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Health Care for All? It Depends on Your Visa

New America Media, Commentary, David Hayes-Bautista Posted: Aug 14, 2009

Not all immigrants are alike. This will be seen clearly in the effects of the current health care reform debate: Some immigrants will benefit, others will not. The concept of segmented immigration provides a framework for determining the immigrant winners and losers in the future system.

Why do some immigrants move quickly and swiftly up the educational and professional ladder, while others appear to remain stymied at the bottom? Three dynamics have a great deal to do with determining their trajectory in U.S. society: the human capital an immigrant possesses upon entry; the governmental policies of welcome provided; and the family and community resources available. Variation in these three dynamics create different segments of immigrants, who will benefit differentially from the health care system being debated.

Consider an immigrant named Jean-Claude. He is an immigrant from France, an engineer from one of the top schools in the country, with a good command of English, who brings with him with a sizeable down payment for a residence. He is sponsored by a Silicon Valley corporation that desperately needs his talent, so he is provided a visa upon arrival. With his high human capital and governmental welcome, Jean-Claude will benefit from the middle-class aspects of health care reform. Mandated coverage means that he must be provided health insurance coverage, either by his employer, or by some other alternative (possibly a public plan) independently of his employer, which coverage he will be able to afford, thanks to his good income. Guaranteed issue means that he will not be denied coverage by his insurer because of some pre-existing condition, such as being a smoker or having asthma. Once in the insurance pool, he will not have his coverage rescinded or taken away because of over-utilization or other reasons. And should he lose his job, or should his company disappear in a corporate merger, he will continue to have his health insurance policy. Because of his advantages, Jean-Claude will not have to rely on his immediate family, nor his community of French immigrants, for any of his health care needs.

Contrast the case of Juan Carlos, an immigrant from Mexico who toils in the rich agricultural fields of California to provide us all with the food we need every day. Compared to the French engineer, Juan Carloss human capital appears meager: eight years of education and an extremely limited ability in English. Worse, he arrived already in debt to a coyote, who brought him across. The coyote was necessary because Juan Carlos presence is not welcomed by governmental policies which denied him a visa to work, while the states economy needs his labor nonetheless to support one of the its most important sectors -- agriculture. From the outset, Juan Carlos has been rejected from participation in the future health care system: the undocumented were deemed ineligible for coverage in the first debates. And even if he should manage to regularize his status, the current debates would deny him participation for a number of years. He will labor in one of the most dangerous occupations in the country and inevitably will be injured or harmed by his working environment. His employer does not offer health insurance, and on his meager pay he cannot afford premiums. He wont have much discretionary income to keep pace with the rising costs of medical care. So, after incurring an illness, he will show up at the doors of an emergency room, and his presence will be castigated as a drain on resources by the very people who are nourished by the food Juan Carlos has labored to provide. Basically, the current system being debated will do nothing to change Juan Carloss situation.

Luckily, Juan Carlos has one dynamic that might assist him: the strength of his family and community resources. Family networks will step forward to provide what assistance and comfort they can. And the community resources, in the form of community clinics, advocacy organizations and a lively in-language media presence, have not shunned Juan Carlos, but instead are attempting to ensure that Juan Carlos be part of the future health care system. His contribution to our well-being is no less important than Jean Claudes, and both segments of immigrants deserve to be included in the future health care system that their presence will help to fund.

David E. Hayes-Bautista, PhD, is a professor of Medicine at the UCLA David Geffen School of Medicine. He is the author of "La Nueva California: Latinos in the Golden State" (UC Press, 2004).

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