During most of her eight years in the United States, Lisenia Rivera stayed away from hospitals because of her status as an undocumented immigrant. After going to the emergency room for a urinary tract infection last year, she got a bill for $2,000. Since she was pregnant and under the federal poverty line, Rivera, 24, qualified for California’s Medicaid program, which covered the cost of her visit. Two months after having her baby, Rivera faced renewed prospects of life without health insurance.
“It was better not to go to the hospital, because I didn’t have money,” Rivera said in Spanish tinged with a Guatemalan accent. “You might be sick, but the sickness of thinking that you will have to pay the bill is more likely to kill you from stress.”
Rivera, however lives in a city that policy makers have increasingly pointed to as a model for health care reform. And, although President Obama told Congress in September that his proposed renovation of health care will, “not apply to those who are here illegally,” health care officials in San Francisco said that would be a mistake.
Healthy San Francisco, the city’s public health plan doesn’t restrict coverage based on immigration status, and Rivera, like other undocumented immigrants, gets free or low-cost health care at many city hospitals and clinics. “We cover the undocumented in our program, so it’s kind of disheartening when so many of the pieces of the program that have made it such a success are being chiseled away at,” said Robert Menezes, the program’s director of marketing and communications.
Some 70 percent of Latino immigrants who arrived in the United States in the last 10 years are uninsured, according to a 2008 study by the Health Initiative for the Americas at UC Berkeley’s School of Public Health. In total, nearly one in four people without health insurance in the country are immigrants from Latin America, according to the study.
“Immigrants, when they are undocumented, usually work in the low paying sector of the economy, which usually doesn’t offer health insurance,” said Xochitl Castañeda, director of the Health Initiative for the Americas.
Castañeda said barring undocumented immigrants from national health reform perpetuates public health threats that know no borders. “We are going to be facing major public health threats and challenges. The recent H1N1 virus is just an example,” she said referring to the virus more commonly known as swine flu. “Those threats will not ask if you have insurance, if you have papers or where you come from.”
Nearly half of the 47,000 plus residents of the Mission are foreign born, according to the census. While Healthy San Francisco covers people regardless of immigration status, the city only receives subsidies to help cover health care for low-income citizens and legal residents. “Anything with state and federal funds attached to it, someone who is undocumented would not be eligible for, except for emergency care,” said Jim Soos, assistant director of policy and planning at the San Francisco Department of Public Health. “They are more of a financial burden because we are the only ones who can pay for them.”
That translates into large expenditures for the city, said Gregg Sass, chief financial officer for the Department of Public Health. He said the city was awarded $75 million of federal funding to help cover the costs of Health San Francisco, but only received $50 million because many enrollees are undocumented, cannot prove their legal status or exceed the poverty level required for financial support from the federal government.
Although Healthy San Francisco doesn’t get any federal money to serve undocumented immigrants, San Francisco’s federally funded clinics do. One such clinic, the Mission Neighborhood Health Center, is a constant bustle of Spanish speaking patients and health care workers that sees more than 66,000 visits each year. With the help of public and private funding, it offers primary care services to uninsured patients on a sliding fee scale based on federal poverty guidelines, and it doesn’t ask patients about their immigration status. The clinic also seeks to enroll patients in Healthy San Francisco, and signed up more than 2,200 patients for the program as of June.
But increased attention to the question of health insurance for undocumented immigrants in the wake of Obama’s speech to Congress could lead to budget cuts to clinics like the Mission Neighborhood Health Center. “Unfortunately, the day after the speech, the senate finance committee began to take another look at the package, with a goal of making sure that undocumented people are not covered,” said Dick Hodgson, vice president for policy and planning at the San Francisco Community Clinic Consortium.
What will happen to federal funding for clinics that serve undocumented immigrants is still unclear, as Congress has yet to reach a compromise on national health reform. Hodgson said San Francisco’s clinics are committed to caring for low-income patients without asking about their immigration status, regardless of what changes may come from Washington. “Our clinics have never, to this day, discussed changing their policies for access to services based on documentation or non-documentation status,” he said.
Back in the Mission, Rivera said getting access to health care through Healthy San Francisco and city clinics is part of her life-line. “If I were to get sick from something, at least they wouldn’t charge me. If you’re in need, they are going to help you,” she said. “Sometimes I’m afraid they are going to tell me that it’s not true.”