The Immigrant Health Care Narrative and What it Tells Us About the U.S. Health Care System
51 Pages Posted: 19 Jul 2011
Date Written: July, 18 2011
Exclusion of immigrants from health care benefits is a touchstone of immigration-related and welfare reform initiatives enacted at the state and federal levels. Increasingly attention is given to the harmful health, economic and other societal consequences of such policies, but this article focuses on a different aspect of the problem. It examines the political, legal, and popular discourse around these benefit restrictions in order to flesh out the narratives that have been created about immigrants’ character and relationship to the rest of society, and to understand how these narratives shape U.S. health policy.
The dominant narrative has been constructed by those who want to restrict benefits as a means of immigration control. Their rhetoric reflects an “Us-Them” dichotomy in which immigrants, often labeled as criminals and welfare abusers, are viewed as jeopardizing the health and safety of law-abiding citizens. In terms of health care access, these fears are reflected in discourse that blames immigrants for overcrowded emergency rooms, accuses immigrant women of coming to the U.S. only to give birth (and therefore “steal” U.S. citizenship for their children), and claims that Medicaid fraud by immigrants makes heightened documentation requirements necessary. Despite the apparent rhetorical focus on immigrants here illegally, the impact of this narrative goes beyond the undocumented; it creates a presumption of illegality for certain ethnic groups and undermines acceptance of immigrants’ citizen children. The article then considers the counter narrative offered by health care and immigrant rights advocates who challenge benefit restrictions. These pro-access groups describe a more positive and nuanced relationship between immigrants, the health care system, and society generally. They emphasize statistics about immigrants’ positive contributions as workers and taxpayers, use comparative data to paint a picture of immigrants as less frequent users of public services than citizens, and try to disprove any connection between immigration motives and the availability of public benefits. Many people highlight public health and humanitarian justifications for expanding health care access, and immigrant rights activists challenge immigration status as a basis for denying care because of its fluidity and uncertainty within a broken immigration system.
The remainder of the article explores the limit of this counter narrative as a tool for expanding immigrant health care access in the U.S. Despite laudable goals, this counter narrative may unintentionally trigger the kind of fear, mistrust, or presumption of “potential illegality” that has been used to fuel anti-immigrant initiatives and restrictive health care policies. Moreover, many immigrants experience multiple barriers to health care access beyond lack of insurance; linguistic and literacy challenges, low socioeconomic status, geographic isolation, and discrimination by individual providers are problems that must also be addressed to ensure meaningful access to care. Finally, even successful attempts to reframe the narrative will only have a limited benefit for immigrants in a health care system that contains other structural inequities and excludes many citizens as well.
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