The National Healthcare Agenda: Addressing the Hispanic Healthcare Disparity

8/9/2019 The National Healthcare Agenda: Addressing the Hispanic Healthcare Disparity

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The National Healthcare/ Hispanic Health 1

Running Head: The National Healthcare/ Hispanic Health

The National Healthcare Agenda: Addressing the Hispanic Healthcare Disparity

Nia Llenas

University of Maryland University College


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Abstract

Llenas, N. S. (2007). The National health care agenda: Addressing the Hispanic health caredisparity. Univ. of Maryland, University College.

In a nation of more than 40 million uninsured, Hispanics comprise over 40% of thatsubpopulation, presenting future problems in the US health care system. This paperexamines the role of the Hispanic health care disparity as it relates to the pursuit of anational health care agenda and the factors to be addressed when offering publicprograms to immigrants. Research analysis details the disparity faced by Hispanics andthe factors that contribute, such as, lack of insurance, low CHC capacity, insufficientspending and a lack of culturally and linguistically appropriate services. The datarevealed that Hispanics utilize disproportionately less services than their non-Hispanicwhite and Black counterparts and continuously report lower quality of care scores due tocommunication challenges. These findings suggest that as the US pursues a nationalhealth care system, reduction of the Hispanic health care disparity through education,increased levels of access to care, and quality improvement, may have future implicationson the health of the nation and its workforce.


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The National Healthcare Agenda: Addressing the Hispanic Healthcare Disparity

IntroductionAs the possibility of a national health care system looms in the horizon, politicians, pundits and

researchers, alike, debate the value and implications of a government run system. While the U.S.

remains an international super power, it lacks the sophistication of smaller countries such as

Cuba and France who boast free health care for all citizens. In order for the US to move forward

with a national system, one must understand the impending population shift and rapidly changing

face of the average American.

The Hispanic population comprises over 40% of the uninsured and remains the fastest growing

population in the U.S., due largely to higher birth rates and immigration. Hispanic immigrants

are excluded from public health services during the first five years of residency according to the

Welfare Reform Act and the children of immigrants routinely lack access to medical care.

Combining a lack of access with other factors such as, socioeconomic background, low English

proficiency, poor education levels, and immigration status, the Hispanic health care disparity is

one of the main reasons the U.S. needs national care.

Literature Review

In 2004, the Census Bureau estimated that the Hispanic population will increase by 148

million through 2050, and will comprise 24.4 percent of the population (U.S. Census Bureau,

2004). In 2006, Hispanics accounted for almost half of the United States population, totaling

44.3 million now residing here. Consequently, a demographic shift can be seen across the

country, for instance, California, Texas , Florida and Arizona have seen astronomical increases


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in population and proportion over the past two years, Los Angeles County being home to over

4.7 million Hispanics and Starr County, Texas having a 97 percent Hispanic population (Census

Bureau, 2007).

While the population grows, so does the number of uninsured, as early estimates from the

National Health Interview Survey (NHIS) find 31.7 percent of Hispanics uninsured, compared to

14.4 percent of Blacks and 13.1 percent of Asians (Cohen & Martinez, 2007). The densely

populated California registers 36.7 percent of Hispanics as uninsured, with immigration status

playing a key role. Noncitizens without green cards were almost twice as likely to be uninsured

all or part of the year, when compared to noncitizens with a green card (Brown, Layarreda,

Ponce, Yoon, Cummings, & Rice, 2007). These findings, coupled with a rising interest in health

care reform, provide a basis for current public health research on the Hispanic health disparity. In

this paper, the role of the Hispanic health care disparity is examined as it relates to the national

health care agenda. I hypothesize that this disparity will lead to a greater need for federal

involvement in health care as population shifts occur. The following literature review provides

background and supporting information as it relates to this hypothesis.

Disparity

The minority health care disparity has been researched thoroughly, giving way to discussions

on the actual cause of disparities. Williams and Jackson (2005) define the minority disparity as a

social problem, shedding light on the effects of socioeconomic status, residential segregation,

and access to medical care on the actual health outcomes of minorities. In fact, they argue that

while education and income affect health practices, residential segregation does little more than


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aggravate these issues by adversely impacting income, facilitating violence and increasing

susceptibility to disease (Williams & Jackson, 2005).

