Children in Immigrant Families Deserve Health Care.

Abstract

We are a nation of immigrants. One in 4 children in the United States lives in an immigrant family, where at least 1 parent was born outside of the United States (first- and second-generation families), and by 2060, this proportion will increase to 1 in 3 children.1 Among children in immigrant families (CIF), 90% are United States citizens, 6% are documented noncitizens, and 4% are undocumented.2 In addition, there are >4.4 million children with an undocumented parent in the United States.3 It is crucial to understand how federal public policy impacts the health of CIF and recognize the importance of child health policy at the state level, where Medicaid programs insure >1 in 3 children. The article by Rosenberg et al highlights the variation of care to CIF by examining state-by-state variation of health care access and utilization by these children, comparing states that have expanded Medicaid eligibility for undocumented children with those that have not.4 Their findings demonstrate that inclusive health care policy increases the proportion of CIF that are insured, improving several of their health outcomes. Yet, it is important to recognize that the improved health insurance status of CIF seen in this study is inclusive of United States-born children, which make up the great majority of CIF. As noted by the authors, this may occur because of a “welcome mat” effect that decreases fear among families who have undocumented children or parents. This effect also may impact families who are documented but may be concerned about the effect of public charge on their immigration status. Moreover, it is also worth noting that those states that expanded health care to undocumented children also had a significantly lower proportion of uninsured children among nonimmigrant families. This suggests a “halo effect” whereby caring for the most vulnerable helps improve health care access for all children.State-sponsored health insurance coverage for all children has positive public health outcomes, as noted by Rosenberg et al and supported by other studies. Overall, policies to improve the social determinants of immigrant families can improve children’s health. For example, Hainmueller et al demonstrated that mothers who qualified for Deferred Action for Childhood Arrivals had United States-born children with a 50% lower risk of being diagnosed with adjustment and anxiety disorders, compared with children born to mothers who did not qualify for Deferred Action for Childhood Arrivals; the most plausible mechanism for this lower risk was mothers’ decreased fear of deportation.5 So, what makes some states institute policies to help undocumented children and others not? This is a complex issue involving a mixture of federal and state law, advocacy by local organizations to provide services to undocumented children and families, and perhaps the visibility of these families’ encouraging political leaders to action. The latter 2 may be contributing factors to other policies that enhance the well-being of children, particularly newborns. For example, a study by Wherry et al reviewed the care for undocumented pregnant women and found that states have used various policies to extend care to them, in some cases using state funds and in others using the Children’s Health Insurance Program unborn option or the Children’s Health Insurance Program Reauthorization Act of 2009 option for eliminating the 5 year waiting period.6 These state actions can make a difference in the health and well-being of CIF and can help us improve our care for children in general.Rosenberg et al showed the effects of regional health policies on CIF. Better health for all children demands that we increase the number of extended-eligibility states. How do we make change happen? We believe that we can achieve change by highlighting data to policy leaders that show the impact of public policies on CIF, particularly undocumented children, partnering with advocates to use data for a positive collective impact on our immigrant communities and becoming leaders in our own health care systems to ensure that they provide quality care to all children. The current antiimmigrant rhetoric must be countered by accurate data, advocacy, and leadership at all levels. This is a battle for our children’s health and our future.