No Health-care, Representation for Undocumented Residents

By Charlie Weems, Whitman ’12

There is a consensus under the Obama Administration that we shouldn’t even think about immigration reform until after 2012; it’s just too controversial.

– Nisha Agarwal, Director of the Health Justice Program at New York Lawyers for the Public Interest

This year, the National Immigration and Integration conference in Seattle attracted over 740 experts in the field of immigration to talk about issues ranging from Health to Active Citizenship. Many of those attending the conference help directly in the process of welcoming newcomers to the U.S. by running organizations that help with paperwork, job searches, language skills, and a whole host of other tasks that must take place for a smooth transition into life in America. This is no small task; The U.S. Immigration and Customs Service (USICS) naturalizes over a half-million immigrants as American citizens annually. As a volunteer in the “Health Track” I was able to listen to lawyers, researchers, and program directors discuss the desperate state of affairs for immigrants in the American health care system. I left the conference with a far better understanding of how a lack of political representation has led to exclusion from the health-care system.

One of the most striking facts to arise from this panel was that immigrants, whether documented or undocumented, come to the U.S. with better health than after having lived here for ten years. José Ramón Fernández-Peña, founder of the Welcome Back Initiative noted that this phenomenon can be measured across the board, in terms of diabetes prevalence, cholesterol levels and heart attacks, likelihood of workplace injury, and the list goes on. What is clear is that immigrants, especially the undocumented, are suffering from a form of invisible violence, where their life expectancy is measurably lowered by coming to the United States.

A series of problems were pointed out over the course of the conference: firstly, doctors in the U.S. lack cultural diversity and are often unable to serve their patients due to the barriers that arise from a lack of cultural competence. The Welcome Back Initiative focused on this issue by seeking out recent immigrants with a health career in a foreign country and attempting to transfer their credentials, train, and place them in the medical field. With more “cultural competency” on the part of health-care providers, Mr. Fernández-Peña hopes that chronic health issues among immigrants can be explained and solved.

The second problem that was highlighted was the lack of affordable health-care for undocumented workers: they are specifically excluded from the The Health Care and Education Reconciliation Act of 2010. Opponents of providing health-care to undocumented workers often cite this as a privilege belonging to citizens, while ignoring the fact that the undocumented often pay taxes, social security, and even enlist in the military. In short, government agencies are happy to deal with undocumented residents when the military or IRS stands to benefit, but otherwise the government gives the cold-shoulder.

Furthermore, the position of marginalizing undocumented residents has been adopted by both parties in government. For Republicans, this means carrying on the established rhetoric of prioritizing American citizens over “illegals”. In contrast, the approach by the Democratic party could be characterized by a lack of rhetoric, and a fear that supporting undocumented residents will lead to further conservative backlash. Inevitably, the issue of providing health care (or even immigration reform) to undocumented residents is tabled by democrats pending the improvement of the economy, or until after the next election cycle.

Indeed, we often attach immigrants to economic decline, while the reality is that we need young immigrants to support our aging population. At NIIC, this argument was framed as changing the rhetoric surrounding immigrants from a negative tone of exclusion, to one that values the potential contributions of a new workforce. This is certainly a line of argumentation that ought to be incorporated into the Democratic party’s arguments for immigration reform. I would, however, add two more perspectives to this rhetoric:

The first is the nature of using the phrase, “undocumented immigrant” to characterize anyone living in the United States without a visa or citizenship. The very word “immigrant” (latin combination of, e- (out of) + migrat (to move or shift)) implies transience and an unsettled nature. Quite to the contrary, many “immigrants” are in fact closer to what we would consider “residents” – fixed members of our communities who will not simply disappear overnight. Indeed, it becomes far easier to deny health-care to those who we consider a transient faction of society. By characterizing “immigrants” as undocumented residents who are here to stay, regardless of the state of the economy or election cycle, a move towards “immigration reform” could gain traction.

My experience with the individuals attending NIIC led to a second significant revelation: the reality of immigration in the United States is that a Somalian political refugee (for example) will have an easier path towards citizenship after a few months of residency than an undocumented worker who has lived in the U.S. for more than two decades. For the estimated 12 million undocumented members of our communities, this lack of a path towards citizenship amounts to a deprivation of rights that we consider essential in a democratic society. Imagine the combined populations of New York and Los Angeles being deprived of the right to vote while still having to pay property, income, and sales tax, and you would just begin to scratch the surface of the injustice perpetrated by the current state of our immigration system.

After having established that undocumented residents are here to stay, the social justice aspect of immigration has stronger roots to take hold. It is far more compelling to speak of social injustice in terms of second class (nearly) citizens who are denied health-care and the right to vote, than it is to conceive of a nebulous and transient group of “immigrants”. This line of argumentation is a brief summary of the social justice aspect of citizenship for undocumented residents. It could be contrasted with the far more prevalent “economic” argument mentioned above. The two are not incompatible with one another, though it should be noted that if politicians take the dangerous step of addressing immigration reform, it is usually through economic rhetoric.

From a historical perspective, the prevalence of economic rhetoric was an aspect of the initial approach towards making slavery illegal. It was simply far “safer” ground for elected officials to approach the issue in scientific analysis of the economy both with and without slavery. Yet these economic arguments are not what most people remember as the purpose of emancipating the slaves; in the end the rhetoric of social justice is what carries movements for social equality. In the battle for effective health coverage for undocumented residents, and eventually for their citizenship, the rhetoric of social justice in terms of right to representation must take a central role.

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