health care innovation and access schemes for their populations, including newcomers. These actors functioned with funding from the federal government’s Medicaid and Medicare programs. When waiting periods were introduced for documented immigrants under PRWORA, and undocumented immigrants and other newcomer populations were not addressed at all, the federal government provided a patchwork model of care for these populations. Most of the aspects of this patchwork program report to the Department of Health and Human Services. The Center for Disease Control (CDC) runs preventative and treatment programs for infectious disease (partially funded by the Office of Refugee Resettlement), the Migrant Health Program provides a limited number of vaccinations and preventative services, and the Office of Minority Health distributes a few grants to subsidize the cost of healthcare providers. With the eradication of Medicare and Medicaid as viable options for many newcomer populations, specifically undocumented and documented immigrants residing in the country for under 5 years, there is no specified stream of funding. Indeed, many states have taken issue with the federal government for not counting immigrant populations in the federal census (which determines funding levels), and thus, states are not able to provide adequate services to their actual population. Federal funding for immigrant health care is then a cornerstone of the policy issue.
The health care options for newcomers and immigrants are then restricted almost entirely to emergency care. The emergency model of care (barring access to preventative treatment), has cost many states millions, and has worsened and jeopardized the health conditions of newcomers, based on a policy funding issue.
The passage of PWORA allotted newcomer populations essentially no access to healthcare (other than emergency rooms) any healthcare would need to be funded by the state, and they could not use federal block grants to provide this care. With the exception of refugee populations who have been in the country less than 5 years (the time they can receive Medicare and Medicaid was slashed dramatically in most cases), newcomers would need to achieve citizenship before they could access healthcare. There are a variety of barriers to achieving citizenship, namely, learning English, history and government to pass the citizenship test (a test many studies have shown is not passed by most U.S.-born citizens). Additionally, some states have long waiting lists for applicants to take the test (some as high as 18 months). The barriers to newcomers who have just become citizens and wishes to benefit from federally-funded public services, do not end there. Sponsors are required to sign a legally-binding affidavit of support, newcomers undergo verification requirements and an FBI criminal background check.
The political (xenophobic and racist) desire to restrict immigration through the vein of public health concerns began when newcomers were rejected at Ellis Island, and either detained or sent home. Physicians, nurses and public health officials had the power to name who was “desirable” and who was not. Today, our public policies say the same things. By restricting preventative and adequate medical care to newcomers and eliminating entire pools of public funding for this, the government literally funds the lives it deems worth treating and saving.
While there are many issues with immigration policies in this country (citizenship test, as one example), the primary issue being explored here is health care. For this to be a country worth coming to (and staying in), health care must be a quality good that is accessible to all. This means a cost-effective and accessible system, interested in administering a public good and not creating self-contained profit. Health care needs to be public, and universal. Most studies show that single-payer healthcare is the most cost-effective way of providing health care to the entire population, and this is the policy I propose, without restrictions to any populations (especially newcomers).
(Sources: Smith, Linda S. “Health of America's Newcomers”. Journal of Community Health Nursing, Vol. 18, No. 1 (Spring, 2001), pp. 53-68 <http://www.jstor.org/stable/
No comments:
Post a Comment