Report: Many Immigrants Eschew Care
The 300,000 young Latino immigrants in California who qualify for the Deferred Action for Childhood Arrivals program are less likely to use healthcare services than their U.S.-born counterparts even though they are also less healthy.
That's the finding of a new study by the UC Berkeley Center for Labor Research and Education, the UCLA Center for Health Policy Research, and the Philip R. Lee Institute for Health Policy Studies at UC San Francisco.
The federal Deferred Action program stays any deportation proceedings against undocumented immigrants who arrived in the U.S. before the age of 16, were under the age of 31 in June 2012 and are either students or have graduated from high school, hold an equivalency degree or have been honorably discharged from the military. Their status would presumably change if Congress ever passes comprehensive immigration legislation into law.
However, their uncertain legal status in the years before the Obama administration initiated Deferred Action has made those youth wary of many U.S. institutions, including healthcare providers.
“Participants shared experiences of discrimination in healthcare settings, including profiling based on race and documentation status,” the report observed. “As a result, many avoid mainstream healthcare providers.”
Researchers used data from the California Health Interview Surveys from 2007 and 2009 for their report. Focus groups were conducted with 61 youth eligible for Deferred Action, and 28 others interviewed individually.
According to the study, 37% of those who qualify for Deferred Action had no usual source of healthcare, compared to 29% of U.S.-born youth. Nearly a third of those Deferred Action youth had no physician visits in the previous year, compared to 21% of their U.S.-born peers, a more than 50% differential. That's despite the fact that 21% of Deferred Action youth said they were in poor health, compared to 11% among those born in the U.S.
Mental health issues were nearly chronic among the Deferred Action group, with high rates of anxiety, trauma, depression and stress reported.
“Many focus group participants reported that they seek health information online in an effort to self-diagnose and self-treat,” the report said. “Participants also reported asking family members for medical advice and using home remedies or remedios, such as teas, provided by parents and other family members. Some participants also reported sharing prescription drugs that had been given to another family member with similar symptoms.”
The report cited high costs for accessing healthcare in the U.S. – and its attendant consequences – as the primary barrier for Deferred Action youth. “My worst fear is getting sick, not having enough money to pay for it, being sent to collections, and then the government would find out about it. A lot of people I know fear collections,” said one interviewee.
Another barrier was low health literacy – for example, many did not know that they could seek care at Federally Qualified Health Clinics regardless of their immigration or insurance status. Or they had some form of insurance, but either they or their families were unaware of what it covered.
A separate UC study on the Deferred Action population in California released in February concluded that a large number of that group also eschewed obtaining coverage through the Medi-Cal program, even though they qualify for coverage under state law.
The latest report suggested that Deferred Action youth and their families are often misinformed about their options. Misinformation may come from family members and peers, as well as from some eligibility workers who perpetuate inaccuracies regarding program requirements,” the report read. “One key informant reported that these inaccuracies may be due to deliberate discrimination toward undocumented immigrants or an unintentional lack of training during a time when significant changes in healthcare are occurring with the implementation of the (Affordable Care Act).”
The report suggested creating a clearer path for citizenship for Deferred Action youths would alleviate some of the stresses they feel that may contribute to their relatively poor health. Strengthening the healthcare safety net and integrating behavioral and primary care services and making them more readily accessible was also recommended, as well as providing more culturally sensitive care and creating campaigns to strengthen healthcare literacy.
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