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Healthcare in Immigration Nation

Dante Chinni

Posted: 06.25.2009 / 7:19 AM PDT

If you look at a map of where America’s uninsured are or see those numbers charted using our 12 Patchwork Nation community types, one group of places stands out: the 210 counties that constitute “Immigration Nation.”

In those counties, which are on average 44 percent Hispanic, nearly 1 in every 4 residents did not have insurance in 2005.

If Washington’s goal in healthcare reform is to get to near-universal coverage, major changes will have to occur in these counties. But the problems these places present are many in number and complex in nature.

A closer look at one “Immigration Nation” community, El Mirage, Ariz., shows why.

The employee base

In 2005, 21 percent of the people living in Maricopa County, El Mirage’s home, lacked health insurance. That’s already high, but the number was almost certainly higher in El Mirage, which has a downtown area that is overwhelmingly Spanish-speaking.

The paychecks for a lot of the people there are small, and some of the residents are illegal immigrants.

Last year, Rachel Gomez, who co-owns two area restaurants called the Rio Mirage Café, offered her 89 workers insurance, with the restaurant picking up 75 percent of the tab.

That’s a fairly generous plan in 21st century America – particularly for a restaurant – but it went nowhere.

“We needed 15 to agree, and we got about 10,” Ms. Gomez says. “There were all sorts of reasons. Some said their wives had it. But the truth is, when you only make $100 a week as a buser or a server … 25 percent can be [a big] chunk of your check.”

The restaurants wound up providing 100 percent coverage to its managers, but the others remain uncovered – unless they get coverage from family members.

The status quo

Sylvia Rivera, who owns her own business as a seamstress in El Mirage, says she doesn’t bother with health insurance because she doesn’t want to pay for what she doesn’t need.

“Once you start, you know, getting up in age … the premiums get real crazy. You’re paying, what, four or five hundred dollars a month sometimes for insurance,” she says. “I’ve never had insurance.”

Her solution, she says, is simply to wait until she has to go to the doctor and deal with her problems as needed.

“If you go to the hospital, they take you anyways, whether you have insurance or not, and then make arrangements for you to pay it back.”

The problem, as hospitals and physicians will tell you, is those payments rarely account for the whole cost. They are manageable sums with the rest essentially written off to those who have insurance.

These problems happen everywhere, but they are exacerbated in “Immigration Nation” communities, because wages tend to be lower and illegal immigrants often won’t go to the doctor unless it is absolutely necessary – when problems are further along and more expensive.

Is there a fix?

The one thing that Ms. Rivera says would push her to get insurance is a government mandate – precisely the option Washington wants to avoid.

In other words, despite all the talk of carefully crafted plans that bring lobbyists on board and offer a government plan as a choice, fixing the problem of the uninsured in places most lacking coverage is likely to prove difficult