Again, this sentiment is validated by Kawachi, Daniels and Robinson (2005), as they address

race and class in conjunction with the health care disparity, providing a more narrow view. Most

notable in this research is the assertion that, treating race as a co determinant of health

disparities along with class still leaves open the possibility that race independently influences

health through pathways such as personal experiences of discrimination or cultural differences in

lifestyles (Kawaci, Daniels, & Robinson, 2005, p. 347). This inclusion of both race and class

applies directly to Hispanics when discussing disparity, race being the most prevalent variable in

research.

While discussing race applies to a broad range of information, more data on individual

subgroups is needed in order to produce a clear picture. A study by Shah and Carrasquillo (2006)

sought to fill that gap by analyzing health coverage disparity across four groups: Mexicans,

Puerto Ricans, Dominicans and Cubans. Although the outcome of the study revealed stark

differences in subgroups, merely suggesting that the differences among groups be considered in

health care policy, leaves much to the imagination.

Likewise, when discussing the reduction of the health care disparity, several co variants

emerge. In order to understand why there is a disparity at all, we must evaluate the barriers to

access, spending and utilization patterns, as well as the organizations and laws that govern this

process. While all minority groups have been observed to have less access and utilization of

health care compared to non-Hispanic whites, Hispanics are more frequently the focus of recent


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research in this field. In the following sections I will discuss how Hispanics may drive the need

for health care reform.

Barriers to Access

One of the most immediate concerns in public health is the problem of access. Many

Hispanic immigrants, both legal and illegal lack access to preventative and acute health care.

These barriers have been studied repeatedly across major -minority populations. Several barriers

to access include cultural and linguistic differences, lack of insurance, and welfare reform.

Welfare Reform. The 1996 Personal Responsibility and Work Opportunity Reconciliation

Act (Welfare Reform) has become a major barrier to access. Many studies examined the

estimated effect that welfare reform has on the immigrant population. Carrasquillo, Ferry,

Edwards and Glied (2003) found that, between 1999 and 2000, only an estimated 10,000

immigrants would qualify for coverage if the law were repealed, as would another 250,000 if

states were covering parents of children in the SCHIP program. These estimates used from data

from Immigration and Naturalization Service which now can see were quite conservative.

In opposition to those findings, several analyses of welfare reform, confront the future

implications the law may have on population health. Kullgreen (2003) calls it a threat to the

health of the community at large (p. 1633), citing the adverse circumstances and subpar living

by which illegal immigrants arrive in this country as catalysts to communicable diseases.

Additionally, others view the law as counterproductive, in a society that seems to encourage

immigration particularly in the labor force, some 85 percent of immigrants are legal and still

ineligible, while illegal immigrants continuously pay into Social Security; money that could be

used to supplement health service funding (Lillie-Blanton & Hudman, 2001).


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Lack of safety-net.Two recent studies focused on Community health centers (CHC) assafety-net providers. CHC across the country, are implementing outreach programs targeting

Hispanic populations using language appropriate services for little or no cost, however, the local

safety net is failing to fulfill the need for resident Hispanics because of staffing needs and

interpreter fees (Casey, Blewett, & Call, 2004). Jack Hadley, Peter Cunningham and J.

Hargraves (2006), refined the process by confronting the possibility of increasing CHC capacity

and proximity to low income communities. Their findings support the need for tailoring health

programs to Spanish-speaking-Hispanics who are less likely than their English-speaking

counterparts to have insurance or seek treatment when needed. One limitation of this study

stimulated changes in insurance status assuming national coverage which, in the context of

welfare reform, is currently not available to recent immigrants.

Cultural and financial differences. While immigration status has a noticeable effect on health

care access for the Hispanic population, socioeconomic background and English proficiency may

further compound the problem. Those with limited English proficiency report fewer visits to a

usual source of care, in addition to being most likely to receive lower quality care due to a lack

of understanding and satisfaction (Derose, Escarce, & Lurie, 2007). A second study of Hispanics

in southwest Pennsylvania found no statistically significant presence of a language barrier,

although, high levels of accuralation positively determined having a regular source of care

(Documet & Sharma, 2004). Moreover, immigrants, especially Hispanics, face stigmatism even

in health care settings. Feelings are perpetuated by public opinion toward them bordering on

discriminatory and unworthy. Being part of a stigmatized group can make immigrants reluctant

to seek care because of concerns about poor treatment. (Derose, Escarce, & Lurie, 2007)

