By Rubén Tapia, Reporting on Health Collaborative
Juana, an undocumented immigrant, opens the medical kit that contains what she needs to care for her diabetes. She depends on community clinics for medical care. Photo: Rubén Tapia
In the Los Angeles apartment she rents, 65-year-old Juana opened a small kit that she uses to help manage her diabetes.
Inside is insulin that she injects and a small blood sugar monitor. Ten years ago, Juana attended a health fair out of curiosity.
“I didn’t feel bad; I remember that it was the first time I had gone to one of those places,” she remembered.
There, at the fair, they told Juana that she had diabetes. It was totally unexpected.
“I spent a good while crying,” she said.
Juana does not have immigration documents, which is why she did not want to identify herself with her full name.
Because of her immigration status, her options for receiving medical care are limited. She does not qualify for public medical insurance like Medicaid (or Medi-Cal in California), nor can she apply for insurance through the new exchange established through the Affordable Care Act.
Like many undocumented immigrants, Juana receives medical care to control her illness in a community clinic. The consultations are free, or offered at a very low cost, but even so, her situation is precarious. Juana only earns $4,500 per year cleaning houses. She has to spend almost $1,000 per year on medications that the clinic does not cover.
“For example, if I need eye drops, or a special foot powder for diabetics, I have to pay for it,” she said. “And those products aren’t cheap.”
Exhausted from the burden of her age, and with progressive deterioration of her body due to her diabetes, Juana is now paying more attention to the news. She recently found out that there is a proposal in the California legislature to offer health insurance to people who, like her, do not have documents.
Imelda Plascencia is one of the authors of the report “Undocumented and Uninsured,” a report by the UCLA Labor Center. Photo: Rubén Tapia
“When undocumented Californians seek care, the types of options are ‘Band-Aid’ options,” said Imelda Plascencia, co-author of “Undocumented and Uninsured,” a recent research project of the UCLA Labor Center (www.undocumentedanduninsured.com). The center’s research showed that three out of four of undocumented young people need care from a doctor, but most do not have health insurance.
“Seventy-four percent of the immigrant youth population has received some type of ‘Band-Aid’ care, like community clinics or public hospitals, which offer a temporary or quick remedy, but do not recognize the need for preventative or long-term health,” Plascencia said.
The UCLA study, as well as other recent research, recommend expanded medical coverage for undocumented people. Some of the proposals include establishing binational insurance that could cover preventative care in the United States, and the most expensive services such as surgical interventions in Mexico. Other proposals would increase government funding to institutions that offer free or low-cost services.
A few months ago, state senator Ricardo Lara proposed the legislative initiative “Health Care for All” to offer health insurance to the undocumented population.
“It would be a program similar to Obamacare, in which immigrants who are able to pay for health insurance can do that and those who cannot pay are covered by Medi-Cal,” Lara said.
On the national Radio Bilingüe program Línea Abierta, Lara asserted that the undocumented community contributes $2.7 billion to the state economy. That’s about twice the estimated amount that is spent caring for them in emergency rooms.
It is still unclear where the additional funds would come from to finance a health insurance program for undocumented people like the one the senator is proposing. Lara says that he is analyzing several options. One would be a tax on exports, he said.
“Another strategy that we are looking at is if we add a fee to drivers’ licenses,” he said.
Lara’s proposal generated immediate support among those who offer medical care to undocumented people, like Mario Chávez, director of community relations for the Saint John’s Well Child & Family Center network of clinics. The majority of the more than 65,000 patients that these clinics care for each year are Latino, and most of them do not have documents.
Los Angeles is one of the few counties in California that offers a program that covers preventative services, hospitalization, pharmacy, and laboratory procedures for low-income patients who do not qualify for Medi-Cal. Through the Healthy Way L.A. Unmatched program, the county grants $54 million per year to the more than 200 community clinics and health centers in the county to cover undocumented patients.
But Chávez says that it is not enough to cover demand at St. John’s.
Mario Chávez is the Community Relations Director at St. John’s Well Child and Family Centers. Photo: Rubén Tapia.
“St. John’s gets $800,000, and that covers, out of our 35,000 visits, only 8,500 visits,” said Chávez.
Even more worrisome, says Chávez, is that in recent years at Saint John’s, an increasing number of undocumented patients with chronic illnesses have been registered.
“For us it is very critical that not only the $54 million continue, but that the amount of money grows to invest in immigrant communities,” said Chávez. “Because when a crisis comes, because at the end of the day, a person without insurance, where does he go? Instead of coming to our clinic, they are going to end up at the emergency room.”
Healthy Way L.A. Unmatched serves a little more than 100,000 undocumented people in the city. This represents a small part of the uninsured undocumented people, estimates Edward Chávez, from One L.A., a coalition of community, religious, and trade union organizations.
“Right now there are a million people in Los Angeles County who are left out of healthcare coverage,” said Edward Chávez.
Chávez says that in the coming months, One L.A. will pressure Los Angeles County to increase health resources for undocumented people, and they will also ask the California legislature to approve Lara’s initiative, “Health Care for All.”
“We believe that to have health insurance is a right and not a privilege,” Edward Chávez said.
Juana said she will be watching this initiative, with hope.
“Hopefully, for humanity, they’ll pass it,” she said.
About Living in the Shadows: This project results from the Reporting On Health Collaborative, which involves MundoHispánico in Atlanta, New America Media in California and New York, Radio Bilingüe in Oakland, WESA Pittsburgh (an NPR affiliate), Univision Los Angeles (KMEX 34); Univision Arizona (KTVW 33), and ReportingonHealth.org. The Collaborative is an initiative of The California Endowment Health Journalism Fellowships at the University of Southern California’s Annenberg School for Communication and Journalism.
We Want to Hear from You! As the Living in the Shadows series unfolds, we welcome your ideas. You are part of the story too and we invite you to share your perspective and experiences by writing to immigranthealth@reportingonhealth.org, calling us at (213) 640-7534 or by joining the conversations on these topics on Facebook at https://www.facebook.com/immigrantshealth or on Twitter at @immighealth.
