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 Once in the insurance pool, he will not have his coverage “rescinded” or taken away because of over-utilization or other reasons.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 Carlos’s 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 state’s 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 won’t 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 Carlos’s 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 Claude’s, 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).


Page 1 of 1

Share/Save/Bookmark

User Comments


S. Ault on Aug 27, 2009 at 17:32:14 said:

Although it hurts people to say it, we have reached the apex where the 'have' and 'have nots' are about equal. Over 50% of legal US citizens now receive some form of government aid (medicare, medicaid, welfare, reduced/free lunches et al). Because of that it is necessary to close the loop that encourages illegal immigrants access to these facilities and change the way we issue assistance to legal citizens.


S. Ault on Aug 27, 2009 at 12:11:47 said:

Although it hurts people to say it, we have reached the apex where the 'have' and 'have nots' are about equal. Over 50% of legal US citizens now receive some form of government aid (medicare, medicaid, welfare, reduced/free lunches et al). Because of that it is necessary to close the loop that encourages illegal immigrants access to these facilities and change the way we issue assistance to legal citizens.


Dave Anders on Aug 21, 2009 at 08:05:04 said:

I really believer employers should be providing healthcare. I don't like this new era where executives add to their paychecks by paying their employees less, making more jobs "part-time" to screw people out of their benefits and hiring foreign workers at a lower pay rate. If the government would force employers to provide benefits those of us who work hard and are dedicated employees would EARN the benefits we deserve.


Nezua on Aug 19, 2009 at 11:51:41 said:

Hmmmmmm.

I say we draw the line between selfish and not-selfish. That is, not-selfish people get covered. Selfish people who would see other humans sicken and die from lack of money should also live in that world of noncompassion and illness, uncovered, uninsured, and unloved.


JSmith on Aug 17, 2009 at 05:13:17 said:

Charles: Want to know where I draw the line? There is no provision under the Constitution allowing the Congress to take money from one American to pay the medical fees for another person, legal or illegal. Any diversion of taxpayer funds to pay for someone else's medical care is unconstitutional. As James Madison stated, "I cannot undertake to lay my finger on that article of the Constitution which granted a right to Congress of expending, on objects of benevolence, the money of their constituents." Taking money from me to pay your bills is theft.


Dave Anders on Aug 16, 2009 at 15:51:34 said:

Charles does have a good point. I say we draw the line on who gets health care with being a US citizen. Recent immigrants have sponsors who are responsible for them.


Dave Anders on Aug 16, 2009 at 15:18:33 said:

Charles does have a good point. I say we draw the line on who gets health care with being a US citizen. Recent immigrants have sponsors who are responsible for them.


Charles on Aug 15, 2009 at 20:00:10 said:

So where would these two commenters stop the class division? Which classes receive health care and which classes do not? The same argument you make for the undocumented who works in the US you can make for the american poor, whom would not deserve health care in the US because they have not earned their right to health care. Obviously the poor and all the children are a burden to the rest of us. Should we make sure they also do not get health care?


Dave Anders on Aug 14, 2009 at 07:19:43 said:

Of course someone in the country illegally with no education will not have access to healthcare. It is the responsibility of his own government, not the US taxpayer to provide this for him. The fact that someone\\\'s government does a bad job of providing him/her healthcare does not give them the right to become a burden to US citizens.


J Cir on Aug 14, 2009 at 06:38:33 said:

Serious health care reform would mandate proof of citizenship or valid immigrant ID be presented every time someone enters a doctors office or hospital for non-emergency conditions. Folks like Mr. Carlos, whom Dr. Hayes-Bautista somehow overlooked identifying in his piece as an ILLEGAL immgrant, would learn quickly that the welfare trough is not available to him, and the source for non-emergency health care is to be found in Mexico, the country where he legally resides.

-->




Advertisement


ADVERTISEMENT


Just Posted

NAM Coverage

Immigration

ADVERTISEMENT

Advertisements on our website do not necessarily reflect the views or mission of New America Media, our affiliates or our funders.