Utilization and Spending


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When Hispanics seek out care, they do so sporadically and not with a usual source of care. A

study of the 1999 National Survey of Families highlighted the lack of utilization of health

services in children, whereby foreign born children of noncitizen parents were 5 times more

likely to have no usual source of care when compared to native born children of citizens. The

former also rated their childrens health at fair or poor over 12 percent of the time, compared to

the latter at fewer than 4 percent (Huang, Yu, & Ledsky, 2006). Chow, Jafee and Snowden

(2003) narrow the focus to the mental health arena, analyzing service use patterns of minorities

in low and high poverty areas. Utilization among Hispanics and non-Hispanic whites varied

widely, with Hispanics in most cases being forced to seek help by social services or criminal

justice systems, whereas non-Hispanic whites were more likely to seek treatment on their own or

with the help of family and friends. These findings support the need for more ethnic-specific

programming to target at risk groups, educating them on the benefits of such services, as well as

removing the stigma associated with seeking such programs.

Although nationally representative data suggests that utilization by Hispanics is below

average, the general debate has been focused on spending. In some circles, it may seem that

health care spending is out of control due to the influx of immigrants, primarily Hispanics,

although I found no such proof of that theory. In 2000, Los Angeles County spent twice as much

on native born citizens than foreign-born, with less than a tenth being spent on undocumented

immigrants. Although foreign born residents at this time comprise 45 percent of LA Countys

population, they accounted for only 33 percent of all health related spending. Estimates of

national spending summarize foreign born spending as 8.5 percent of total medical costs

compared to 13.1 percent of the population that year (Goldman, Smith, & Sod, 2006).


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Recently, detailed studies on health care expenditures, both public and private, revealed that

immigrants were responsible for $39.5 billion in U.S. health care expenditures, only 7.9% of the

total. Similarly, a significant difference in expenditure was also found in children under the age

of 12, showing immigrant children spending half as much as native-born children. Also, taking

into account the insurance status of each group yielded similar results, that even with insurance,

immigrants health care expenditures were 52% lower than insured US-born persons. On the other

hand, per capita emergency room expenditures were highest among immigrant children,

suggesting barriers to a usual source of care may be to blame (Mohanty, Woolhandler,

Himmelstein, Pati, Carrasquillo, & Bor, 2005).

To further understand the use of emergency rooms by Hispanics, Dubard and Massing (2007)

described Emergency Medicaid in North Carolina, grouping usage by immigrant status,

including age, sex and diagnoses. Emergency Medicaid for recent legal immigrants,

undocumented pregnant women and children is available in 23 states covering major acute

medical conditions in which the patients health is in serious danger. By analyzing Medicaid

claims from 2001 to 2004, researchers found over 93% of the patients to be Hispanic and 89%

female, resulting in over 80% of Emergency Medicaid spending attributed to pregnancy. This

increase coincided with spending increases for children and families with dependent children.

Despite noted increases in Emergency Medicaid usage, during 2004, expenditures on

undocumented immigrants totaled only 5% of the budget, less than 1% for the total Medicaid

budget. This has led several high density states to take the option to cover pregnant women under

the State Childrens Health Insurance Program, hoping to alleviate budgetary concerns for

hospitals and taxpayers (Dubard & Masing, 2007)

Federal involvement.


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The federal government has taken several steps to examine health care disparities, one such

step includes creating the National Healthcare Disparities Report (NHDR) which tracks

disparities and quality differences over time, for example, the 2004 NHDR reported that,

disparities in quality are pervasive at the national level. There are several challenges, however

in addressing disparities through a medium like the NHDR. For example, assessing quality

standards, in which NHDR does not take into account patient preference which may differ across

subgroups, nor does it address the interaction between race, ethnicity and socioeconomic status

(Moy, Dayton, & Clancy, 2005). In addressing these challenges, the federal government may

find the largest source of health care disparities yet.

Lurie, Jung and Lavizzo-Mourney (2005) inspected the possibility of reducing disparities

through a quality improvement framework and placing the federal government in a leadership

role to do so. In their study, the role of the Centers for Medicare and Medicaid Services would

expand its role in addressing disparities in conjunction with its federal partners. As a result the

federal government would set standards for data collection and quality improvement procedures

as they relate to racial and ethic identifiers for specific populations.

A truly significant example of federal involvement effectively reducing the health care

disparity among minority groups is the State Childrens Health Insurance Program (SCHIP).

