One might contend that the US health care system is like patchwork, with various components stitched together. In reality, the US health care system is more akin to a spider web, with strings being pulled by various stakeholders and interests groups. According to Grumbach, the U.S. health care system is not a system per se, but rather a free market where health care is a commodity regulated by market forces. There are no fixed regulations on pricing and everything revolves around demand and supply. These market forces are key to understanding why the U.S has the highest quality health care available and spends the most on health care, yet according to the World Health Organization still ranks very poorly amongst developed nations in access to care.
Research indicates that US healthcare is a market driven system providing access to health care based on the ability to pay into the system. This ultimately means only people with employer insurance, State and Federal Insurance programs and consumers paying out of pocket for insurance, are able to access affordable healthcare. According to Shi and Singh, approximately 40.5 million (16.8%) of Americans were uninsured in 2000 and now this number has reached almost 50 million people. Among the 40.5 million uninsured are middle class families with no medical insurance from employers and recent immigrants.
When my parents moved to U.S., I had serious concerns about their access to health care, as in the United States there is limited initial medical support from the government for new immigrants. In fact, most immigrants are required to be legal residents for 5 years before they qualify for public health insurance such as Medicare and Medicaid. Furthermore, information regarding access to health care is not easily accessible and healthcare services are not well integrated for those people who do not have insurance plans.
Consequently, the first and the easiest option for recent immigrant is to seek care in community based health clinics which can provide basic services to all people regardless of immigration and insurance status. Another option is to be seen by a medical practitioner in a nearby county hospital where medications, radiography and other specialized examinations can be conducted at a nominal door fee. At times, the nominal fee can be waived under the charity care benefit with appropriate documentation. However, even with charity care status, some aspects of medical expenses are not covered, such as pharmacy bills and dental care. Additionally, in the county hospital system, the waiting time for a patient to see a specialist can sometimes be six to eight months.
Apart from community health centers and the county health care system, there are other nonprofit organizations working in major metropolitan cities to support and guide new immigrants to obtaining better health care services. These include Umma Clinic based in California and Illinois-based Compassionate Care Network. In addition, some philanthropists have also started free medical clinics where basic medical tests and examinations are performed free of cost. However, this still leaves a question of how individuals will manage the costs of major surgeries, as these procedures are not performed in free clinics. In addition, chronic diseases require constant out-of-pocket expenses that can quickly overwhelm most families.
There is no single magic pill which can address all of the issues related to our healthcare system with regards to recent immigrants. However, as we are shifting towards universal health care coverage with the full implementation of the Affordable Care Act by 2014, we can expect some drastic changes in the U.S. health care system that will hopefully improve access to care for recent immigrants.
Immigrants who are here legally and are employed by companies in the United States can still be among the ranks of the uninsured because employers are not mandated to provide health insurance to their employees. The Affordable Care Act (ACA) will in part address this problem through a special provision requiring larger employers to provide their employees with health insurance and giving tax benefits to smaller employers if they do provide employer based insurance. The ACA will provide increased opportunities for legal immigrants in the U.S. to have access to affordable health insurance via state administered insurance exchanges. This news is like moonlight in a dark night for recent immigrants.
It is evident from the above discussion that the U.S. health care market is a multi-layered system with modalities that are not well integrated. This lack of integration makes access to care particularly difficult for the uninsured and for new immigrants. The expansion of Medicaid to more U.S. residents will be an opportunity to improve lack of amalgamation of various medical services, potentially providing new immigrants with more services under one roof. Consequently, it will lead to fewer emergency visits by this population and in turn cost containment can be achieved. The Affordable Care Act and widening of Medicaid coverage by states, provides reason for optimism that new immigrants will be able to receive better and well incorporated services.