It’s been a full week since the opening of the health insurance marketplaces created through the Affordable Care Act. But only certain people qualify to buy insurance through that system.
Immigrants must be “lawfully present” to qualify to buy through the marketplace. That includes Green Card holders, refugees, Cuban or Haitian immigrants, people on worker and student visas and victims of human trafficking. But the 1.5 million undocumented immigrants estimated to live Texas are not included.
"Those families will have to continue to use our sliding-fee clinics, use the charity programs at hospitals," says Kit Abney Spelce, director of Seton's Insure a Kid.
Here in Austin, undocumented immigrants have a few options. Texas' federally qualified health centers – including CommUnity Care, Lone Star Circle of Care, and People’s Community Clinic – are not required to and don’t collect data on citizenship status.
By law, undocumented immigrants are also ineligible for Medicaid and the Children’s Health Insurance Program (CHIP).
Hospitals in Texas spent $5.5 billion on uncompensated care in 2011. Those are costs from charity care and unpaid hospital bills. A Center for American Progress Action Fund study in 2009 suggested the average family premium in Texas was marked up by $1,800 a year to cover those costs.
But experts say undocumented immigrants are not solely to blame.
"There’s this myth that undocumented immigrants use emergency rooms at higher rates than others, or that they’re flooding the emergency rooms, and that’s just not born out by the evidence," says Jenny Rejeske, a health policy analyst with the National Immigration Law Center.
But the undocumented are more likely to delay or forego care when it’s needed. Jennifer Ng’andu is director of the Health and Civil Rights Policy Project of National Council of La Raza, a Hispanic civil rights advocacy group.
"If an undocumented person ends up going to the emergency room, they may need more costly care because their situation is worse than it should have been," Ng'andu says.
And without more access to insurance, undocumented immigrants will continue to influence the cost of health care. Some of them, particularly immigrants from Mexico, can get medical care through a program called Ventanilla de Salud. It’s run out of Mexican consulates across the U.S.
"What we ideally try to do is work with our population and make sure they’re taking preventative health measures and not having to use emergency health resources," says Natalie Richardson, a community health worker with Ventanilla in Austin.
This Saturday, Ventanilla de Salud will offer free services – regardless of immigration status – including mammograms, vaccinations and STD testing at Kealing Middle School in Austin.