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Immigration (Health) Reform

There has been some discussion surrounding non-citizens in health reform, much of it stemming from the notion that reform will provide coverage to illegal residents. This is simply not true, as both the House and Senate proposals explicitly disqualify illegal immigrants from insurance subsidies and credits. Nevertheless, the large amount of immigrants in the country (legal or not) will be a substantial portion of the 3-5% of the population that will remain uninsured after reform. Many uninsured LEGAL immigrants are unaware of the fact that they qualify for low-income coverage or are afraid that their enrollment would jeopardize their residency status. The reform proposals will help to reduce this stigma through public program eligibility expansions and strategies to facilitate enrollment in those eligible populations. Reform will also improve access to care in these populations through increases in the number of community clinics and school-based health centers.

Since we are an ethically-evolved society, needed medical care is administered by law in an ER no matter the citizenship status. Medicaid in California (Medi-Cal) actually covers emergency and prenatal care to the undocumented, though excludes preventive and routine care. The CHIP program also excludes undocumented children. Thus, it is important to address how/when/where this care is administered and what reform actually means for immigrants especially in California where non-citizens constitute 16% of the population (compared to 7% nationally.) For example, in order to reduce overuse of expensive emergency care for non-emergencies, educational measures should be taken to shift these care-seekers to less expensive community clinics. Reform should continue to address delivery system use in this population, at the very least improving the population’s access to primary care and coverage strategies for children. Future immigration reform may also create an avenue for coverage through a cost-sharing program by registering for some type of new ‘temporary/foreign worker’ status.

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