Hispanics and Health Care Reform

As a growing demographic group, Hispanics have concerns that belong at the forefront of any debate on reforms

WASHINGTON (By Mary Sanchez, Poder 360) October 27, 2009 ― Healthcare reform is like most things when it comes to Hispanics. Consider their burgeoning numbers to gauge Hispanics’ impact.

At 17 percent of the U.S. population, or 47 million people, Hispanics arguably would be expected to hold a prominent seat at the table as reforms are being pounded out in Congress. Add in the fact Hispanics are the least likely of any ethnic or racial group to have insurance, and their lack of input could represent a serious shortcoming in efforts to drive down costs and improve care.

One in three, or 34 percent, of Hispanics do not have health insurance. This is true despite their higher-than-average presence in the workforce. So their faint representation in the national conversation on reform is, at best, worrisome to some, and a source of outright outrage to others.

“I don’t think they are even being talked about as an important entity in this debate,” says Jeanette B. DeJesus, president and CEO of the Hispanic Health Council and Hispanic Policy Initiative. “Not including Hispanics and not addressing their issues will really sandbag the reform efforts.”

Some blame insufficient representation on the national level. Others point fingers to the problem undocumented immigration is interjected into any debate that attempts to address the needs of Hispanics. And then there is what many view as the mainstream press’ dismissal of many issues of relevance to Hispanics, making their concerns appear tangential to the overall debate and therefore not worthy of coverage.

“Everybody focuses on 80 percent of the population, and forgets about the other 20 percent,” says Elena Rios, President and CEO of the National Hispanic Medical Association. Rios is among those investing much time and energy on Capitol Hill, pressing for the Senate and House bills to address the concerns of Hispanics. Also among them is the National Council of La Raza, the nation’s leading Hispanic civil rights organization, is spearheading efforts to convince Congress to include insurance coverage for language services as well as to expand assistance to legal immigrants who have been in the U.S. for less than five years. Currently, recent legal arrivals are excluded from many of the healthcare initiatives being considered.

One factor may be keeping Hispanics out of the debate: their relative health despite their lack of insurance or access to preventative care. Hispanics have lower rates of many diseases, including many cancers. Some of those differences are attributable to being comprised of a younger demographic compared to other groups. The younger people are, the healthier they tend to be. But given Hispanics represent the fastest-growing ethnic group, a dollar’s worth of prevention for them today is a long-term investment in the future of the nation.

Already the nation’s largest ethnic or racial group, Hispanics are expected to make up 60 percent of the U.S. population’s growth between 2005 and 2050. Meaning, without drastic changes in their ability to access insurance, the potential cost of their health problems would be substantial.

“Hispanics are the backbone of this country as they are the backbone of the workforce,” says Erika Montoya, a news editor with Terra.com. The international Spanish-language website is attempting to catch the snippets of news being reported on how healthcare reform will affect Hispanics for its global and U.S. audiences.

Before she entered journalism, Montoya spent a year as a translator for the City of New York in 2002. She was with a client when the woman suffered a heart attack mid-interview with social workers. Montoya found herself suddenly riding in the ambulance and translating to paramedics and then at the hospital. No one else spoke Spanish.

In that case, the woman lived. But it is not a stretch to envision how many health issues are missed or misidentified simply due to language problems. “In that one year of translating, I saw so much and it really left me amazed,” Montoya says.

Overcoming Barriers

If advocates are successful, reforms that would add insurance coverage for something as simple as language translation services would greatly affect Hispanic healthcare. That is one of the talking points for the National Council of La Raza’s Jennifer Ng’andu, Deputy Director of NCLR’s Health Policy Project.

Another focus is to get Congress to handle all legal immigrants equally. In language currently in the House bill, legal immigrants in their first five years are excluded from many healthcare initiatives, such as Medicaid and low-income subsidies for insurance. Advocates say the ban is a leftover from welfare reform, when Congress was attempting to cut costs by limiting federal dollars spent. Recent immigrants, some say, were simply an easy target.

For Ng’andu, it boils down to fairness. Legal immigrants, no matter how long they have been residing in the U.S., deserve the same access to lower costs for insurance as the native-born population, she says.

The number of uninsured may be the flashpoint for the current healthcare debate, but other measurements more completely highlight the health status of the nation’s Hispanics. According to a 2007 joint study by the Robert Wood Johnson Foundation and the Pew Hispanic Center, more than one-fourth of Hispanic adults in the U.S. do not have a health care provider, a family practice doctor, or somewhere to go for routine care. About the same number say they received no information on health within the prior year. And more than eight in 10 rely on means such as television or the radio to gain such important information that one could argue should be coming from a trained medical source.

