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‘HEAL Act’: A Small Step in Addressing Health-Care Disparities for Immigrant Families

Tina Vasquez

"I don’t want any woman’s health suffering because she had to wait five years for coverage that she should have had immediately.”

Congresswoman Michelle Lujan Grisham (D-NM) re-introduced a bill this week seeking to ensure access to affordable health care for lawful permanent residents (LPRs) and Deferred Action for Childhood Arrivals (DACA) recipients.

The so-called Health Equity and Access Under the Law (HEAL) for Immigrant Women and Families Act, first introduced in 2014, would remove the current, mandatory five-year waiting period for lawful permanent residents to access affordable federal health care and remove restrictions for DACA recipients.

As Rewire reported in 2014, ever since the passage of what has become known as the “1996 laws,” LPRscommonly referred to as “green card” holders, who have been granted lawful permanent residence in the United States but have not yet become U.S. citizens—have had to wait five years until being able to access health care coverage such as Medicaid. There are some exceptions to the five-year bar, though it varies by state.

DACA recipients—all of whom are of reproductive age—have had even less access to affordable health care. While President Barack Obama’s DACA program granted young, undocumented people who met specific requirements a renewable, two-year reprieve from deportation (as well as driver’s licenses, work permits, and increased access to education and work opportunities) it also completely banned them from Medicaid, the Children’s Health Insurance Program, and the Affordable Care Act (ACA).

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Among women of reproductive age, 36 percent of the 6.5 million immigrants who are not U.S. citizens are uninsured, compared with 11 percent of naturalized citizens and 10 percent of U.S.-born women, according to the Guttmacher Institute. For women of reproductive age living in poverty, the circumstances are even more dire, with over half of noncitizen immigrant women lacking health insurance—more than twice the percentage of U.S.-born women.

Congresswoman Lujan Grisham told Rewire in an emailed statement that the HEAL Act seeks to “right the wrong” in these health-care disparities and act as a first step toward “broader health care coverage” in immigrant communities.

“Many Americans don’t realize that immigrants who are lawfully present in the United States still face barriers to health care coverage based on their immigration status,” Lujan Grisham said. “The disparities are significant and well documented; they can also be very difficult to combat. This bill focuses on disparities in coverage, and hopes to address disparities in the prevention, diagnosis, and treatment of negative health outcomes that is often the result of a lack of access to affordable coverage.”

The bill, however, does not include the estimated 11 million undocumented immigrants currently residing in the United States. Like LPRs and DACA recipients, many in this population have been in the country for years, paying taxes that fund federal health programs like Medicaid and the ACA. Yet they cannot access these programs.

Without access to health coverage, immigrants face significant barriers to health care. Immigrant women in particular have higher birth rates and, because they are disproportionately young and poor, are at high risk for sexually transmitted infections (STIs), Rewire has reported. Although some states have adopted more progressive approaches—like California, which offers undocumented immigrants Family PACT, a state program that pays for many sexual and reproductive health services, and Medi-Cal, which pays for pregnancy-related health care including prenatal care, delivery, postpartum care, and abortion—other hurdles such as transportation, language barriers, or fear of deportation may also prevent immigrants from accessing the care they need. 

Dr. Sara Imershein, a member of Physicians with Reproductive Health, one of the nearly 120 organizations that signed on to support the HEAL Act, told Rewire that funding Title X “to the fullest” is one of the primary ways to address the barriers undocumented immigrants face when trying to access reproductive and sexual health care.

An Obama-era rule aimed at stopping state legislatures from interfering with Title X federal funding of preventive services, like breast cancer screenings and contraception, affects 1.5 million Planned Parenthood patients. The American Health Care Act, the Trump administration’s ACA replacement that is now in the Senate, includes a provision stopping Medicaid funds from going to Planned Parenthood for one year. Since 2011, Republican budget proposals have also “included cutting Planned Parenthood off from Title X and other grants,” the Washington Post reported.

“Title X recipients, like Planned Parenthood, provide confidential high quality care on a sliding fee scale. Those services cannot be replicated by other health centers if Title X is eliminated,” Imershein said. “Through Title X you have access to birth control, but also live-saving preventive care like STI testing and treatment, Pap smears, and breast cancer screening. Title X clinics are an important entry point into the health-care system for millions of people.”

The physician told Rewire that while she is concerned about undocumented immigrants being omitted from the HEAL Act, the bill is “a start” and hopefully, a bipartisan, successful endeavor.

“Women’s health care is under attack. Many conservative and liberals share compassion for welcoming immigrants to the United States. We’re starting with small steps to allow legal workers to access health care, particularly Medicaid, if they are low-income and do not have employer-based insurance,” Imershein said.

Under an anti-choice administration that has taken a hardline stance on immigrants, the New Mexico congresswoman sees the HEAL Act as “more important now than ever before,” she said. It’s her attempt, she said, to be proactive in the face of attacks on women and immigrant communities. But it’s also personal.

“I faced a significant health care issue at a young age, so I know how important it is to have access to preventive care and the coverage that ensures that access,” the congresswoman said. “It’s unacceptable that there are immigrant women and families who are lawfully present, paying taxes, and contributing to their communities, who should have access to federal health programs and don’t. I don’t want any woman’s health suffering because she had to wait five years for coverage that she should have had immediately.”

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