Affordable Healthcare for Hispanic immigrants

As Block, Bustamante, de la Sierra and Cardoso (2014) point out, there are more than 12 million Mexican immigrants in the U.S. who have no realistic access to affordable care, as nearly half of them are uninsured. Indeed, access to quality care is next to impossible for all groups with a low-socioeconomic background (Sherrill, Crew, Mayo et al., 2005). The Affordable Care Act (ACA) was meant to provide greater access to care for low income populations; however, it “does not address lack of insurance for some immigrants, and the excluded groups are a large proportion of the Mexican–American community” (Block et al., 2014, p. 179). Block et al. (2014) suggest that the solution to this problem should be an innovative new form of health insurance coverage, such as bi-national health insurance—but they note that their research indicates such a concept is unlikely to find traction among an overwhelming majority of Americans, and neither would such a solution solve the problems inherent in the ACA itself regarding eligibility of specific immigrant populations for health care.
Marshall, Urrutia-Rojas, Mas and Coggin (2005) present a similar problem for undocumented Hispanic immigrants (i.e., illegal immigrants in the U.S.) who have no insurance coverage and virtually no access to affordable care. Their study found that undocumented Hispanic women “were less likely to report having health insurance and a regular health care provider, and reported lower education and income” (p. 916). The proposed solution of Marshall et al. (2005) was to suggest “providing immigrant women with health services such as health fairs, affordable health insurance programs, community health services, and increased opportunities for participation in federal and state programs” (p. 916)—though this too raises the question of who will pay for these services and where the funds will come from. Should taxpayers shoulder the cost for undocumented immigrants’ health care services? This question is divisive and polarizing for people across the political spectrum, particularly for individuals who feel that universal health care is a step towards socialism—and they see countries like Venezuela on the verge of collapse and believe that is what would happen to the U.S. should it begin adopting socialistic practices. Marshall et al. (2005), like Block et al. (2014) offer up a solution, therefore, that is unlikely to gain traction in the U.S. as the issue of health care and who should pay is one that is fundamentally designed to inflame the political and social sensibilities of a vast number of voters.
Another solution to the problem is the Patient Protection and Affordable Care Act of 2010 (PPACA), which is meant to expand health insurance coverage and thereby increase access to quality care among patients. However, as Brown, Wilson and Angel (2015) show, “health insurance coverage under PPACA excludes undocumented immigrants” (p. 990), which means that 3.7% of the population and 5.2% of the workforce are still not going to have the access to quality care they need (Brown et al., 2015). PPACA is, in short, another solution that is not really a solution, and falls in line with the proposals of Block et al. (2014) and Marshall et al. (2005). The solution proposed by Sherrill et al. (2005)—that the Accessible and Culturally Competent Health Care Project (ACCHCP), which is “designed to offer culturally appropriate, sensitive, accessible, affordable and compassionate care in a mobile clinic setting” (p. 356) presents the only real, viable alternative. The ACCHCP is unique in that it brings “nurse practitioners, health educators, bilingual interpreters, medical residents” and university students and professors together to help the underserved population of Hispanic immigrants in the rural southeast (Sherrill et al., 2005, p. 356). The ACCHCP works in the sense that the immigrants who used the mobile facility clinic stated that without this access to care “their only option for health care would be the emergency room” (Sherrill et al., 2005, p. 366). The program also works because it relies on a combination of volunteers, student learning, educational leadership, political leadership, and funding—all of which goes to support the population most in need. This is the type of solution that can help immigrant Hispanics to obtain the access to care that they currently lack—and it is a viable solution because it taps into the resources of American generosity and innovation in the sense that it relies upon funding set aside specifically for this purpose and is supported by educators, students and health care professionals who want to learn the tools of the trade and make a positive impact on the community.
Such a solution is really what is needed when discussing the issue of access to care for the immigrant Hispanic community in America. Other solutions depend too much upon the bureaucratic system that languishes at the federal level and is manipulated by powerful lobbying groups whose main concern is not the communities most in need but rather the pocket books of pharmaceutical makers and specialized medicine service providers. For them, health care is a big business. Only at the local level, can a real, genuine local concern for the local community of immigrants with no access to care be understood, appreciated and acted upon. That is what makes the solution provided by Sherrill et al. (2005) so much better than the other solutions suggested by Block et al. (2014) or the others. The problem with it, however, is that it depends upon local stakeholders taking an active role in addressing the issue. If local role players do not step up to take the initiative, no one will. So it puts the onus of acting on the local community—but that is not necessarily a bad thing. It just means that people should not be looking to the federal government for assistance. They have the power to make a difference right within their own communities, and all they need to do is tap the local resources—from nursing students to big fund donors who want to see their money go to a good cause.
