Denying Medicaid-funded prenatal care to undocumented immigrants. Cross-listed at The Century Foundation’s Taking Note section
I happen to be an immigration moderate. It seems a bit crazy to me that we handle birthright citizenship the way that we do, and that we donâ€™t have a credible national ID card system to enforce immigration law. If there is a humane, intellectually coherent, administratively effective, politically feasible pathway to decent immigration policies, I havenâ€™t seen it. One tragedy of the last decade has been the failure of such disparate figures as George W Bush, John McCain, Ted Kennedy, and Barack Obama to forge a sensible compromise.
The enemies of such a sensible policy continue to be an odd combination of hypocrisy across the political spectrum, xenophobia within the Republican base, and employersâ€™ powerful desire to legally or illegally employ compliant and productive low-wage workers. There is also the unstated–but possibly correct–belief held by many people that the human and economic costs of our current muddle would be worsened if our dysfunctional political system now attempted to meet the challenge of comprehensive immigration reform.
Postscript: For further administrative details (including its harmful effects on low-income women legally authorized to be in the country), see Table 7 of this Voices for Children issue brief.
Maybe weâ€™re better off tackling this issue a decade from now, when the Latino vote is more powerful than it is today, and (if we are lucky) the American body politic is less polarized and more accepting of race/ethnic diversity than it is right now.
Thereâ€™s only one problem with this suggestion: We are making too many good people suffer along the way.
We continue to ask unauthorized residents: Please harvest our fruit, pack our meat, mind our children and our elderly parents, cut our grass, and build our houses. Oh yeah: While you are doing this, please donâ€™t use our emergency rooms if you get hurt. Donâ€™t use our public services that your taxes support. Donâ€™t become an open participant in the civic life of the community in which you may have lived for many years.
One human consequence of such policies was brought home by Nebraska reporter JoAnne Young in the Lincoln Journal Star (h/t Matthew Yglesias and Andrea Nill of Thinkprogress). A year ago, Nebraska eliminated Medicaid funding for about 1,600 low-income pregnant women. About half of the affected women are undocumented.
Because of such policies, many women left uninsured must travel great distances to receive care. The costs of such care is then absorbed by safety-net providers willing to treat them. Many of the affected women receive no prenatal care at all. Several babies have apparently died in this group. I canâ€™t really tell from the story whether the new policy is to blame for these deaths. I can say such bullying policies are a disaster for Nebraskaâ€™s maternal and child health system.
During the 1980s, Henry Waxman and other policymakers realized that one couldnâ€™t promote the health and well-being of pregnant women or their children while millions of pregnant women went uninsured. Nor could one have an effective and properly financed maternal and child health system when labor and delivery was the largest single item of uncompensated care.
Prenatal care is the gateway to almost every essential intervention during the relatively short period of pregnancy. When women donâ€™t present for care until very late in pregnancy, perhaps during active labor itself. There is little opportunity to address poor maternal nutrition, gestational diabetes, maternal tobacco use, sexually-transmitted infections, genetic issues, domestic violence, and more. Itâ€™s even difficult to carefully plan the logistics of the delivery itself. So many women, their families, and their providers have a more harrowing, sometimes dangerous experience than needs to occur.
Such financial and delivery-system realities led to the Medicaid eligibility expansion of the 1980s and early 1990s, one of the most admirable and successful health policy initiatives in recent decades. Responding to the real and alleged problems associated with undocumented immigrants, and responding to Medicaid budget challenges that affect many states, states such as Nebraska are tarnishing this admirable record by enacting punitive measures.
The infants born less healthy than they could be, under more difficult circumstances than need be, are American citizens. They deserve better. So do their families, who are here contributing to our society and to our economy. Everyone in America deserves better, too. For many practical reasons, these policies are foolish and counterproductive.
More than that, in bullying and mistreating the desperate strangers we have invited here to do difficult and menial work, we diminish ourselves. We are better than that. At least I hope so.