The positive side of the report is those Hispanics said they are rarely sick. For instance, despite having reduced access to prenatal care, Hispanics are more likely to avoid problems like low birth weight for their babies and infant mortality. And certain types of cancers are less prevalent among Hispanics, including breast, lung, skin and thyroid, according to research distributed by the National Council of La Raza.

But disparities exist among differing sub-groups. Consider Puerto Ricans have higher rates of asthma, which is not overly represented as a health problem among other Hispanics. And Puerto Rican children are especially at risk, with one in five suffering from asthma, compared to one in 10 Hispanic children overall and one in 13 for non-Hispanic white children under the age of 18.

Other studies have shown differences between new immigrants and second- and third-generation Hispanics. New immigrants, still eating a diet high in fruits and vegetables from their native lands, are generally healthier than U.S.-born Hispanics who have a greater tendency to eat a diet high in sugar and processed foods.

These differences are one reason some argue Hispanics must be carefully considered in health reforms. Indeed, even the differing ways Hispanics access care when they seek it is of concern to some leaders attempting to influence the healthcare debate.

The nation is dotted with community-based social service agencies that act as a bridge between many Hispanics and healthcare systems — such as the Guadalupe Centers, the longest continually operating center for Hispanics in the United States. Christina Jasso is the Emergency Assistance/Homeless Project Manager for the 90-year-old agency based in Kansas City, Missouri. Her position is not a job normally compensated by healthcare initiatives, yet she spends untold hours at area hospitals coordinating between families and health providers.

In a tragic case last fall, she virtually lived at a children’s hospital when a Honduran family’s 15-year-old daughter was dying from a rare form of leukemia. The hospital had its own translators, but none of them could be with the family on such a 24/7 schedule. Jasso was an integral connector between the hospital staff, the family and even immigration attorneys and advocates who attempted to help the family navigate the bureaucracy to bring the girl’s grandmother to the U.S. before the child died. The case is an example of gaps that such social workers work to close throughout the nation.

“The doctor may see them for 10 minutes, while we may see them for four hours,” says DeJesus, of the Hispanic Healthcare Council that serves more than 30,000 people annually in Hartford, Connecticut. DeJesus advocates partnerships between hospitals and social service agencies so that federal funding can support efforts that clearly have an impact on health. “We make sure they go to their appointments, check their diets, visit them in their homes, translate and can ensure they are checking diabetes properly.”

Forward Movement

Overall, Hispanic leaders have been supportive of President Barack Obama’s plan for healthcare reform. The National Hispanic Leadership Agenda, a coalition of 26 national and regional Hispanic civil rights and public policy organizations, has been especially active in its support. It speaks for groups such as the U.S. Hispanic Chamber of Commerce, the League of United Latin American Citizens, and the National Hispanic Medical Association.

“It’s a phenomenal bill as far as minority health is concerned,” says Rios, the Hispanic Medical Association’s president and CEO. The House bill’s provisions to increase the number of primary care physicians will greatly help with outreach to the Hispanic community, Rios says. Currently, Hispanics comprise only five percent of all doctors, three percent of dentists and a mere 2 percent of nurses.

Still, Rios is concerned with the White House and Congress’s lack of push to reauthorize the Office of Minority Health within the U.S. Department of Health and Human Services. “It’s a shame that you would see a major bill without that office,” Rios says. She suspects that because the day is coming when there literally will be more “minorities” than white non-Hispanics within the U.S. population, there has been recent movement toward eliminating government structures and efforts geared exclusively to people of color . To Rios, such views are shortsighted, because numbers alone will not erase the health disparities. In fact, they might exacerbate their effect, as the Hispanic population grows more by births, and less by immigration.
 
The Question of Undocumented Immigrants

Perhaps no other issue has more unfairly distracted healthcare reform for Hispanics than the question of undocumented immigrants. The vast majority of the Hispanics in the U.S. are legal residents, naturalized, if not U.S.-born citizens. And yet, their interests are far too often pummeled by voices seeking to ensure undocumented immigrants do not receive benefits they are not entitled to.

Some suspect the angry rhetoric concerning undocumented immigrants keeps some Hispanic leaders silent in healthcare debates in an attempt to avoid being tainted by the dialogue. No better example for how the question of illegal immigration derails the conversation was the “You lie!” outburst by South Carolina Rep. Joe Wilson during the president’s recent nationally televised speech to a joint session of Congress. (See Republican Racism Rears its Ugly Head Again Toward Hispanics).

The idea that immigrants soak up far more healthcare, and therefore are responsible for skyrocketing costs, plays huge on conservative talk radio. The facts, however, disprove that contention. Consider a study published in 2005 in the American Journal of Public Health that tabulated the immigrant population’s overall use of healthcare in the U.S. Despite representing 10 percent of the U.S. population at the time, immigrants consumed only 8 percent of total health services.