This is the first installment of “The Borderline,” a new column in which Maggie Tishman focuses on immigration issues and how they affect America’s urban areas.
“Are we there yet?”
No family road trip is complete without the bleating of this timeless refrain. And though it might annoy us, it also reminds us that children are impatient creatures. Waiting can be more aversive than a plate of steamed broccoli. For a youngster, then—particularly a sick one—a few hours’ delay can be torture. A period like, say, five years might as well be an eternity. But five years is exactly how long the federal government makes newly naturalized citizens—including, yes, children—wait before they are eligible to receive health care benefits like Medicaid and SCHIP.
But a new health care reform bill, passed by the House and Senate in the past few weeks, aims to change all that—at least for minors and pregnant women. The new bill aims to provide broader coverage for all children, including 4 million presently uninsured ones, but holds special significance for the estimated 400,000 immigrant children who are currently ineligible for government-sponsored health subsidies.
The rule dictating the five-year waiting period was introduced in 1996 as part of the Personal Responsibility and Work Opportunity Act (better known as welfare reform) and has remained a contentious issue since. Supporters of the ban cite fears that government benefits will give foreigners additional incentive to migrate to the U.S. Opponents argue that while immigrants often come in search of jobs, to join family members or to escape persecution, it’s doubtful that the U.S.‘s health-care subsidy programs (hardly the most extensive among developed nations, even after the new reform bill) will carry much weight in immigrants’ decisions to enter the country. Furthermore, they say, immigrants must already wait a number of years (five, after getting their green card) before they can apply for citizenship, making the additional waiting period unnecessary and unduly long.
These activists have successfully fought other anti-immigration provisions of the Welfare Reform bill on at least two other occasions, first in 2003 when they managed to secure immigrant children’s eligibility for food stamps and again in the same year when the Medicare Modernization Act eliminated a similar waiting period for senior citizens. In fact, this is not the first time they have gotten Congress to eliminate the five-year ban for minors. Similar health care reforms made it through both houses no less than twice in 2007 before being thwarted by then-President Bush’s veto.
Since 1996, several states (including Pennsylvania, California, and New York, three of the states with the largest immigrant populations) have been forced to improvise, filling the federal-funding gap with their own cash to provide state-sponsored health care subsidies to legal immigrants. For immigrants in these places, little will noticeably change. However, for children living in other states, able to access important medical services for the first time, the difference will be huge.
Moreover, given that immigrants tend to cluster in cities, as do the current beneficiaries of health-subsidy programs, the bill could also have powerful implications for urban health care institutions. Dr. Leighton Ku, a health-policy professor at George Washington University, expects that increased access to primary care for children and prenatal care for pregnant women will reduce costly emergency room visits. Clinics and hospitals will also benefit, he says, from the new insurance revenue.
In the absence of a clear immigration-rights agenda, many say new health care bill is just one of the proxy battles that will define the struggle in coming years. Proxy or not, immigrant and urban policy advocates are poised to celebrate this victory. As to whether we’re “there yet,” with Obama’s signature still pending and non-pregnant, non-senior adult immigrants still barred, the bill can’t provide an answer to that haunting question. Still, it might comfort immigrant parents to be able to offer any encouragement to their sick child—we’re not there just yet, but we’re getting closer.