My family got some bad news last week. My 21-year-old niece, Caitlin, a student at the University of Texas, learned that she’d had a relapse of the leukemia that struck a year ago and forced her to undergo months of intensive chemotherapy. She endured that experience with pluck and grace and the leukemia went into remission. Then, last week, two months into a semester of study abroad in Spain, she learned her cancer had returned.
She quickly returned home and from the moment she got off the plane to resume her battle with leukemia, she issued an order to her parents: no moping and no tears. Once again, she is inspiring all of us, her family and friends, with her grace, courage and humor.
In one respect, Caitlin and our family are fortunate. Thanks to a key provision of Obamacare, she remains covered on her parent’s health insurance, as do some 3.1 million other young adults under the age of 26 who might otherwise be uncovered. That means she has access to excellent, cutting-edge treatment at one of the premiere cancer-treatment centers in the U.S.—and it won’t put my brother’s family into debt or bankruptcy.
For thousands of other young people, the situation is quite different. Oday Guerrero came to the U.S. at the age of 4 when her parents fled the violence and poverty of Tijuana, Mexico. Now 23, Guerrero became the first member of her family to go to college and last year graduated from UC-Irvine.
Thanks to the executive order issued last year by President Obama, she and as many as 1 million other undocumented immigrants under age 30 are no longer at risk of being deported. But they remain at risk of having health conditions go untreated. At the very moment when the U.S. is making its biggest effort ever to widen access to health care, undocumented immigrants are being shut out. They are excluded from the Affordable Care Act, ineligible to purchase subsidized insurance or to be covered by Medicaid.
Guerrero says she’s healthy and that not having insurance hasn’t greatly affected her so far. But she worries about her mother, who has a thyroid condition that may worsen without access to care. “Where are we going to get the money to pay for treatment and medication?” Guerrero asks. “That’s always on our minds.”
Lack of health insurance fractured the family of Anthony Ng, who came to California from the Philippines in 2001 at the age of 12. In 2008, his father, the chief breadwinner for the undocumented family, began having dizzy spells and other mysterious symptoms. Anthony was then a senior at Van Nuys High School in Los Angeles, trying to maintain a 4.0 grade-point average and working 20 hours a week at a restaurant. The family sought help from doctors, using the health insurance his father earned from his supermarket job. Doctors eventually figured out that Anthony’s father had suffered a stroke, but by then he’d lost his job and his insurance.
“We had no money so we put his condition under the rug,” Anthony recalls. “We hoped he would get better naturally but that didn’t happen.” Anthony went off to college at UC-Irvine and, a few months later, his father moved back to the Philippines so he wouldn’t feel he was burdening the family. Anthony didn’t even get to say goodbye in person.
Across the country, some 48 million people remain uninsured, a number that has begun to decline as provisions of the Affordable Care Act take effect. In 2011, the number dropped by about 1.3 million, according to U.S. census data, largely because young adults got on their parents’ insurance. Next year, the number of uninsured should start falling substantially as key provisions of Obamacare kick in.
Economists predict that over the next few years, the number of uninsured people nationally will drop by around 60 percent to 19 or 20 million. Some 3.5 million of them are likely to be undocumented immigrants, says Lynn Blewett, a health policy researcher at the University of Minnesota. In California, 3 or 4 million will be left uninsured and some 800,000 are likely to be immigrants, says Anthony Wright, executive director of Health Access, a California health advocacy group.
Today, California is one of just five states using federal money to help community clinics and hospitals provide basic care to low-income residents who, starting next year, should gain coverage through the Affordable Care Act’s Medicaid expansion. In California, this bridge to Obamacare is called the Low Income Health Program (LIHP) and it serves about 500,000 people. The question now is what should become of the program. It is slated to phase out next year as people transition to Medicaid. Health advocates say that would be a terrible mistake.
Rather than ending the program and slashing funding to clinics, organizations like Health Access and the California Endowment are calling on California Gov. Jerry Brown and the state legislature to allow counties to keep about $1.4 billion in state funds that counties have long used to help provide care to the poor. They propose that the program continue to provide care to people who are uninsured—in this case undocumented immigrants who are shut out of the Affordable Care Act and others who can’t afford to purchase insurance. In this way, the existing infrastructure of clinics would be used to maintain a healthcare safety net.
It’s the right thing to do, says Anthony Wright of Health Access, and it also makes economic sense. People who are uninsured and can’t get check-ups and primary care still end up in emergency rooms when they have health crises—and counties are obliged to care for them, no matter what their immigration status. Studies suggest that people without access to regular care are more likely to need crisis care, the most expensive kind of treatment.
“If we have limited dollars, isn’t it better to provide people with up-front preventive care and keep them out of the ERs?” Wright says.
In recent years, thousands of young immigrants, including Oday Guerrero and Anthony Ng, have fought for the ability of undocumented youth to remain in the country where they were raised. Now they’ve joined a new cause—for the right of all people to heath care. They’re the stars and voices of a social media campaign, and a TV commercial the California Endowment has been airing on stations around the state.
“Our country has spoken, saying that everyone should have access to affordable health care,” the youth say at the end of the 60-second spot. “Does everyone include me?”