That the Hispanic immigrant community is in need of these services wherever they are located is not up for debate, as Ramos, Appana, Brock et al. (2015) show. Moreover, this community is going to suffer health-wise if nothing is done to address the problem: “deficits in health care infrastructure for this largely transient community may compromise their ability to meet health care needs and concerns” (Ramos et al., 2015, p. 148). The point that Ramos et al. (2015) make, which is in line with what Block et al. (2014), Brown et al. (2015), Marshall et al. (2005) and Sherrill et al. (2005) show, is that the Hispanic immigrant community is in need of access to quality health care: the ACA is not providing it and other federal programs are not helping to address the situation. They cannot address the situation because they are too bogged down by bureaucratic red tape, which is put in place to protect the profits of the pharmaceutical industry, the overall health care industry, the specialized services industry, and all other major players and stakeholders in health care. Profits generally come before people in the American health care system, in spite of the high hopes that people had when the ACA was passed under Obama. Obama talked up a big game but the end result fell far short of the goals that everyone wanted to see achieved. For that reason, the Hispanic community continues to suffer—and it is up to the people at the local level to make a difference, as Sherrill et al. (2005) illustrate well in their study on the ACCHCP in the rural southeast and the role that health care students, professors, professionals and policy makers at the local level play in bypassing the bureaucratic red tape at the federal level and addressing a real need of the community at the local level.
The way to solve the problem of little to no access to care for Hispanic immigrants, therefore, is to follow the blueprint provided by Sherrill et al. (2005). Local level players must be the ones responsible for providing this access—it will not be performed at the national level because of the divisive and polarizing politics that go into how people think, vote, and react when ideas of universal coverage are brought up. The local level care represented by the ACCHCP is not universal care—it is simply a representation of local stakeholders coming together to do something that they know is right. That is what health care should be about: putting people before profits. That is what health care truly is.
In conclusion, the struggles of Hispanic immigrants when it comes to obtaining affordable healthcare or in terms of simply being eligible for health insurance coverage have not gone away under the ACA. They have not disappeared because in spite of the promises made by ACA advocates, the Act does nothing to ensure care or coverage for Hispanic immigrants. No solution at the federal level is forthcoming or likely, because of the role that politics and profits play in lawmaking at this level of government. The problem must be addressed at the local level, as Sherrill et al. (2005) show. It must be addressed by concerned citizens of the communities wherein the Hispanic immigrant population exists. These are the role players who are there and can see and feel the need; they are the ones who can get together like real human beings to address the issue, learn their craft, and make the kind of difference that needs to be made.
References
Block, M. A. G., Bustamante, A. V., de la Sierra, L. A., & Cardoso, A. M. (2014).
Redressing the limitations of the Affordable Care Act for Mexican immigrants through bi-national health insurance: a willingness to pay study in Los Angeles. Journal of Immigrant and Minority Health, 16(2), 179-188.
Brown, H. S., Wilson, K. J., & Angel, J. L. (2015). Mexican immigrant health: health
insurance coverage implications. Journal of Health Care for the Poor and Underserved, 26(3), 990-1004.
Marshall, K. J., Urrutia-Rojas, X., Mas, F. S., & Coggin, C. (2005). Health status and
access to health care of documented and undocumented immigrant Latino women. Health Care for Women International, 26(10), 916-936.
Ramos, I. N., Appana, S. N., Brock, G., Kalbfleisch, T., He, Q., & Ramos, K. S. (2015).
Health Status, Perceptions and Needs of Hispanics in Rural Shelbyville, Kentucky. Journal of Immigrant and Minority Health, 17(1), 148-155.
Sherrill, W. W., Crew, L., Mayo, R. M., Mayo, W. F., Rogers, B. L., & Haynes, D. F.
(2005). Educational and health services innovation to improve care for rural Hispanic communities in the U.S. Education For Health-Abingdon-Carfax Publishing Limited-, 18(3), 356.