The U.S. Congress is debating immigration policy and what should be done about the estimated 11 million or more foreigners living and working in the United States illegally. The debate has centered on legislation that would slow the tide of people sneaking into the country, and, at the same time, provide those already here with pathways towards legal status. The legislation would do nothing, however, to address a crisis affecting both illegal and legal immigrants in this country, and that is the difficulty of finding basic, affordable health care.
The problem is acutely felt in the Bushwick neighborhood of Brooklyn, New York, for example, a ramshackle district where mainstream American life seems far away. Most residents there were born and raised in Mexico, the Dominican Republic or elsewhere in Latin America. As in many New York neighborhoods with majority immigrant populations, the quality of public health and public health care in Bushwick lag behind what most native New Yorkers enjoy.
Theo Oshiro, a Peruvian born health advocate at "Make the Road by Walking," a local immigrant aid group, says that Bushwick's per capita rates for both cardiovascular disease and chronic asthma far exceed city averages - a fact that he says can be explained by the conditions in which many residents live
"Houses have a lot of mold, insects and rodents and things like that, things are known to worsen asthmatic conditions," he says. Oshiro likens it to a vicious cycle. "For people who don't speak English, it's a lot harder to access health care. Often they are turned away because people at the hospitals don't understand them or don't know how to help them."
Dominican-born Yorrelis Vidar's experience seems typical. She recalls an incident eight years ago, when she'd already been living and working in the U.S. as an undocumented immigrant for several years.
"When I arrived at Woodhall Hospital, I was already in labor and since the person that was helping me didn't speak Spanish, she didn't understand what was going on with me and sent me home," Vidar recalls. "It had a negative result because when I was able to go back to the hospital, I was there waiting and I had to give birth in the hallways. That was a treatment that I didn't think was fair."
Most immigrants also face a culture gap when dealing with the American health care system. They are unaccustomed to dealing with the corporate bureaucracies of American hospitals.
Also, many immigrants come from countries where health services are inseparable from the government. That's not the case in the United States, but many undocumented immigrants fear possible exposure and deportation at the local hospital or clinic, says Adam Gurvitch, the director of health advocacy for the New York Immigration Coalition, which has just published a study of immigrant health issues in partnership with the New York Academy of Medicine.
"Even for people who have legal status, or are in the process of getting their green cards, they just don't want any hassles," Gurvitch says. "They want to stay out of the government's eyes. It's kind of a monster that people don't enjoy dealing with."
Other misconceptions abound. Some immigrants believe that only a fixed dollar amount of government aid is available per person, regardless of its intended purpose. Jinny Park, an advocate at Korean Community Services, which helps many of New York's quarter-million Korean immigrants, knows one mother - a legal immigrant - who will not use the government health insurance available for her child. Parks says that when she asked her why "she said 'if we are getting this public benefit, then once my children enter college, they are not going to get scholarships, or they are going to get very negative effects entering school.' Which is really not true!"
Under American law, everyone, including all immigrants, has a right to emergency medical care. But there is no right to health insurance. While impoverished American citizens are entitled to government health insurance called Medicaid, illegal immigrants and many legal immigrants who are not citizens are not. Indeed, immigrants are two and a half times less likely to be insured than citizens. This is another reason why immigrants avoid seeking health services - even when their lives might depend on it.
"People don't understand how the system is set up, and they don't understand what their rights are to health care," says Gurvich. "And if they do access health care, they have no idea what their payment options are…" He adds that "people are terrified of financial debt, which creates a huge disincentive for people going back in and getting follow-up care."
Gurvich warns that situation could have devastating consequences in case of an epidemic "or another crisis where it's in everyone's interest in the community to feel safe and secure going in and getting tested, or getting vaccinated or interacting with the health care system. It's an incredibly dangerous situation to have members of the community afraid to show up and get health care. It's incredibly bad pubic policy."
That's a situation many health experts fear is likely to continue, so long as significant numbers of immigrants live their lives on the margins -- or in the shadows - of American society.