DACA helped some immigrants finally get health care. Now they could lose it.

DACA helped some immigrants finally get health care. Now they could lose it.

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Originally published by VOX

When she was working as a family medicine doctor in Fresno, California, earlier this year, Anjani Kolahi brought an ultrasound machine to the fields where some of her patients worked.

She and her colleagues knew that many undocumented farm workers in the area weren’t visiting their health center, even though they qualified for affordable care. Kolahi wanted to bring that care to them.

She found two women in their third trimester of pregnancy, one over 40 and one a teenager. Neither had received any prenatal care. “That moment was actually joyous,” said Kolahi, a fellow with Physicians for Reproductive Health. “They could see their baby; they could hear the baby’s heartbeat.”

But going without prenatal care can be risky for mother and baby. Unfortunately, lack of insurance and fear of deportation mean undocumented immigrants often don’t receive necessary reproductive health care.

Deferred Action for Childhood Arrivals (DACA) helped some recipients get access to health care. But now that President Trump has rescinded the program, leaving Congress to come up with a replacement, DACA recipients’ future is in doubt — and that includes their ability to get the care they need to stay healthy and plan their families.

Rescinding DACA puts some recipients’ health insurance at risk

Immigrants face some obstacles to health care even if they are legal residents — as theNational Women’s Law Center notes, they are barred from Medicaid and the Children’s Health Insurance Program (CHIP) for the first five years of their legal status. DACA recipients are also barred from Medicaid and CHIP, and from buying insurance on the Obamacare exchanges.

When she was working as a family medicine doctor in Fresno, California, earlier this year, Anjani Kolahi brought an ultrasound machine to the fields where some of her patients worked.

She and her colleagues knew that many undocumented farm workers in the area weren’t visiting their health center, even though they qualified for affordable care. Kolahi wanted to bring that care to them.

She found two women in their third trimester of pregnancy, one over 40 and one a teenager. Neither had received any prenatal care. “That moment was actually joyous,” said Kolahi, a fellow with Physicians for Reproductive Health. “They could see their baby; they could hear the baby’s heartbeat.”

But going without prenatal care can be risky for mother and baby. Unfortunately, lack of insurance and fear of deportation mean undocumented immigrants often don’t receive necessary reproductive health care.

Deferred Action for Childhood Arrivals (DACA) helped some recipients get access to health care. But now that President Trump has rescinded the program, leaving Congress to come up with a replacement, DACA recipients’ future is in doubt — and that includes their ability to get the care they need to stay healthy and plan their families.

Rescinding DACA puts some recipients’ health insurance at risk

Immigrants face some obstacles to health care even if they are legal residents — as theNational Women’s Law Center notes, they are barred from Medicaid and the Children’s Health Insurance Program (CHIP) for the first five years of their legal status. DACA recipients are also barred from Medicaid and CHIP, and from buying insurance on the Obamacare exchanges.

And increases in deportations and raids under President Trump, as well as some of his executive actions, have created a new sense of uncertainty among immigrants, Lopas said. “The lack of solid information that people have to make decisions on right now is really leading folks to be as cautious as they can be.”

Lack of care can lead to unintended pregnancy, illness, and other problems

Immigrant women in general are at disproportionate risk of a variety of reproductive health problems, in part because of lack of access to care, according to the National Women’s Law Center. They are less likely to be screened for cervical cancer than women born in the United States, and so Asian and Pacific Islander and Latina immigrant women are more likely to get cervical cancer than US-born women, and more likely to die from it. Immigrant women are also less likely to get contraceptive care and more likely to have an unintended pregnancy.

Lack of prenatal care can mean undocumented immigrant women don’t receive screening for conditions like gestational diabetes or infections that could be transmitted to the fetus, said Kolahi. They also miss out on the information and reassurance that a doctor can provide, especially for first-time parents.

When undocumented immigrant women seek abortions, they face all the obstacles women born in the United States face, including restrictive laws and a dearth of providers, along with problems unique to their immigration status, Garcia said. Add in the need to pass through a checkpoint to get to a clinic, and undocumented immigrant women may be unable to get an abortion at all, or may have to push the procedure until later in pregnancy when it is more expensive.

Uncertainty about the future of DACA and other immigration policies can also affect immigrants’ family planning decisions. Fears of being deported or of losing a scholarship or other opportunities because of immigration status can keep people from having the children they want to have, Garcia said. “All of those things can get in the way of being able to make the decision that really is the right one for you.”

One of Kolahi’s former patients, a naturalized citizen in her 20s, is in a relationship with a young man who is a DACA recipient, Kolahi said. When Trump rescinded DACA, they decided to get married. “It’s just so awful that this external US policy is now pressuring them to get married,” Kolahi said. “It’s a very personal decision that you have to be ready for.”

DACA recipients need more access to health care, not less

To make sure undocumented immigrants get the reproductive health care they need, preserving the Affordable Care Act is an important first step, Garcia said. Then DACA recipients and undocumented immigrants need to be allowed to get Medicaid and CHIP coverage and buy insurance on the exchanges. Beyond that, she said, “we really need to make sure that providers have policies in place that make it possible for people to access care and know that their information is not going to be used to call immigration.”

Many reproductive health providers, including Planned Parenthood, have stepped up to offer care regardless of immigration status, said Lopas. Providers have certain legal rights they can assert to prevent patient information being taken by the government (the National Immigration Law Center has a list of these rights). For undocumented patients, Lopas said, “one of the biggest protections is really just the providers themselves.”

Changes in immigration policy — namely, an end to detention and deportation — are also necessary to truly safeguard all immigrants’ access to health care, Serrano said. He also advocates for a single-payer system that includes coverage for immigrants. “Even as we hear conversations about single-payer, we don’t hear if immigrants are going to be included,” he said.

Ultimately, keeping undocumented immigrants from getting necessary health care is bad for everyone, Garcia said. Health care is more expensive when people can’t get it until they’re very sick. And lack of health care increases the risk of chronic illness, which can make people unable to work or be active in their communities. When it comes to immigrants and health care, Garcia said, Americans need to take a broad view: “What kind of society do we want to live in?”

Read more: www.vox.com/identities/2017/9/28/16351866/daca-health-care-reproductive-health-undocumented-immigrants

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