SCHIP provides health care access for children in low income families, with reasonable premium

payments and several choices of managed care plans. A study of the SCHIP program of New

York provided the proper demographic characteristics for a detailed study of the effect of federal

involvement in reducing disparities. The resulting effects of SCHIP was a virtual elimination of

preexisting disparities in access, unmet need, and continuity of care, including an increase of


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parent ratings of quality improvement, lending credibility to the governments ability to

implement health care programs (Shone, Dick, Klein, Zwanziger, & Szilagyi, 2005).

Although previous studies have examined the Hispanic health care disparity and more recent

studies have assessed the barriers that influence the disparity, they have not demonstrated the

link between the Hispanic population and national health care. On the whole, reducing racial

disparities in the fastest growing population should be addressed on a national level through

complete federal programs in order to secure the health of the nation.These programs should

seek to increase insurance coverage, provide culturally and linguistically appropriate services,

repeal the Welfare Reform Act and implement Federal and state level programs targeting the

Hispanic population.

Increasing insurance coverage

Since the implementation of Welfare Reform, Hispanic insurance coverage has continued to

decline in relation to population growth. According to Shah & Carrasquillo (2006, p. 1617), a

twelve year study on Hispanic insurance coverage revealed that, naturalized and noncitizen

Hispanics experience more public coverage losses during the Welfare Reform than U.S. born

Hispanics and are almost 1.5 times less likely to have employer-sponsored health insurance when

compared to non-Hispanic whites. This suggests that Hispanics, although employed, work in

industries that do not offer health insurance at affordable rates and in some cases may be

working "under-the -table". For Hispanics, insurance status largely depends on income,

education and time living in the U.S. As time passes, those lacking insurance are likely to

become eligible for public health programs, yet some choose to go without insurance due to

financial reasons (Documet & Sharma, 2007, p.11).


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While Hispanics continue to have the worst levels of health care access compared to

other ethnic groups: non-Hispanic whites and African Americans (Hadley, Cunningham &

Hargraves, 2006, p. 1682), families seem to be most affected as their children lack a usual source

of care and in some cases use emergency rooms as a last-ditch effort to health care. Almost 70%

of children with foreign-born noncitizen parents lacked medical insurance for 12 consecutive

months in 1999, leading us to believe that although 80% of the parents were aware of Medicaid

programs, most were ineligible or did not want to risk their future naturalization (Huang, Yu &

Ledesky, 2006, p. 637).

On the contrary, the SCHIP program has almost eliminated the health care disparity

among ethnic groups. In 2001, a study of the New York SCHIP program proved that access, use,

continuity and quality of care for non-Hispanic whites, Blacks, and Hispanics improved

significantly. Before SCHIP enrollment, only 81% of Hispanics had a usual source of care

compared to 95% of non-Hispanic whites. During enrollment, 98% of Hispanics reported a usual

source of care with higher usages of preventative care and significantly lower levels of unmet

need reported across the subgroup (Shone, et al, p. e6990). However, Hispanic parents still

recorded lower quality ratings than other groups, suggesting the influence of cultural or language

barriers in the health care environment.

In addition to a lack of insurance, many Hispanics are burdened by the lack of culturally

and linguistically appropriate services (CLAS) available. Several studies in recent years have

highlighted the importance of immigrant access to providers who not only understand their

culture but language as well. As population growth shifts from metropolitan to rural areas, the

need for bilingual health professionals is rapidly increasing.


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Hispanics demonstrating low English proficiency are more likely to report low levels of

satisfaction with the health care experience than English-speakers, and tend to lack pertinent

information regarding their health. The need for trained interpreters, especially in less populous

regions, can likely affect patient safety due to communication problems. Providers may prescribe

harmful medication or give instructions that are not thoroughly explained in the patients native

language (Derose et al., p.1261).

Absence of Culturally and Linguistically Appropriate Services

Currently, only ten states offer free interpretation services or reimbursement for Medicaid

or Medicare services, and force patients to rely on friends and family members. Inadvertently,

interpreter usage may cause providers to spend more time with such patients, especially in

private practices, limiting the amount of patients that can be seen and affecting the patients

perceived level of quality (Casey, Blewett & Call, 2004, p. 1710). Studies have shown that

Hispanics value the providers commitments and interest, citing interest in a warm and personal

relationship (Documet & Sharma, 2004, p.10), which could easily define the patients view of

the medical system and promote further usage. On the other hand, feelings of marginalization or

discrimination lead to a decreased usage of the medical system and those using providers who

understand the linguistic and cultural differences report higher levels of quality care.

