Health Care to the Uninsured and Undocumented Population

Imagine working hard all year, no vacation, Monday through Sunday, probably even 2-3 jobs and still not having enough to make ends meet. On top of this, if you get sick or your family gets sick, there’s nothing that you can do because medical care is obviously way out of your price range. Not to mention, you don’t have the option of paying for health insurance. Now, stop imagining because this is the reality that some Californians are facing.

Even though the Affordable Care Act has significantly lowered the number of uninsured Californians, the number of individuals at the poverty level is still high. According to the United States census conducted in 2016, "15.8% of individuals are below the poverty level in California" (Data Access and Dissemination Systems (DADS), 2010). What's worse is that "one in 5 Californians lived fairly close to the poverty line" (Bohn, Danielson & Thorman, 2018). Due to this shocking truth, the Safety Net is essential to help the uninsured population in California obtain affordable healthcare.

The California Healthcare Foundation defines the safety net as "an array of providers delivering a broad range of health care services to medically underserved and uninsured populations, regardless of a patient’s ability to pay" (Saviano, 2018). The safety net has no clear definition because it has different licensing, different funding, so it has no formal structure. Among these are "a combination of public hospitals, county-run public health clinics, community health centers, rural health clinics, and free clinics" (Connolly & Newman, 2018). Some of these programs include State programs such as Medical and County Programs such as the Medically Indigent Adult (MIA) program. Episodic programs include the: “Breast and Cervical Cancer Treatment Program; Child Health and Disability Prevention Program; Expanded Access to Primary Care; Family Planning, Access, Care and Treatment (PACT); and California Children’s Services” (Becerra, 2018). There are also programs for low-income individuals and individuals with no government insurance. Within these programs are “CaliforniaKids, Kaiser Permanente Child Health Program, and Healthy Kids (Becerra, 2018)." The providers of these programs vary from program to program, with hospitals, clinics, and private doctors. The emergency departments are a significant part of the safety net because they "are federally mandated to provide necessary treatment to all patients who seek care" (McConville, 2018).

Safety net programs are much different from regular programs in California. For example, safety net hospitals differ from regular hospitals in the sense that they "serve a higher share of patients covered by Medicaid and the uninsured." All of these programs tend to tailor to specific populations of poor individuals, the same race, and Medicaid insured.

When an individual begins to feel symptoms of a disease, they are most likely to avoid going to the doctor for a proper diagnosis. Instead, they may take over-the-counter medicine and ignore the problem until it becomes so severe that they end up in the emergency room. It is only then they find out they have a terminal illness in its late stages, resulting in a high medical bill that could have been avoided with early diagnosis at a clinic. These programs are essential to Californians because they provide affordable healthcare, which results in fewer sick, uninsured individuals and reduces mortality and bankruptcy rates.

Now, let's revisit our previous scenario, but add the complication that you are an undocumented immigrant. Although there are several programs to help the uninsured, there is little to no assistance for the undocumented population living in California. "Undocumented immigrants are explicitly excluded from financial help for coverage through the Affordable Care Act, and even from using a state marketplace like Covered California to purchase health coverage using their own money" ('County & Community Safety Net', 2018). In fact, 11 of the 58 counties in California do not provide non-emergency care to undocumented immigrants. The situation is so severe that hospital emergency rooms are only required to stabilize a patient in an emergent situation. Thus, while an ER will treat a heart attack or gunshot wound, a private hospital has the ability to turn away a patient with chronic illnesses like cancer or diabetes ('California’s Uneven Safety Net: A Survey of County Health Care', 2018).

Despite these challenges, there are a few options for undocumented immigrants to obtain healthcare. The LA Times reports that undocumented immigrants can purchase private health coverage through an insurance carrier or broker. They can even take advantage of tax subsidies to pay for coverage (Zamosky, 2014). However, this option is expensive since it requires them to bear the full cost without any financial assistance. Another alternative is to turn to safety net providers such as community clinics and hospital emergency rooms that offer free or reduced-price care based on patient income level, regardless of immigration status (McConville, Hill, Ugo & Hayes, 2018). Finally, undocumented immigrants may also be eligible to obtain Medi-Cal, a public health insurance program that provides needed health care services for low-income individuals, including those with specific diseases such as tuberculosis, breast cancer, or HIV/AIDS ('Medi-Cal Overview', 2018).

In order to obtain this, individuals must meet two requirements. The first is permanently residing in California, and the second is to meet the household's income requirements, which are at or below 138% FPL. Unfortunately, even when aware of these programs, most immigrants will not take advantage because they are afraid that their immigration status will be reported. The Dream Resource Center states that "Personal information given to healthcare services will be used to establish healthcare eligibility, NOT for immigration purposes" ('Enrolling in Medi-Cal as a California DACA Recipient', 2018). So, it is important for immigrants to know that this is a health right to which they are entitled and that their information will not be used to enforce immigration laws. They also have help from their individual counties through County Indigent Care Programs that "serve uninsured adults who meet county-determined eligibility standards but are not eligible for Medi-Cal—most often because their incomes are too high, they are unauthorized immigrants, or they do not meet the categorical eligibility requirements, such as having dependent children or a qualifying disability" (Belshe, 2014).

