NIU Prof. says IL Medicaid expansion to undocumented older adults a step forward
WNIJ previously reported how the Illinois Legislative Caucus’ agenda for the 2023 legislative session includes achieving further expansion of Medicaid regardless of immigration status.
A local historian’s research helps to put into context the gains made and the challenges that lie ahead in the path to access to healthcare for immigrants and migrants. Northern Illinois University History Professor Beatrix Hoffman upcoming book, titled “Borders of Care,” provides an historical account of the struggle for healthcare for immigrants and migrants in the U.S. from 1848 to present. It’s scheduled to be released in 2024 by the University of Chicago Press.
In July 2022, the state expanded Medicaid to qualifying undocumented Illinois residents ages 42 and up.
Children regardless of immigration status were already eligible for AllKids Healthcare, the state-run health insurance. Illinois is among at least nine states that offer healthcare to all children.
Hoffman said the new program expansion was the outcome of immigrant right’s organizations' grassroot efforts, since undocumented residents are ineligible to purchase healthcare throughcare through the Affordable Care Act's Marketplace.
“After that exclusion, by Obamacare, the fight really had to move to the states,” Hoffman said. “So that's when we started to see states like Illinois and California have, you know, local movements to push their legislators to pass smaller Medicaid expansions . . . [on a] state-by-state basis.”
She said Obamacare prohibited insurance companies from excluding people based on pre-existing conditions and subsidized coverage for folks in certain income categories.
“But the affordable coverage has a lot of out-of-pocket payments, [so] that people end up paying a lot more, and it also covers a lot less,” Hoffman said. “So they can't take you off, but they don't have to cover everything.”
She said the American healthcare system is profit-driven, which incentivizes excluding some and limiting coverage. Also, Hoffman said hospitals and insurance companies have a lot of influence in the political system.
“It's a mess,” Hoffman said.
She said historically, some of the pretext for excluding and deporting immigrants was that they were viewed as carrying disease.
“But the history actually shows that immigrants do not tend to be unhealthy,” she said. “Immigrants do not bring epidemics. And in fact, it's coming to this country that often makes immigrants sick.”
She said research, including her own, shows that immigrants aren’t a burden on public health or welfare programs. She said that undocumented residents are ineligible for many programs, but fear also plays a role in deterring some from seeking services they qualify for.
“The system is designed to make immigrants and asylum seekers and refugees afraid to seek health care or to seek help,” Hoffman said.
She said it stems from fear of being identified as undocumented and exposed to deportation.
She said alongside a healthcare system that excludes undocumented immigrants is a U.S. economy that historically depends on immigrant labor.
She said during World War II and up to the mid 1960s, through the Bracero program, American companies recruited and employed Mexican workers onto farms and railroads.
Hoffman said the end of the program meant there was no longer a legal pathway for workers to take jobs that were available.
“So, it was really government policy” she said, “that created the undocumented worker.”
And she said the policy satisfied groups who, based on racial ideology, believed Mexican immigration threatened the white race.
“So, there were racist motivations, to labeling Mexican and other workers and other immigrants as undesirable,” Hoffman said. “But the fact that they weren't fully restricted, and that people kept coming in was also of great benefit to these industries.”
She referred to agriculture -- fruit and vegetable picking -- and meat packing factories throughout the country that are heavily dominated by immigrant labor.
“And so those industries do benefit from having them come in,” she said, “but having them not have a lot of rights, and they certainly don't have to provide their workers health care.”
It's grassroots movements that have spurred government to improve access to healthcare and lead the push for a just immigration policy, Hoffman said. She said even when Democrats hold the majority in Congress, legislation providing a path to citizenship doesn’t go through. And Even DACA, the deferred action for Childhood arrivals, the last major immigration policy created, she said was not an easy feat.
“Obama had to be pushed very hard to create DACA,” Hoffman said. “And that was a reaction to the fact that he was deporting so many people.”
That “push” was fueled by immigrant youth, among them students on college campuses throughout the country, including Northern Illinois University.
Undocumented residents can obtain care in the emergency room and at federally funded health clinics, but she said there’s not enough of them. These limitations, she said, can lead to bad health outcomes and put a financial strain on the system.
Hoffman said the US is long overdue for an overhaul of its healthcare system and immigration policy.
“I think that immigration policy also has to change,” she said, “because our immigration policy now is really bad for everybody's health.”
WNIJ has reported on how immigrant rights groups like the Illinois Coalition for Immigrant and Refugee Rights, despite the healthcare limitations, educate and promote immigrants and migrants to seek medical care as a human right. They also lead grassroot efforts to push legislators in Springfield to expand Medicaid in Illinois to more qualifying adults regardless of immigration status.