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Health Care - Immigrants and Nurses


Will Healthcare Reform Be Fair to Immigrants? 

By Sharmeen Gangat

For reform to work, argues the author, it must fully include immigrant communities, whose members already struggle to afford decent medical care in the United States.

July 28, 2009

President Obama’s healthcare plan is promising. Yet, it draws concerns from the immigrant community—especially at a time when the Massachusetts Senate, in an effort to close a growing deficit, has passed a state budget that eliminates coverage for 28,000 legal immigrants.

The first and foremost concern is the disparity in treatment experienced by racial and ethnic minorities in the current healthcare system, documented by the 2002 Congressionally mandated report by the Institute of Medicine. The study, Unequal Treatment, found that members of minorities received poorer care even when they had the same incomes, insurance coverage and medical conditions as whites. What protection is there to ensure against Obama’s public insurance option falling prey to those same discriminatory factors?

The second worry is the issue of immediate accessibility. Ever since welfare reform was enacted in the mid-nineties, newly arriving immigrant families must wait five years for federal health benefits under Medicaid, the chief provider of health insurance to immigrant women. While immigrant women may access emergency services pertinent to labor and childbirth, there are no provisions for prenatal and postpartum care and family planning services, which are financed by their tax dollars.

"If reform is going to work and reduce costs for all Americans,” says Sonal Ambegaokar, health policy attorney for the National Immigration Law Center, it “must be inclusive and must end the unfair treatment of immigrants.” Few people are even talking about the economic and social welfare effects of leaving undocumented workers uncovered and forced to rely on expensive emergency care.

And last but not least, while it’s hard to imagine reaching universal coverage with any plan that uses employer-based healthcare insurance without requiring that businesses provide benefits or contribute to a public fund, the effect of such mandating provisions on small businesses concerns immigrant workers. To the extent that these employers feel they must lay off workers, immigrant communities would be among the first to suffer.

In New Jersey, for example—one of the most ethnically diverse states in the country—the “number of people who are provided insurance through small staff size companies has shrunk by 111,667 in the last 10 years, including 36,000 in 2008 alone,” according to New Jersey’s Department of Banking & Insurance. Proposed subsidies to help low-income families and measures to aid small businesses need to be sufficient to offset such damaging effects.

In addition to the monetary impact, loss of jobs and health coverage can also cripple the emotional health of immigrant women who see themselves as resources for their families. In fact, a qualitative study on immigrant women’s health suggests that “the family-centeredness of immigrant women's well-being is a mediating factor in all aspects of their [own] health.”

Immigrant communities in Massachusetts are hoping that state legislators approve a $70 refund for health care proposed by Governor Deval Patrick. Similarly, expectations run high across the nation. All eyes are on President Obama to ensure equity in healthcare because he stands before us as a testament to equal rights for all in the United States of America.

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It’s All About Choices: A Nurse’s View of Health Reform 

By C. Stacy Beam

If health care reform is enacted—and if it works to lower costs and keep Americans healthy—nurses will be a large part of the solution, argues the author. Trust her: she’s a nurse.


 

July 31, 2009

When President Barack Obama appeared in the Rose Garden on July 15, 2009, to continue to stress the urgent need for timely passage of health care reform, there was a reason he was flanked by some of the biggest names in nursing today. No other profession is more trusted than the nursing profession, at least according to Gallup’s Most Trusted Profession poll, which nursing has “won ” for seven consecutive years.

At the president’s side were, among others, Dr. Mary Wakefield, the administration’s highest ranking nurse, and Becky Patton, American Nurse’s Association president. The message was clear—for decades nurses have consistently advocated for affordable, quality, equitable distribution of health care services for all Americans. And while much of the health care debate has focused on major stakeholders such as physicians (largely via the AMA), the insurance and hospital industry, labor unions and to a much lesser extent, the health care consumer, it is nurses who can and will be an essential aspect of any health care legislation that seeks to provide cost-saving, quality care, particularly to America’s most vulnerable populations.

Nurses are in a unique position to attest to the consequences of how today’s current health care market has privileged expensive, acute treatments over more cost-saving models that focus on disease prevention, health education and screening. While much has been made of the plight of the country’s almost 50 million uninsured, less has been made of the growing number of under-insured people, who can no longer afford even their employer-based plans or find that their health care needs are not being met despite their current coverage.

While some naysayers would like to cast any real attempt at true health care reform as anti-market or anti-business, make no mistake: competition among coverage providers has been acknowledged time and time again by nursing advocacy groups as essential to providing quality services at lower cost. The issue nursing has with the current system, however, is one of logic. It simply makes no sense to have a system that purports to be patient-centered while the primary gatekeepers to health care access—insurance companies—compete to insure the healthiest among us at the expense of the sick. This is why any health care reform must include a strong public insurance option that allows individuals to choose between the public plan or a private alternative depending on which they believe, based on their own individual circumstances, is best suited to their needs. This is why the current "compromise" legislation emerging from the Senate Finance Committee, which abandons the public option in favor of insurance reform, is unacceptable and must be remedied prior to final passage and signing by the president.

It is the opinion of most, if not all, major nursing advocacy groups and professional organizations, that any health reform proposal that does not include a strong public option, is not really true health care “reform” in any meaningful sense of the word. And I say “strong” because, as we listen to the pundits, special interests, the media and the politicians spin their own proposals, the general public should not be faulted for being totally confused. Most of the above groups have been attempting to sell as a “compromise” their version of a public option—a bipartisan-sounding gimmick that maintains the current status quo by not really changing all that much of anything. Politicians and health care stakeholders refer to these proposals in various terms—the “trigger” plan, the quasi-public option, the “weak” plan and on and on. But make no mistake, from the perspective of most nursing advocates, none of these plans are adequate to achieve the overlapping goals of cutting health care costs, increasing quality, providing a safety net to the uninsured and underinsured, focusing on disease prevention and streamlining health care delivery. In other words, don’t believe the hype.

Among the various plans being proposed, from a nursing perspective, none offers more promise than the one recently put forth by Senator Ted Kennedy and the Senate’s Health, Education, Labor and Pensions (“HELP”) Committee, the Affordable Choices Act. What makes this plan stand out is its recognition of the importance of a strong public option combined with a focus on cost-saving preventative health care services, some of which could be provided by Advanced Practice Nurses (“APRN”) in nurse-managed health clinics. Such clinics not only provide cost-effective, patient-focused, primary and preventative care, they help deal with the very real problem of physician shortages, particularly in rural and other under-served areas of the country. The purpose of utilizing APRNs in any model of health delivery has never been to supplant the physician’s role, but rather to supplement it. The nursing profession has long maintained that any meaningful health reform must not only deal with quality and cost but also with solutions to physician and nursing shortages, and the Affordable Choices Act does just that.

The need for true, meaningful health care reform has never been more urgent. Luckily, we have a president who demonstrated in the Rose Garden on July 15, 2009, that he understands that any real health reform, which has patients, and not profit, as its primary consideration, requires not only the participation of nurses of all backgrounds at every stage of the reform process but also at every stage of its implementation.

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