Increase Community Health Centers

Many Hispanics rely on public services to obtain quality health care. Clinics and

community health centers (CHCs) are charged with the responsibility of preventing and treating

medical conditions in the Hispanic and immigrant communities. As the population swells, CHCs

are increasingly becoming the safety-net for delivering quality care to largely diverse groups of


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people especially in rural or new-growth states. As a result, rural communities are being exposed

to a largely metropolitan problem: increased usage of emergency services to treat non-emergency

ailments. When usage of emergency rooms for these services increases, so does the need for

CHC availability. Because CHCs mainly serve low-income areas, Hispanic immigrants are more

likely to rely on them for preventative and routine medical or dental service and the availability

of CHCs to treat immigrants largely depends of it capacity, or the amount of grant revenue per

poor person causing a direct effect on overflow in emergency rooms. Counties with low CHC

availability may place undue burden on their emergency health system if grant revenue is not

increased to reflect the needs of the community. (Hadley et al., 2006).

Using data from 1998 to 2003, Hadley et al. (2006, p. 1683), demonstrates that CHC

capacity directly impacts racial/ethnic minorities access to a usual source of care. By increasing

CHC capacity in accordance with the Bush administration increase in funding between 2001 and

2004, and increasing uninsurance by similar amounts during those years, several important

findings emerge. These increases support the probable decrease in disparities in access among

non-Hispanic whites and racial/ethnic minorities, with Spanish speaking Hispanics showing the

most improvement. Additionally, if increases in uninsurance continue, increases in CHC capacity

are likely to offset the effects.

Moreover, CHCs seemingly understand the barriers to care plaguing the Hispanic

community. Even in the rural Midwest, CHCs are tailoring culturally and linguistically

appropriate services by using bilingual staff or volunteer interpreters and addressing largely

unmet needs through preventative services. However, problems still exist, as few physicians and

dentists are willing to take Medicaid and SCHIP patients into an already overloaded practice


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(Casey et al., 2004, p.1710). Therefore, increased funding is needed to relieve the pressures

placed on local providers, especially in rural and non-metropolitan areas.

Spending Trends

As medical costs seemingly spiral out of control, much attention is directed towards the

spending habits of immigrants, Hispanics in particular. While Hispanics take part in public

services, studies have shown that the overall expenditures, both public and private, are well

below proportion when compared to U.S. born residents. In short, this subpopulation continually

feeds into the national economy, paying taxes and social security, while receiving fewer benefits

than natives. Mohanty et al., summarized a National Research Council study which found that

immigrants add as much as $10 billion to the economy each year and they will pay on average

$80,000 per capita more in taxes than they use in government services over their lifetimes

(2005, p. 1431). Since then, several studies have targeted the expenditures of both public and

private insurers on immigrant patients.

Addressing a national health care agenda requires the understanding that the foreign-born

utilize far less health care spending that the native-born. In 1998, the average yearly expenditure

for immigrants was $1407 less than native-born persons. Per capita expenditures for immigrants

with insurance were 52% less than their U.S. born counterparts, and similarly, the uninsured

immigrants spend 61% less. The findings also showed that public coverage spending was heavily

weighted in favor of native born persons, whose expenditures were 56% higher than immigrants

(Mohanty, et al. p.1434).

The lower expenditures of immigrants can be further narrowed down to a study of the

most populous Hispanic community, Los Angeles. Goldman, Smith & Sood, established that


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because of lower rates of service use, immigrants cost L.A. county $4.7 billion in health care, out

of a total $11 billion in spending. This comprises only 33% of all medical spending compared to

45% of the population. Additionally, undocumented immigrants health care costs totaled $887

million, about half of cost associated with a 12% population (2006, p.1708). Considering the

high rates of uninsured among the Hispanic community, payments were less likely to come from

public sources than out-of-pocket expenses.

