Instead, the Senate bill places aspiring citizens into a temporary “Registered Provisional Immigrant,” or RPI, status for a minimum of 10 years while they work, pay fines and taxes, learn English, and meet other requirements. Only after that ten year period can they earn green cards, at which point two new clocks start ticking: three years to apply for citizenship and five years to obtain Medicaid coverage if they qualify for the program.
Ten to 15 years without health insurance can be a death sentence. It is exactly because of barriers to affordable health coverage and care that many immigrant women have significantly higher adverse health outcomes.
There is no bar on public benefits for citizens, but because of likely delays and expense in the citizenship application process, it is entirely possible that many low-income immigrant women will not be able to obtain Medicaid coverage until they hit the 15-year mark—unless the immigration bill is changed to eliminate the five-year ban or to subsume it within in the 10-year RPI period.
Yet another problem remains for those who earn too much income to qualify for Medicaid. Once the health reform law is fully implemented next year, lawful residents will be able to purchase private insurance in the new health insurance markets known as exchanges and will be eligible for tax credits and subsidies that make insurance more affordable. But undocumented immigrants will not be allowed to buy health insurance in the exchanges, even if they can afford to pay the entire premium themselves.
The Senate immigration bill would remove that prohibition for those with RPI status. But even so, moderate income provisional immigrants who cannot afford premiums on their own will still have to go 10 years without meaningful access to health insurance.
Ten to 15 years without health insurance can be a death sentence. It is exactly because of barriers to affordable health coverage and care that many immigrant women have significantly higher adverse health outcomes. For instance, while cervical cancer has been on the decline for U.S. born women, incidence and mortality rates have risen for immigrants.
This disparity is due to low screening rates among the latter. Only 61 percent of foreign-born women residing in the U.S. for less than a decade have received a Pap smear in the past three years versus 83 percent of women born here. Not only are these policies morally wrong, they are fiscally short sighted: treatment for cervical cancer costs between $20,000 and $37,000, compared to $13 to $66 for a Pap test.
A clear majority of Americans believe that immigrants pursuing citizenship should be eligible for Medicaid (63 percent) and premium assistance on the exchanges (59 percent). The Senate proposal is out of step with most Americans’ values and should be fixed to address these concerns as soon as possible.
The time has come for lawmakers to keep their promise and protect the health needs of immigrant women and their families.