To wrap up National Minority Health Month, NCLR is proudly hosting a blog carnival with our friends and partners to celebrate recent progress toward eliminating health disparities for underserved communities—and talk frankly about the challenges that remain. Today, bloggers answer the question: How does race/ethnicity intersect with other identities in ways that compound barriers to health care and lead to health disparities, and how do you approach these concerns?
Clearing the Path to Health Equity Requires Removing Roadblocks for Immigrants
By Kara D. Ryan, Senior Research Analyst, Health Policy Project, NCLR
Amid the celebration of National Minority Health Month, as leaders have highlighted the promise of the Affordable Care Act and national action plans to promote health equity, the government research agency responsible for measuring these gaps in health care access and quality released updated data on the state of health disparities in the U.S. Overall, researchers find that Hispanics fare worse than non-Hispanic Whites on more than 60% of measures of health care access and nearly 40% for health care quality. More bluntly: compared to Whites, more Latinos (and other racial/ethnic minorities) are not getting the health care services they need, their treatment outcomes are poorer, and they’re suffering for it.
Unfortunately, this isn’t breaking news—as the agency itself points out, disparities between Whites and communities of color have been mostly stagnant over the time period for which data has been collected. Indeed, for years, Latinos’ uninsurance rate has hovered around 30%, making Hispanics nearly three times more likely than Whites to be uninsured. What’s more, even insured Hispanics are more likely than insured non-Hispanics to report having no usual source of health care—a key access measure—due to insurance or financial reasons. (For these and other key facts about Latinos’ access to the health system, check out our full slideshow, also available in Spanish).
The persistence of these gaps does, however, reinforce how much is riding on the sound implementation of health care reform and other strategies to promote health equity for Latinos and other underserved communities—and that requires us to take a closer look at how immigrants and their families access health care. More than nine in ten (92%) uninsured noncitizens are racial and ethnic minorities—and these are the Americans with the greatest chance of falling through the cracks left in the health system even after reform is in place.
Take Antoineta, an undocumented Latina who came to the U.S. as a child and has made her home in Los Angeles with her three U.S.-born citizen children. She has worked ever since she arrived, but has never been offered coverage through her job. Thanks to Medicaid, Antonieta can afford to take her kids to the pediatrician, but the high out-of-pocket cost of her own visits means she often skips care herself. “I need to be healthy in order to take care of and feed my children, but I have had to not go to the doctor so that I will have enough money,” she explained. “I am worried I might get sick because I know that no one is going to help me pay for the medical expenses, much less take care of my children.”
By any measure, immigrants like Antonieta are less likely than citizens to have access to affordable, quality health care; for example, nearly half (45%) of noncitizens were uninsured in 2010, compared to about one in seven (14%) of U.S.-born citizens. (See our slideshow on immigrants’ access to health care, also available in Spanish). Additionally, formal and informal barriers that block immigrant access often also spill over onto the lives of citizens—and much of this burden falls on our children. Look no further than the estimated 5.6 million citizen children—nearly 80% of whom are Latino—who live in “mixed-status” families with at least one noncitizen parent. One-quarter (25%) of citizen children living with an undocumented parent are uninsured, along with 14% of citizen children with a legal immigrant parent and 8% of children in all-citizen families. Rates of uninsurance among immigrant children are even higher; nearly half (45%) of all noncitizen kids living with an undocumented parent lack coverage. And even when these children are covered, their families’ health and financial stability may suffer when their uninsured parents cannot afford a trip to the doctor or pharmacy.
So what does this mean for health equity? Despite the new pathways to coverage created by health care reform, Antonieta will remain uninsured—and if her circumstances change, enrolling her kids in an affordable plan for which they are eligible will be more complex than for the average citizen family. Due to an unprecedented exclusion in the health care law, she is forbidden from buying a plan through the private health insurance exchanges that would cover her as well as her children. She will have to find child-only plans and claim the prorated tax credits for which her citizen kids are eligible—also having to overcome any privacy concerns she might have about having her status information shared with other agencies, despite assurances of protection. After all this work, Antonieta will be in the same position she is today—taking calculated risks about when she should seek expensive medical care that she needs to remain healthy for her children.
The health care law promises to connect millions of uninsured Latinos with health coverage and care; yet many of our families will face a road that is uphill and littered with obstacles—or that is blocked altogether. Moreover, implementation decisions at the federal, state, and local levels matter to whether these obstacles will be surmountable to our families. We hail the visionary work of leaders who continue to lay a framework for a more just and equitable health care system. The road ahead is long, but we will work side-by-side with our partners for policy solutions that remove health care barriers for all Americans.