When public sources pay for immigrants health care, the instance must fall under the

guidelines of Emergency Medicaid (EM). Undocumented and legal immigrants are eligible for

EM if admitted to the hospital for pregnancy complications, labor and delivery, or treatment

after the sudden onset of a medical condition manifesting itself by acute symptoms of sufficient

severity, including severe pain, such that the absence of immediate medical attention could

reasonably be expected to result in: (A.)Placing the patient's health in serious jeopardy; (B.)

serious impairment to bodily functions; or (C.) serious dysfunction of any bodily organ or part

(Family and children's Medicaid MA-3330 citizen/alien requirements). The laws that govern this

allowance are quite rigid and funds cannot be allotted to any circumstance outside of the

guidelines.

Each year states attribute a portion of EM funds to both documented and undocumented

immigrants. New-growth states, those recording unprecedented immigrant growths, are also

seeing an increased growth in Hispanic population and use of EM. In North Carolina, 89% of

EM recipients were pregnant women, 99% were undocumented, and 93% were Hispanic.

Although undocumented, pregnant, Hispanic women account for the lions share of the spending,

during the 4 year research period, pregnancy related spending actually remained relatively stable

compared to families with dependent children (70% increase), the elderly (98% increase) and


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disabled patients (82% increase). Dually noted, the overall budget for North Carolinas EM

program is less than 1% of the total Medicaid spending; this after a 35% increase in funding

between 2001 and 2004(Dubard & Masing,2007, p. 1008). This suggests that states may be able

to wisely budget EM funds and direct spending toward preventative prenatal care rather than

emergency care. Spending on routine prenatal care, regardless of immigration status, would

serve a greater purpose in maintaining the health of both mother and child while utilizing public

health centers, keeping costs low.

Although Hispanics utilize public and private sources of health care, the spending on the

subpopulation is relatively low compared to the native-born residents and is mostly attributed to

lower service utilization. For Hispanics and other immigrant populations, this may be a result of

historically lower access levels, the relative good health of young immigrants, lack of health

education and the lack of culturally appropriate services.

Addressing the Disparity on the Federal Level

In 2003, the Agency for Healthcare Research and Quality released the National

Healthcare Disparities Report (NHDR) and the National Healthcare Quality Report (NHQR),

both providing lawmakers with a detailed view of disparities and quality in the United States

health care system. The NHDR measures all differences among populations in measures of

health and healthcare, categorizing the differences after accounting for patients need and

preferences in the availability of health care. (Moy, Dayton & Clancy, 2005, p. 377) In

preparation, federal agencies assisted by supplying data collected on race and ethnicity, and for

the first time allowing participants to choose a mixed race classification. Data was then collected,

sorted by racial, ethnic and socioeconomic groups, and compared to reference groups


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The 2003 NHDR revealed that disparities exist on a national level, although at times,

Moy et al. (2006) revealed that data was not comparable, therefore, lacking when comparing

factors that cause race, ethnicity and socioeconomic status to interact. Still, on a national level,

minorities and the poor stand to gain the most from improvements in quality of care, implying

that more research should focus on the bond between class and racial disparities.

Recently, the influx of immigrants into the US has created new racial categories that have

not been studied to the extent of non-Hispanic whites and African-American populations. These

new races generally fall into the lower class of the economic scale thereby amplifying the present

disparity. Racial disparities persist largely in minority groups due to socioeconomic status,

residential segregation, and lack of medical care and (Williams & Jackson, 2005) identifying

these disparities by the interaction between race and class leaves open the possibility that race

independently influences health through pathways such as personal experiences of discrimination

or cultural differences in lifestyles. (Kawachi, Daniels & Robinson, 2005, p.347)

For example, in a study of racial/ethnic disparities in mental health service use, Chow,

Jaffee & Snowden, discovered that in high and low-poverty areas, Hispanics were more likely to

use mental health services than non-Hispanic whites, but almost half as likely to be treated as an

inpatient. Hispanics in high-poverty areas were also significantly more likely to be referred to

mental health services by the criminal justice system, a pattern which was also observed in the

African-American subgroup (2003, p. 795). Consequently, minority children should be deemed

vulnerable to mental health problems due to socioeconomic status and residential violence

causing stress and behavioral problems.


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The federal government plays a large role in the quality of care for Hispanics by

providing health care through public sources for over half of the population. The establishment

of two particular initiatives seeks to reduce disparities and increase access for foreign and native

born populations. The standards for CLAS were set by the Office of Minority Health to increase

awareness and quality of care for diverse populations. Although providers receiving federal

funds are required to comply with some of the standards, private organizations adoption is

voluntary. (Lurie, Jung & Mourey, 2005, p.360) Meanwhile, Healthy People 2010 utilizes

Leading Health Indicators, aiming to reduce major health concerns plaguing not only Hispanics,

but minorities as well. Plans include individualized state initiatives, increased education and

collaboration with private sector health care groups (Office of disease prevention and health

promotion).