For some individuals, there is the option of the Deferred Action for Childhood Arrivals (DACA), "a kind of administrative relief from deportation" ('What is DACA? - Undocumented Student Program', 2018). The problem is that recipients are still barred from accessing federal healthcare and purchasing any through Covered California. This is because they “are not considered lawfully present” ('Eligibility and Immigration', 2018). However, in the state of California, DACA recipients can qualify for Medi-Cal. The requirements to qualify are the same as for undocumented individuals.

In conclusion, California’s safety net is essential to providing affordable healthcare to the uninsured and undocumented population. It enables patients to receive routine checkups and ensures lower rates of mortality and bankruptcy. Although there are not a lot of health insurance options for the undocumented population, they should still be permitted to use California’s Safety Net. A pathway to affordable healthcare for undocumented immigrants is necessary, as they can only be considered lawfully present following an immigration reform. We are only as strong as our weakest link; if undocumented individuals have access to affordable healthcare, it benefits everyone because healthier families and financially stable families contribute to a better economy and state.

Personally, it was very interesting to see that although there aren't many programs for undocumented people, there are at least some programs to help the uninsured. In my opinion, it really is an uneven safety net. It doesn’t provide equal care for everyone. However, as a state, California offers a lot more options to these populations than any other state, with the provision of Medi-Cal. I also never saw a need to know what programs are available since I have always been a dependent of my mother, who always took care of all that. She went out of her way and made sure I had access to a clinic and a hospital if I ever got sick. Now I know what steps she had to go through, and the struggles she and other undocumented immigrants face with something as necessary as affordable healthcare. As a person who is studying to be a healthcare interpreter for the Limited English Proficient population, this is crucial information for me to know. If I ever have to play the role of advocacy for a patient, I will know exactly what programs are available and where to send them to obtain more information.

Bibliography

1. Becerra, H. (2018). (A.G. File No. 17-0047, Amendment #1. Retrieved from https://lao.ca.gov/ballot/2017/170665.pdf
2. Belshe, K. (2014). Rethinking the State-Local Relationship: Health Care. Retrieved from http://www.ppic.org/content/pubs/report/R_213KBR.pdf
3. Bohn, S., Danielson, C., & Thorman, T. (2018). Poverty in California - Public Policy Institute of California. Retrieved from http://www.ppic.org/publication/poverty-in-california/
4. Boyd-Barrett, C. (2018). Fear Pushes More Immigrants to Avoid Seeking Medical Care | California Health Report. [online] California Health Report. Available at: http://www.calhealthreport.org/2018/02/05/fear-pushes-immigrants-avoid-seeking-medical-care/ [Accessed 31 Oct. 2018].
5. California Health Care Foundation. (2018). How Many in Your Area Are Uninsured — and Why? - California Health Care Foundation. [online] Available at: https://www.chcf.org/publication/how-many-area-uninsured-why/ [Accessed 21 Oct. 2018].
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7. Connolly, K., & Newman, M. (2018). Retrieved from https://www.chcf.org/wp-content/uploads/2017/12/PDF-CAHealthCareSafetyNetSectorTransition.pdf
8. County & Community Safety Net. (2018). Retrieved from https://health-access.org/reform-coverage/county-community-safety-net/
9. Data Access and Dissemination Systems (DADS). (2010, October 05). Retrieved October 23, 2018, from https://factfinder.census.gov/faces/nav/jsf/pages/community_facts.xhtml
10. Dhcs.ca.gov. (2014). Medi-Cal FAQs 2014. [online] Available at: https://www.dhcs.ca.gov/services/medi-cal/eligibility/Pages/Medi-CalFAQs2014b.aspx [Accessed 31 Oct. 2018].
11. Eligibility and Immigration. (2018). Retrieved from https://www.coveredca.com/individuals-and-families/getting-covered/immigrants/
12. Enrolling in Medi-Cal as a California DACA Recipient. (2018). Retrieved from https://iibayarea.org/wp-content/uploads/2015/03/How-To-Enroll-in-Medi-Cal-DACA-v1.pdf
13. Law section. (2018). Retrieved from https://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?lawCode=WIC§ionNum=17000
14. McConville, S. (2018). California's Health Care Safety Net - Public Policy Institute of California. Retrieved from http://www.ppic.org/publication/californias-health-care-safety-net/
15. McConville, S., Hill, L., Ugo, I., & Hayes, J. (2018). Health Coverage and Care for Undocumented Immigrants - Public Policy Institute of California. Retrieved from http://www.ppic.org/publication/health-coverage-and-care-for-undocumented-immigrants/
16. Medi-Cal Overview. (2018). Retrieved from https://www.dhcs.ca.gov/services/medi-cal/Pages/default.aspx
17. Norris, L. (2018). California health insurance marketplace: history and news of the state’s exchange: Obamacare enrollment. [online] healthinsurance.org. Available at: https://www.healthinsurance.org/california-state-health-insurance-exchange/ [Accessed 24 Oct. 2018].
18. Saviano, E. (2018). California's Safety-Net Clinics: A Primer - California Health Care Foundation. Retrieved from https://www.chcf.org/publication/californias-safety-net-clinics-a-primer/
19. What is DACA? - Undocumented Student Program. (2018). Retrieved from https://undocu.berkeley.edu/legal-support-overview/what-is-daca/
20. Zamosky, L. (2014). Los Angeles Times - We are currently unavailable in your region. Retrieved from http://www.latimes.com/business/la-fi-healthcare-watch-20140420-story.html

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