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To care or not to care?
Extent, role of publicly funded immigrant pediatric services sparks debate

By Megan Watkins & Ruth Stefanos & Desi Small-Rodriguez
Daily Staff
Wednesday, April 19, 2006
last updated April 19, 2006 1:25 AM

According to a report by the Children’s Defense Fund, more than 40 percent of immigrant children lack health insurance. And by one account from the Center for Immigration Studies, almost half of all Mexican immigrants and one quarter of all non-Mexican immigrants live in the state of California, making it the state with the largest immigrant population. With such a large percentage of the population being immigrants, and many of them poor, it is no wonder that there are many debates over programs aiming to provide government-funded care.
In 1994, California voters passed Proposition 187, denying illegal immigrants access to many government services, including public education and publicly funded health care. While the drive for Prop. 187 was partially motivated by the attitude that since illegal immigrants weren’t paying taxes, they shouldn’t be consuming public services, many focused on the fact that immigrants were here illegally.

Former House member Randall Cunningham (R-Calif.), now serving eight years in prison for accepting bribes, commented to PBS at the time, “We ought to stop ‘em at the border, and if they’re illegal in this country, the only thing they deserve is a ticket out of here.”

The issue, however, was rendered moot in 1998 when a federal court struck down Prop. 187 on the grounds that determining immigration policy was a federal and not a state issue. Since then, the center ground has shifted in the other direction, with most state politicians disavowing and distancing themselves from the initiative, and many embracing a governmental role in providing health care for immigrants.

In 1997, the federal government created the State Child Health Insurance Program (SCHIP), also called Healthy Families in California, which provides basic health insurance for children ineligible for Medicaid. Medicaid covers individuals with incomes up to 100 percent of the Federal Poverty Level. Families who make between 100 percent and 200 percent of the Federal Poverty Level can enroll their children in SCHIP. However, in order to be considered eligible for SCHIP in much of the United States, immigrant children must be citizens or have proper documentation.

Additionally, under current legislation, even legal immigrants are ineligible for Medicaid and SCHIP programs during their first five years in the United States.

Michael Koch, founder and executive director of CaliforniaKids Healthcare Foundation, a non-profit providing access to healthcare services for many of California’s undocumented children, expresses concern about the number of immigrant children that go uncovered.

“Two to three hundred thousand children in California are not eligible for Medicaid or the Healthy Families Program because of their immigration status,” he said.

Koch also notes that providing coverage is often less expensive than leaving families to seek emergency care when health situations turn dire.

“We at CaliforniaKids feel it is a right not a privilege for kids to have access to preventative and primary healthcare, and that it is poor public policy for kids to be seen in the ER when they could be seen by primary care providers at a fraction of the cost,” he said.

While many families that cannot afford coverage only seek emergency care, others turn to free clinics like Pacific Free Clinic and Arbor Free Clinic in the Stanford area. Both clinics are funded by the University, providing no-cost medical care to the lower class, including a number of immigrants.

Lily Kao, a clinic manager at Pacific Free Clinic and a Stanford medical student, says that despite the need for pediatric services among the large portion of their patients that are immigrants, Pacific Free Clinic is not able to provide services to child immigrants. However, they have efforts in progress that will provide options for pediatric care.

“Pacific Free Clinic does not see pediatric patients due to the limitations of our services and staffing. We currently do not have a formal referral system for pediatric patients. However, in the next two weeks Overfelt Clinic in San Jose will start recruiting pediatric patients directly from PFC during clinic hours,” said Kao in a March interview.

Many California counties, including Santa Clara County, are using public funds to implement their own form of health insurance for undocumented children called Healthy Kids. CaliforniaKids and others use their non-profit funding to cover children in counties where Healthy Kids is not in place.

A new bill proposed in both houses of Congress, the Immigrant Children’s Health Improvement Act, would eliminate the five-year period when legal immigrants are not allowed to receive aid. The bill was introduced in both the House and the Senate last spring, but only a handful of representatives and senators support it. Neither Congresswoman Anna Eshoo (D-Palo Alto), nor either California senator are cosponsors on this bill.

Junior Veronica Ramirez, a human biology major and member of the Latino community on campus, believes that “although [SCHIP] has brought forth some improvement since its establishment, there is still a large population of uninsured children that will most likely continue to increase.”

Some point to this as an example of the tail wagging the dog, saying that increasing public services for illegal immigrants will only encourage more to come. Groups like Californians for Population Stability (CAPS) argue that“the primary cause of overcrowded schools and health care costs is too many people overtaking our finite resources, [something which] immigration policy doesn't take into account,” according to a statement on CAPS’s website.

Others discount these arguments and point to the importance of helping the poor get access to health care. Koch, for his part, says that while the efforts of his organization are important, they aren't a permanent fix.

“Philanthropic support is great for models and bridges, but it is not the answer to financing healthcare for children,”he said.