Call to Repeal the Welfare Reform Act

In 1996, The Personal Responsibility and Work Opportunity Reconciliation Act,

fundamentally changed cash assistance and the treatment of legal immigrants with regard to

social welfare programs by placing a 5-year ban on Medicaid for new immigrants, thereby

forcing many undocumented and legal immigrants to go uninsured (Blanton & Hudman, 2001, p.

1736) The effect of Welfare Reform places immigrants in a position of feeling under-

appreciated. Although the economy thrives on their labor, immigrants have been relegated to

seeking routine health care from emergency departments without the ability to pay the bill.

The result of Welfare Reform places providers at a crossroads that is seemingly

contradictory to their beliefs to forgo the ethical ideal that patients medical needs should be

attended to without regard to their social, political, or citizenship status. (Ziv & Lo, 1995,


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p.1097) Subsequently many administrative offices are drowning in immigration status

paperwork, struggling to put public resources to their most cost-effective use. (Kullgreen, 2003,

p. 1632)

Varied perspectives on the repeal of Welfare Reform exist. An overall majority believe

that the immigration status provision should be relaxed to include families and low income

Hispanics in to the health care system, if not for their own sake, then for the security and safety

of the U.S. Carrasquillo (2003) compiled data referring to patients immigrant status and

insurance, that almost 250,000 immigrants would benefit from a change in the legislation to

include them in Medicaid or SCHIP plans. Even though, the author dismisses the possibility that

states will offer SCHIP expansions to low-income parents, immigrant or otherwise and only uses

data from the Immigration and Naturalization Service. This dismissal was recently challenged

with the inclusion of low-income parents in the attempt to reauthorize SCHIP, and some states

have already launched an inclusion strategy to combat coverage losses.

Conclusion

The future of the nations health may largely depend on the health of Hispanics and

should be taken as a serious threat to its best interest. Providing preventative care for immigrants

could significantly reduce the progress of life-threatening illnesses or infectious diseases,

lessening the burden placed on safety-net providers and emergency rooms. (Kullgreen, 2003 p.

1632) DuBard suggests that targeted initiatives on contraception, prenatal care, work safety and

disease management may be a more sound investment for public health care until bipartisan

legislation can account for racial and ethnic disparities. (2001, p.1738)


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Findings suggest that the key to ensuring future health safety lies with the health of

immigrant children who will grow up and become the driving force behind the US economy.

Ensuring access to health services needed for proper growth and development should be a

national priority.(Mohanty, 2005, p.1437) Programs like SCHIP successfully accomplished the

goal of reducing disparities and educating parents on the benefits of preventative care and

maintenance, providing their children with a healthy start.

Discussion

Lack of insurance and access among immigrants is a major public health crisis. As more

immigrants arrive each year, provisions must be made to ensure the health of the whole nation.

Considering the racial and ethnic barriers to access, using cultural indicators and providing

language appropriate services are all effective steps to reducing health disparities among

Hispanics. Initiatives such as SCHIP, which successfully reduced disparities in children, could

be applied to adult populations, possibly producing favorable results. Additionally, several new

local and state-wide initiatives target small employers and those at-risk for uninsurance,

providing affordable public programs to reduce the proportion of Hispanic uninsured. Most

importantly, the Welfare Reform Act serves as a vehicle for inequality and injustice against

immigrants by refusing them proper access to health care, while promoting their use for hard and

physical labor.

When politicians and lobbyists understand the Hispanic role in the future of the US and

the factors that define this role, there will likely be a shift in legislation to amend or repeal the

Welfare Reform Act. In order to move forward, discussion should center around how to address

the needs of ethnic minorities regardless of immigration status through utilization of both public


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and private programs. Such action is essential to not only the health of our nation now, but for

future generations to come.


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Appendices


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Authors Note

Nia Llenas is a graduate student pursuing a Masters of Healthcare Administration at the

University of Maryland University College. She enjoys spending time with her family, watching

movies and reading.


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The National Healthcare Agenda: Addressing the Hispanic Healthcare Disparity

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